Mental health and burnout during medical school: Longitudinal evolution and covariates.

BACKGROUND: Medical students' rate of depression, suicidal ideation, anxiety, and burnout have been shown to be higher than those of the same-age general population. However, longitudinal studies spanning the whole course of medical school are scarce and present contradictory findings. This study aims to analyze the longitudinal evolution of mental health and burnout from the first to the last year of medical school using a wide range of indicators. Moreover, biopsychosocial covariates that can influence this evolution are explored. METHOD: In an open cohort study design, 3066 annual questionnaires were filled in by 1595 different students from the first to the sixth year of the Lausanne Medical School (Switzerland). Depression symptoms, suicidal ideation, anxiety symptoms, stress, and burnout were measured along with biopsychosocial covariates. The longitudinal evolution of mental health and burnout and the impact of covariates were modelled with linear mixed models. RESULTS: Comparison to a same-aged general population sample shows that medical students reported significantly more depression symptoms and anxiety symptoms. Medical students' mental health improved during the course of the studies in terms of depression symptoms, suicidal ideation, and stress, although suicidal ideation increased again in the last year and anxiety symptoms remained stable. Conversely, the results regarding burnout globally showed a significant worsening from beginning to end of medical school. The covariates most strongly related to better mental health and less burnout were less emotion-focused coping, more social support, and more satisfaction with health. CONCLUSION: Both improvement of mental health and worsening of burnout were observed during the course of medical school. This underlines that the beginning and the end of medical school bring specific challenges with the first years' stressors negatively impacting mental health and the last year's difficulties negatively impacting burnout.

The effect of gender on emotional reactions and perceptions when individuals meet themselves in immersive virtual reality.

Immersive virtual reality-based training and research are becoming more and more popular and are in continuous development. For instance, it is now possible to be trained by one's virtual self (i.e., doppelganger), meaning that a trainee can participate in a training program in which the trainer resembles the trainee. While past research involving doppelgangers showed promising results, findings revealed gender effects such that doppelganger-based training seems to be beneficial only for male trainees. In the present research, we contribute to this literature by investigating the emotional reactions and perceptions that people have when they meet a virtual human in immersive virtual reality. Specifically, we assess the extent to which the appearance of the virtual human (doppelganger vs. unknown avatar) and an individual's gender influence these reactions and perceptions. We found that males felt more positive emotions toward their doppelganger than toward the unknown avatar and that females perceived their doppelganger as less competent and warm than the unknown avatar. Our findings have important practical implications in terms of virtual reality-based training and research design such that the use of a doppelganger (unknown avatar) might be recommended in a training program or research setting involving men (women).

A deepfake-based study on facial expressiveness and social outcomes.

Artificial intelligence (AI)-generated media is used in entertainment, art, education, and marketing. AI-generated faces or facial expressions using deepfake-based technologies might also contribute to nonverbal behavior studies. As a proof of concept, in this research, we test the replicability of past results regarding the positive effects of facial expressiveness (e.g., gazing, nodding, and smiling) on social outcomes. Because the facial expressions when listening to someone (i.e., nonverbal immediacy) encompass several behaviors that are typically related (i.e., smiling while nodding), the effect of combinations of these behaviors is challenging to study. We thus test the effect of facial expressiveness (gazing, nodding, and smiling vs. none) on first impression judgements in a job interview setting using AI-generated experimental video material. We measure how competent, warm, and favorably independent observers (n = 823) perceive the targets (n = 159) showing AI-generated facial expressions. Our results replicate past research showing that the more targets are facially expressive, the more they are perceived favorably. Apart from supporting evidence of the importance of facial expressiveness for conveying a positive impression, we show the benefits of relying on AI-generated experimental video material for the study of nonverbal behavior.

The relationship between medical students' empathy, mental health, and burnout: A cross-sectional study.

