What do patients think about the Hungarian health care system and medical students' learning outcomes? A cross-sectional study on the patients' perspective in Hungary.

BACKGROUND: The doctor-patient relationship has changed a lot in the 21st century and the varying expectations of the patients play an important role in future professional medical care. The knowledge of patients' needs is crucial in determining the learning outcomes in medical education. The objective of this study was to examine the expectations of the patients regarding professional and soft skills (e.g. communicational skills, empathy) of doctors and to get a deeper view. METHODS: Face-to face data collection through self-reported questionnaire in accredited health care institutions (GPs, hospitals, outpatient care) in Hungary was carried out in 2019. Descriptive statistics, independent sample t-tests, k-means cluster and gap matrices were performed to analyze the data. RESULTS: In total 1115 patients (male-female: 50-50%, age groups: between 18 and 30: 20%, between 31 and 60: 40% above 60: 40%) participated in the survey. They rated sixteen learning outcomes along with two dimensions: importance and satisfaction. Except for one learning outcome, patients rated the outcomes more important than they were satisfied with them (negative gap). Positive gap was registered only in the case of respecting individual specialty during patient care. CONCLUSIONS: The results suggest the importance of learning outcomes in relation to the rate of satisfaction from the patients' perspectives. In addition, the results support that patients' need are not met in medical care. Patients' ratings also make an emphasis on the fact that besides professional knowledge other learning outcomes are also important in health care which should have been emphasized as a basis in medical education.

Tobacco Smoking and Smokeless Tobacco Use among Domestic and International Medical Students in Hungary.

BACKGROUND: Medical students as future physicians will have an important role in tobacco control; therefore, their tobacco use behavior is of particular interest. Consumption of combustible tobacco (cigarettes, waterpipes, cigars, and pipes) is prevalent throughout Europe, whereas smokeless tobacco use is common mainly in the Nordic countries. Objectives: Aim of our study is to assess tobacco use among medical students from different countries studying in Hungary with special focus on students from Norway where smokeless tobacco is widely used. A self-administered questionnaire survey was carried out to measure current tobacco use. Results: The survey included 1337 students from Hungary, Norway, Germany, and from other countries (Multinational group). The lowest prevalence of cigarette smoking was found among students from Norway (13.0%) when compared with students from Hungary (21.5%), Germany (34.2%), or with students in the Multinational group (29.5%). Conversely, prevalence of smokeless tobacco use was the highest among students from Norway (40.9%) when compared with students from Hungary (1.4%), Germany (2.6%), or with students in the Multinational group (6.2%). Waterpipes, cigars, and pipes were rarely used, mostly only 1-3 times a month in all groups. More than half of Norwegian students used some form of tobacco (smokeless and/or combustible tobacco). Conclusions: Considering the impending role of medical students in tobacco control, faculties of medicine should sensitize their students on the topic of possible health risks associated with combustible and smokeless tobacco products. Culturally tailored tobacco cessation programs need to be offered to medical students coming from different cultural backgrounds.

Effectivity of near-peer teaching in training of basic surgical skills - a randomized controlled trial.

BACKGROUND: Near-peer teaching (NPT) is a special way of teaching where the tutor is one or more academic years ahead of the person being tutored. The literature agrees on the benefits of the method, but there are only a few publications examining its effectiveness using objective methods. The aim of our study was to examine the effectiveness of NPT in the training of basic surgical skills. METHODS: We included 60 volunteer students who participated in a 20 × 45 min long surgical skills course. Based on the results of a pre-course test, we randomly divided the students into six equal groups. All groups completed the same curriculum, with three groups being assisted by a NPT tutor. After the course, they completed the same test as at the beginning. The exams were recorded on anonymized videos and were blindly evaluated. The students' satisfaction was monitored using a self-administered online anonymous questionnaire. Statistical analysis was performed using the Mann-Whitney and Wilcoxon tests. RESULTS: Overall, student performance improved with completion of the course (from 119.86 to 153.55 points, p <  0.01). In groups where a NPT tutor assisted, students achieved a significantly better score (37.20 vs. 30.18 points improvement, p = 0.036). The difference was prominent in surgical knotting tasks (14.73 vs. 9.30 points improvement, p <  0.01). In cases of suturing (15.90 vs. 15.46 points) and laparoscopy (7.00 vs. 4.98 points), the presence of the NPT tutor did not significantly affect development. Based on student feedback, although students positively assessed the presence of NPT, it did not significantly improve students' overall satisfaction since it was already 4,82 on a scale of 5 in the control group. CONCLUSIONS: Overall, involving a NPT tutor had a positive impact on student development. An outstanding difference was observed in connection with knotting techniques.