OBJECTIVE: To investigate how medical students' empathy is related to their mental health and burnout. METHODS: This cross-sectional study included 886 medical students from curriculum years 1-6. The cognitive, affective, and behavioural dimensions of empathy were measured with self-report questionnaires and an emotion recognition test. Regressions were used to test the relationship between the empathy dimensions, depressive symptoms, anxiety, and burnout as well as the influence of curriculum year and gender. RESULTS: Cognitive and behavioural empathy were significantly related to less mental health issues and burnout, whereas affective empathy was related to more mental health issues and burnout. Students in later curriculum years reported less mental health issues and burnout than students in earlier years, whereas no systematic difference could be observed for empathy. Female students reported more mental health issues and burnout as well as higher empathy, except for behavioural empathy for which male students scored higher. CONCLUSIONS: The cognitive, affective, and behavioural dimensions of empathy were differently related to the mental health and burnout of medical students. Students presenting mental health issues or burnout might have more difficulty to adapt their behaviour in social situations and keep a certain distance when taking others' perspective.

The role of social categorization and social dominance orientation in behavioral adaptability.

Behavioral adaptability is the ability to adapt one's interpersonal behavior to the expectations of the social interaction partners. In this paper, we investigated two factors that impact the extent to which people express behavioral adaptability. First, we investigated whether behavioral adaptability depends on the interaction partners' social categories (in-group vs. out-group). Second, we tested whether social dominance orientation (SDO) is related to behavioral adaptability and whether this relationship depends on the interaction partners' belonging to the in- or out-group. To do so, we conducted 2 studies in which we manipulated whether the interaction partners belong to the in- or to the out-group and in which we assessed participants SDO. In both studies, participants were in the role of a leader who had to give separate pep talks to 2 subordinates who differed in terms of preferred leadership style and we operationalized behavioral adaptability by coding to what extent participants adapted (Study 1) or reported that they would adapt (Study 2) their leadership style according to their subordinates' individual preferences. Study 1 used immersive virtual reality and included White/Caucasian male participants (N = 173). Study 2 was a vignette study including men and women who were either White/Caucasian or Black/African American (N = 741). Results showed that the subordinates' social category did not impact the extent to which participants express behavioral adaptability. However, SDO was differently related to behavioral adaptability depending both on participants social categories (e.g., ethnicity and sex) and subordinates' belonging to the in- or out-group. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy.

INTRODUCTION: Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students' interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients. METHODS AND ANALYSIS: This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1-6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills. ETHICS AND DISSEMINATION: The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

Nonverbal Social Sensing: What Social Sensing Can and Cannot Do for the Study of Nonverbal Behavior From Video.

The study of nonverbal behavior (NVB), and in particular kinesics (i.e., face and body motions), is typically seen as cost-intensive. However, the development of new technologies (e.g., ubiquitous sensing, computer vision, and algorithms) and approaches to study social behavior [i.e., social signal processing (SSP)] makes it possible to train algorithms to automatically code NVB, from action/motion units to inferences. Nonverbal social sensing refers to the use of these technologies and approaches for the study of kinesics based on video recordings. Nonverbal social sensing appears as an inspiring and encouraging approach to study NVB at reduced costs, making it a more attractive research field. However, does this promise hold? After presenting what nonverbal social sensing is and can do, we discussed the key challenges that researchers face when using nonverbal social sensing on video data. Although nonverbal social sensing is a promising tool, researchers need to be aware of the fact that algorithms might be as biased as humans when extracting NVB or that the automated NVB coding might remain context-dependent. We provided study examples to discuss these challenges and point to potential solutions.

The effect of physician self-disclosure on patient self-disclosure and patient perceptions of the physician.

OBJECTIVES: Physician self-disclosure is typically seen as patient-centered communication because it creates rapport and is seen as an expression of empathy. Given that many physician behaviors affect patients differently depending on whether they are shown by a female or male physician, we set out to test whether physician self-disclosure affects patients' intentions to self-disclose and patients' perceptions of their physicians depending on physicians' gender. METHOD: Two hundred and forty-four participants were recruited and randomly assigned to read one of 4 vignettes as if they were the patient in the dialogue (analogue patient design). They were then asked to report how they would react to the physician and how they perceived the him or her. RESULTS: Physicians who self-disclosed were perceived as more empathic than physicians who did not, regardless of physician and patient gender. Physician self-disclosure had an effect on the behavioral intentions of the analogue patients, and this was moderated by physician gender. Analogue patients indicated to be more willing to self-disclose to female than to male physicians who self-disclosed. CONCLUSION: It is important to consider physician gender when training physicians in patient-centered communication because the same behavior can have different effects on patients depending on whether it originates from a female or a male physician. PRACTICAL IMPLICATIONS: Physicians can use self-disclosure to express empathy. When female physicians do so, they might obtain more personal information from patients, which can positively affect diagnosis and treatment.