Increasing Prevalence of Electronic Cigarette Use among Medical Students. Repeated Cross-Sectional Multicenter Surveys in Germany and Hungary, 2016-2018.

BACKGROUND: Use of electronic cigarettes (e-cigarettes) is gaining popularity among young adults. Medical students' nicotine use behavior is of particular interest because of their impending role in health promotion. Objectives: Aim of our study is to assess changes that occurred between 2016 and 2018 in the prevalence of e-cigarette use among medical students and to explore associations between e-cigarette use, demographic characteristics, and cigarette smoking. Self-administered questionnaire surveys were used to obtain cross-sectional data of medical students in Budapest and Pécs, Hungary, and Dresden, Germany. Results: Sample sizes for 2016 and 2018 were 2297 and 1514, respectively. In the whole sample, past-30-day use of e-cigarettes increased from 4.5% to 8.0% (p < 0.001). The increase in e-cigarette use was significant in both genders (from 3.6% to 5.6% among females, p = 0.028, and from 5.9 to 11.4% among males, p < 0.001). Prevalence of e-cigarette use was higher among Hungarian students than among German students (2.2% versus 5.7% in 2016, and 4.1% versus 10.5% in 2018, p < 0.05 for both years). There was no significant difference in e-cigarette use among different academic years. The ratio of e-cigarette users increased significantly among current cigarette smokers but not among nonsmokers. We could not detect a decrease in cigarette smoking. Conclusions: Prevalence of e-cigarette use increased significantly among medical students without a reduction in cigarette smoking. Medical schools should add the topic of e-cigarettes to their curricula and need to develop cessation programs to help their students quit both cigarettes and e-cigarettes.

Do we need special pedagogy in medical schools? - Attitudes of teachers and students in Hungary: a cross-sectional study.

BACKGROUND: The quality of medical education is a key factor. The fact that mostly physicians teach tomorrow's physicians without acquiring pedagogical skills before becoming a teacher is a cause of concern. In Hungary, where traditional teaching methods are common, and teachers have not had pedagogical courses in medical education there has not been any research dealing with the issue. On the one hand, we aimed with this cross-sectional study to examine the attitudes of teachers towards learning outcomes of medical students to get a view about the opinions about their importance and rate of delivery. On the other hand, we analyzed the pedagogical skills of teachers from the students' and teachers' perspective in Hungary. METHODS: Data collection through self-reported questionnaires in online form in all the four Hungarian higher education institutions offering medical education was carried out among teachers and students with active student legal status in 2017. We validated the questionnaires of the two respondents' groups. We used gap matrices to represent the correspondences of the delivery and perceived importance of the learning outcomes. We calculated averages of the pedagogical skills and compared them with t-tests. RESULTS: The response rates are 11.18% in case of the students (1505) and 24.53% in case of the teachers (439). The results indicate the lack of concordance between the rates of the learning outcomes in terms of their importance and delivery - no positive gap can be observed -, and the need for pedagogical skills among teachers and students. The opinions of students compared to teachers' are all statistically higher according to the averages. CONCLUSIONS: The study results underline the necessity of a transition and paradigm shift in medical education from delivering solely professional knowledge towards pedagogically prepared practice and patient oriented teaching methods as well as acquiring pedagogical knowledge as part of the training of medical teachers in Hungary.