Doppelganger-based training: Imitating our virtual self to accelerate interpersonal skills learning.

Interpersonal skills require mastering a wide range of competencies such as communication and adaptation to different situations. Effective training includes the use of videos in which role models perform the desired behaviours such that trainees can learn through behavioural mimicry. However, new technologies allow new ways of designing training. In the present study, given that virtual reality is emerging as a valuable training setting, we compare two different demonstration conditions within virtual reality by investigating the extent to which the use of doppelgangers as role models can boost trainees' interpersonal skills development as compared to a role model that does not resemble the trainees. We also assess trainees' level of self-efficacy and gender as potential moderators in this relationship. Participants delivered a speech in front of a virtual audience twice. Before delivering their second speech, they watched a role model giving a speech in front of the same audience. The role model was either their doppelganger or an avatar of the same gender depending on the condition they were randomly assigned to. Results showed that the doppelganger-based training was the most beneficial for male trainees low in self-efficacy. These findings have important implications for training design, suggesting that doppelganger-based training might be effective only for a specific subset of trainees.

The leaky pipeline in research grant peer review and funding decisions: challenges and future directions.

The growing literature on gender inequality in academia attests to the challenge that awaits female researchers during their academic careers. However, research has not yet conclusively resolved whether these biases persist during the peer review process of research grant funding and whether they impact respective funding decisions. Whereas many have argued for the existence of gender inequality in grant peer reviews and outcomes, others have demonstrated that gender equality is upheld during these processes. In the present paper, we illustrate how these opinions have come to such opposing conclusions and consider methodological and contextual factors that render these findings inconclusive. More specifically, we argue that a more comprehensive approach is needed to further the debate, encompassing individual and systemic biases as well as more global social barriers. We also argue that examining gender biases during the peer review process of research grant funding poses critical methodological challenges that deserve special attention. We conclude by providing directions for possible future research and more general considerations that may improve grant funding opportunities and career paths for female researchers.

Virtual patient simulation in breaking bad news training for medical students.

OBJECTIVE: The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education. METHODS: The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis. RESULTS: Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs. CONCLUSION: The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment. PRACTICE IMPLICATIONS: The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.

Power and social information processing.

We review the scientific evidence concerning the relation between power and social information processing. Does having or obtaining power affect how we perceive and judge our social interaction partners and how accurately we do this? High power individuals perceive others as more agentic and tend to project characteristics of themselves onto others. People in power tend to stereotype others more and see them as less human and generally in a more negative way. Powerholders are not more or less accurate in assessing others; rather, the way they understand their power (as responsibility or opportunity) seems to make the difference: Power as responsibility results in better interpersonal accuracy. Our analysis shows that it is not so much being high or low in power that explains how we perceive others, but rather how we understand our power, whether our high power position is stable, and what our current interaction goals are.

Undergraduate training in breaking bad news: A continuation study exploring the patient perspective.

OBJECTIVE: This paper reports on the continuation of an initial study that demonstrated the effectiveness, as rated by experts, of an undergraduate training in breaking bad news (BBN) using simulated patient (SP) and individual feedback. The current study aimed to further explore whether such an individualized training approach also has positive effects from the perspective of the patient, using the analogue patient (AP) methodology. METHODS: A subsample of 180 videotaped interviews with SPs were selected from the existing data set (N = 332), consisting of 60 pre- and post-training interviews of students benefiting from the individualized approach (intervention group) and 60 post-training interviews of students having small-group SP training and collective supervision (comparison group). Sixty-eight APs-healthy untrained observers-were asked to view the videotaped interviews while "putting themselves in the patient's shoes" and evaluate satisfaction, trust, liking, and the competence of medical students. RESULTS: The intervention group students improved significantly from pre- to post-training on several dimensions evaluated by the APs: patient satisfaction, trust in the student, liking of the student, and perceived medical competence. Increased AP satisfaction was related to different changes in students' communication behavior between pre- and post-training: increase in positive talk, emotional responsiveness, biomedical and psychosocial information, and biomedical counseling. There was no significant between-group difference at post-training. CONCLUSIONS: AP evaluation showed significant improvement between pre- and post-training. This result provides additional and complementary evidence of the positive effects of individualized training in BBN from the AP perspective, a proxy of (real) patients.