Cigarette, waterpipe and e-cigarette use among an international sample of medical students. Cross-sectional multicenter study in Germany and Hungary.

BACKGROUND: Tobacco use is the leading preventable cause of death worldwide. Besides cigarette smoking, waterpipe and e-cigarettes are gaining popularity among young adults. Medical students' smoking behavior is of particular interest because of their impending role in health promotion as future physicians. Aim of our study is to examine the prevalence and predictors of cigarette, waterpipe and e-cigarette use and the association of tobacco use with self-reported health status in an international sample of medical students. METHODS: In a multicenter cross-sectional study data on different aspects of health behavior were collected from medical students of 65 nationalities using a self-administered questionnaire in Germany (Dresden, Munich) and Hungary (Budapest, Pécs). The survey was conducted among 1st, 3rd and 5th year students. To explore associations between smoking behavior and socio-cultural factors Pearson's chi2-tests and multivariate binary logistic regression analyses were performed. RESULTS: The largest subpopulations were formed by German (n = 1289), Hungarian (n = 1055) and Norwegian (n = 147) students. Mean age was 22.5 ± 3.3 years. Females represented 61.6% of the sample. In the whole sample prevalence of cigarette smoking was 18.0% (95% CI 16.6-19.4%), prevalence of waterpipe use was 4.8% (95% CI 4.0-5.7%), that of e-cigarette 0.9% (95% CI 0.5-1.2%). More males (22.0%) than females (15.5%) reported cigarette smoking. The lowest prevalence of cigarette smoking was found among Norwegian students (6.2%). Cigarette smokers were older, waterpipe users were younger than non-users. E-cigarette use was not associated with age of the students. Religious involvement was protective only against cigarette smoking. Financial situation showed no association with any kind of tobacco consumption. Cigarette smokers and e-cigarette users were less likely to report very good or excellent health status. CONCLUSIONS: Cigarette smoking is still the most popular way of consuming tobacco, although alternative tobacco use is also prevalent among medical students. To further health consciousness, medical schools should pay more attention to students' health behavior, especially their smoking habits. Tobacco prevention and cessation programs for medical students should consider not only the health risks of cigarette smoking but the need to discourage other forms of tobacco use, such as waterpipe.

Do socio-cultural factors influence medical students' health status and health-promoting behaviors? A cross-sectional multicenter study in Germany and Hungary.

BACKGROUND: Physical and mental health is important for coping with the high requirements of medical studies that are associated with a higher risk for severe stress, insomnia, smoking, harmful alcohol consumption and easier access to drugs. Health behaviors of medical students influence not just their own health but also the health of their future patients. We examined whether socio-cultural factors can explain differences in students' health status and health-promoting behaviors. METHODS: A multicenter cross-sectional survey in Germany (Dresden, Munich) and Hungary (Budapest, Pécs) enclosed international medical students in their 1st, 3rd and 5th academic years. The students were invited to voluntarily and anonymously complete a questionnaire on different aspects of health behavior during obligatory seminars and lectures in 2014. The response rate of the total sample was 56.2 % (n = 2935); the subgroup analysis enclosed data of German (n = 1289), Hungarian (n = 1057) and Norwegian (n = 148) students. RESULTS: A high number of Norwegian students (84.5 %) assessed their health status as very good/excellent. In comparison, only 60.3 % of the Hungarian and 70.7 % of the German participants reported a very good/excellent health status. The distributions were comparable between the study sites. Although gender, financial situation and nationality were significant health status predictors, they could explain only 8.2 % of the total variance of health status in the multivariable model. A comparably high number of Hungarian students (95.3 % vs. 67.4 % German and 56.7 % Norwegian) reported that they can currently do a lot/very much for their health. In contrast, a significant number of Norwegians (73.0 % vs. 63.7 % Hungarian and 51.5 % German) reported that they currently do a lot/very much for their health (chi(2)-test, p ≤ 0.001). Financial situation, study site and study year were the strongest predictors for health promotion activities (Nagelkerkes R(2) = 0.06). CONCLUSIONS: Based on our study, gender and study year played only a minor role in the health status and health promotion beliefs and activities of medical students. Structural (study site) and somewhat socio-cultural factors (nationality, financial situation) mainly explained the differences regarding health promoting behaviors. Obligatory, free-of-charge courses for health promotion (activity and relaxation) should be included in study curriculums.

[Attitudes of freshman medical students towards education in communication skills]. / Elsö évfolyamos orvostanhallgatók attitüdjei az orvosi kommunikáció oktatásával kapcsolatban.

UNLABELLED: In their institute authors teach medical communication skills in three languages (Hungarian, English and German) for medical students in the first year of their studies. In order to improve teaching methods, authors wanted to explore the attitudes of students towards the communication skills learning. For this purpose authors applied the Communication Skills Attitudes Scale created by Rees et al., which is an internationally accepted and well adaptable instrument. AIMS: In this survey authors wanted to validate the Hungarian and German version of the Communication Skills Attitudes Scale. In addition, their aim was to analyze possible differences between the attitudes of each of the three medical teaching programs. METHODS: Questionnaires were filled anonymously at the beginning of the practices. Principal component analysis with varimax rotation was performed to evaluate the attitudes using the SPSS 10.5 version for analysis. RESULTS: Authors created a model consisting of 7 factors. Factors were the following: 1: respect and interpersonal skills; 2: learning; 3: importance of communication within medical profession; 4: excuse; 5: counter; 6: exam; 7: overconfidence. It was found that students had mainly positive attitudes. Except the learning factor, all other factors showed significant differences between the three medical teaching programs. CONCLUSIONS: although students had mainly positive attitudes toward learning communication skills, there were negative attitudes which can be partly modified by improving the teaching methods. However, results may create a proper base for further research to help improving communication skills teaching methods of the authors.

The role and tools of trust and empathic communication in healthcare during the COVID-19 epidemic / A bizalom és az empatikus kommunikáció szerepe és eszközei az egészségügyben a COVID-19-járvány idején.

Összefoglaló. A járvánnyal szembeni védekezés során mindennapossá vált a maszkhasználat, amely jelentos kihívást jelent a hétköznapi kommunikációs helyzetekben. Az egészségügy bizonyos területein korábban is jelen volt ez a probléma, azonban a most általános érvényu, folyamatos maszkviselés és védoruha-használat szimbolikus és gyakorlati értelemben is akadályként jelenik meg az orvos és a páciens között, ami több szinten nehezíti a hatékony kapcsolatteremtést és kommunikációt. Ezért szükségessé vált olyan egységes kommunikációs protokollok kidolgozása, amelyek segítik a bizalmi kapcsolat kiépítését az egészségügyben úgy, hogy az ellátók érzelmi elérhetosége és a biztonságos fizikai távolságtartás egyszerre valósuljon meg. Tanulmányunk célja, hogy a kurrens szakirodalom áttekintése révén összefoglaljuk a maszkviselés és a védoruha-használat hatásait az orvos-beteg kommunikációra és a kapcsolatban megjeleno bizalomra és empátiás folyamatokra, valamint fel kívánjuk hívni a figyelmet az egészségügyi személyzetet éro hatásokra is. Célunk továbbá, hogy a hazai és nemzetközi tapasztalatokat figyelembe véve olyan ajánlásokat fogalmazzunk meg, melyek segítségével javítható az egészségügyi dolgozók kommunikációja, azon keresztül pedig az ellátás legfontosabb szereploinek, a betegeknek és az ellátóknak az elégedettsége a kapcsolattal. Orv Hetil. 2021; 162(23): 897-904. Summary. In the fight against the epidemic, the use of masks has become commonplace, which is a significant challenge in everyday communication situations. This problem has been present in some areas of healthcare in the past, but today's universal use of masks and personal protective equipment (PPE) is both a symbolic and practical barrier between doctor and patient, making it difficult to establish an effective communication and connectivity on several levels. Therefore, it has become necessary to develop unified communication protocols that help building a relationship of trust in healthcare so that emotional availability of providers and safe physical distance are achieved simultaneously. The aim of our study is to summarize the effects of mask wearing and PPE usage on the physician-patient communication and also the trust and empathy processes that emerge within the relationship through the review of the current literature. We would also like to draw attention to the effects on healthcare staff. Our goal is also to formulate recommendations, taking into account domestic and international experience, that can be used to improve the communication of healthcare professionals, and through that, the satisfaction of the most important actors in care, patients and caregivers. Orv Hetil. 2021; 162(23): 897-904.

Accepting cultural differences in the integration of foreign medical students / Kulturális különbözoségek elfogadása a külföldi orvostanhallgatók beilleszkedésében.

Összefoglaló. Bevezetés: A 21. századra a multikulturális társadalmi közegben az interkulturális tudás, mint készség, fokozott mértékben válik kulcskompetenciává. E társadalmi kompetencia elsajátításának egyik lehetséges területe a nemzetközi hallgatói mobilitás, mely világszerte, így hazánkban is, egyre nagyobb jelentoségu. Célkituzés: Magyar és külföldi hallgatók körében folytatott vizsgálatunk fókuszában a beilleszkedési folyamatoknak, valamint az interkulturális kompetencia és érzékenység kialakulásának és fejlodésének vizsgálata állt, a Pécsre érkezo mintegy 60 különbözo kultúra, valamint a magyar befogadó közeg vonatkozásában egyaránt. Kutatásunk során többek között arra kerestünk választ, hogy az eredeti és a befogadó kultúra közötti különbségek mely területeken nyilvánulnak meg a leginkább, illetve egy másik kultúrához történo alkalmazkodás során milyen beilleszkedést lassító vagy támogató tényezok tárhatók fel. Módszer: Kutatásunkban kvantitatív és kvalitatív módszereket alkalmaztunk, önkitöltéses kérdoíves felmérés, valamint fókuszcsoportos interjúk formájában. A PTE ÁOK német, angol és magyar nyelvu általánosorvos-képzésében részt vevo hallgatókat a 2010 és 2018 közötti idoszak tavaszi szemesztereiben saját fejlesztésu, anonim, önkéntesen kitöltheto kérdoívvel kerestük meg (a kitöltött kérdoívek száma: n = 13 084 kérdoív). A kérdoíveket három tanévben hét, félig strukturált fókuszcsoportos interjúval egészítettük ki (n = 92 fo). Eredmények: A hazánkba érkezo külföldi orvostanhallgatók számára a befogadó közeghez való alkalmazkodást tekintve a kapcsolódás elsosorban a szocializációs, nyelvi, kommunikációs különbségek miatt bizonyult kihívásnak. Megállapítható azonban, hogy a képzési ido elorehaladtával a különbözoségekbol fakadó nehézségek csökkentek, így a hallgatók egyre inkább képessé váltak az etnorelatív irányba történo elmozdulásra, valamint a multikulturális közeg pozitív aspektusainak értékelésére. Következtetések: A multikulturális környezetben folytatott tanulmányok alatt a kultúraközi kapcsolódási pontok és együttmuködések kialakulása és fejlodése lehetové teszi és támogatja az interkulturális kompetencia elsajátítását, annak minden résztvevoje számára, akár az egyetemi képzésen túlmutatóan, a késobbi orvosi pályát tekintve is. Orv Hetil. 2021; 162(25): 978-987. INTRODUCTION: In the increasingly multicultural social environment of the 21st century, intercultural knowledge as a social skill is gradually becoming a key competence. One of the possible areas of acquiring this competence is international student mobility, which is of increasing importance worldwide, including Hungary. OBJECTIVE: The focus of our study was to examine integration processes and the development and improvement of intercultural competence and sensitivity among Hungarian and international students, both in relation to the approximately 60 different cultures arriving in Pécs and in relation to the Hungarian host environment. In the course of our research, we sought - among other factors - areas, in which the differences between the original and the host culture are the most prominent, and we aimed at identifying those factors that are slowing down or supporting the integration during the adaptation period to another culture. METHOD: In our research, we used both quantitative and qualitative methods, in the form of a self-administered questionnaire and focus group interviews. General medical students of the University of Pécs studying in the German-, English- and Hungarian-language programmes participated in the survey during the spring semesters of the academic years between 2010 and 2018. We used our self-developed questionnaires (number of completed questionnaires: n = 13 084), which were filled in on a voluntary basis and anonymity was ensured. The questionnaires were supplemented with seven semi-structured focus group interviews over three academic years (n = 92 students). RESULTS: Regarding the adaptation to the host environment of foreign medical students studying in Hungary, relationship building arising from socialization, language and communication differences, proved to be a challenge. However, it can be stated that as the training time progressed, the difficulties arising from the differences decreased, so that the students gradually became more able to move towards an ethno-relative direction and evaluated the positive aspects of the multicultural environment. CONCLUSION: During studies in a multicultural university environment, the emergence and development of intercultural connections and collaborations enable and support the acquisition of intercultural competence for all of the students, which will be of great benefit for them, even beyond the university, in their future medical career. Orv Hetil. 2021; 162(25): 978-987.

Employment discrimination in hungary and its effect on health.

A dramatic drop in employment occurred in Hungary following the change of regime which particularly affected the Roma, people of reduced working ability, and mothers with young children. Alongside economic considerations, the prejudices of employers and discrimination in employment constitute the most significant obstacles to returning to the workplace. The poor mental and physical health of these groups further reduces their chances of finding employment. Only legislation exists to manage the problem, which-in the absence of other interventions-has not brought a breakthrough in the employment of these groups in either the state or local governments or in private spheres.

Prevalence of rheumatoid arthritis in the South-Transdanubian region of Hungary based on a representative survey of 10,000 inhabitants.

OBJECTIVE: To assess the prevalence of rheumatoid arthritis (RA) in a representative study of the South Transdanubian region of Hungary. METHODS: Ten thousand individuals aged between 14-65 years were interviewed. The stratified sample was representative for age, sex and urban/rural residence structure of the regional population of the South-West Hungarian region. As a second step, all individuals with possible RA were asked to undergo a clinical investigation to confirm the diagnosis of RA according to the American Rheumatism Association (ARA) 1987 criteria. Of 10,000 interviewed individuals, 632 reported having RA or symptoms including digital pain, stiffness, and/or swelling. Two hundred and twenty-four individuals were investigated clinically. Individuals fulfilling the 1987 ARA criteria were considered as having definite RA, and their clinical data were evaluated. RESULTS: RA was confirmed in 13 cases. The male/female ratio was 3/10. The prevalence of RA among individuals aged 14-65 years was 0.37% (95% confidence interval, CI: 0.26-0.51), 0.23% (95% CI: 0.15-0.35) in men and 0.48% (95% CI: 0.35-0.64) in women. CONCLUSION: The prevalence of RA in the South Transdanubian region of Hungary is similar to those of other recent studies from other regions around the world.

'Doctors by Fax' or cleaner production: the problem of prevention in post-communist Hungary.

In 1989, approximately half of the medical visits in Hungary were to factory doctors. Two thousand physicians in the National Health Service were assigned to factories and all medical students served in factories as part of their training. There were certainly problems in the system, but workers preferred the factory doctors to other physicians based in communities or districts; and factory physicians knew about workplace hazards, knew what production processes looked like, and were mandated to deal with work environment problems as well as provide other kinds of patient care. With the reform of the National Health Service, the role of factory physician was eliminated, although companies could institute their own medical services (and sometimes employed the previous medical staff). Later legislation required companies to have access to occupational medical services, but critics have called the new system "Doctors by Fax." We discuss the adequacy of the new legislative requirements (including mandatory health and safety committees) and report on new issues in worker health and safety that have emerged post "reform." Finally, the possibility of linking the prevention of occupational disease and injury prevention to "cleaner production" in Hungary is discussed.