The academic-industry divide in health communication: A call for increased partnership.

OBJECTIVE: Healthcare communication research, teaching, and practice is in a period of innovation and disruption from new technologies, consumerization, and emerging models of care delivery. The goal of this commentary is to discuss perceived barriers and provide baseline metrics of academic-industry partnership in health communication. METHODS: We coded industry affiliations of authors published in Patient Education and Counseling (PEC) in 2018, and attendees and authors of accepted submissions at the 2018 International Conference on Communication in Healthcare (ICCH). We examined perceived barriers to collaboration by summarizing a roundtable discussion between industry and academic participants at the 2018 ICCH conference. RESULTS: In 2018, less than 5% of contributions to PEC, 16 abstracts (3.1%) and only 7 attendees (1.4%) at ICCH had industry affiliations. Roundtable participants identified actual or perceived motivational differences, publication challenges, and distinct metrics/outcomes as key barriers to collaboration. CONCLUSION: These rough estimates provide a benchmark for current industry collaboration in our professional society. We discuss potential benefits of increased partnerships, suggest approaches to reduce barriers, and highlight recent progress. PRACTICE IMPLICATIONS: As individuals and professional organizations, we should promote ethical, multidisciplinary, and high impact research, teaching, and practice in partnership with our colleagues in industry.

Modeling empathy as synchrony in clinician and patient vocally encoded emotional arousal: A failure to replicate.

Empathy is a well-defined active ingredient in clinical encounters. To measure empathy, the current gold standard is behavioral coding (i.e., trained coders attribute overall ratings of empathy to clinician behaviors within an encounter), which is labor intensive and subject to important reliability challenges. Recently, an alternative measurement has been proposed: capturing empathy as synchrony in vocally encoded arousal, which can be measured as the mean fundamental frequency of the voice (mean F0). This method has received preliminary support by one study (Imel, Barco, et al., 2014). We aimed to replicate this study by using 2 large samples of clinical interactions (alcohol brief motivational interventions with young adults, N = 208; general practice consultations, N = 204). Audio files were segmented to identify respective speakers and mean F0 was measured using speech signal processing software. All sessions were independently rated by behavioral coders using 2 validated empathy scales. Synchrony between clinician and patient F0 was analyzed using multivariate multilevel models and compared with high and low levels of empathy derived from behavioral coding. Findings showed no support for our hypothesis that mean F0 synchrony between clinicians and patients would be higher in high-empathy sessions. This lack of replication was consistent for both clinical samples, both behavioral coding instruments, and using measures of F0 synchrony occurring at both the session-level and minute-level. We considered differences in culture and language, patients' characteristics, and setting as explanations for this failure to replicate. Further replication testing and new developments regarding measurement methods and modeling are needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predictive Validity of Thin-Slice Nonverbal Behavior from Social Interactions.

We present five studies investigating the predictive validity of thin slices of nonverbal behavior (NVB). Predictive validity of thin slices refers to how well behavior slices excerpted from longer video predict other measured variables. Using six NVBs, we compared predictive validity of slices of different lengths with that obtained when coding is based on full-length (5-min) video, investigating the relative predictive validity of 1-min slices as well as of cumulative slices. Results indicate some loss in predictive validity with 1-min slices, but relatively little loss when Slices 1 and 2 were combined for five of the six NVBs. This research establishes an empirical basis on which researchers can decide how much of their recorded corpus needs to be coded for NVB. The results also provide some guidance on effect sizes in power analyses for researchers coding specific behaviors in a thin-slice design.

Measuring nonverbal behavior in clinical interactions: A pragmatic guide.

OBJECTIVE: Understanding nonverbal behavior is key to the research, teaching, and practice of clinical communication. However, the measurement of nonverbal behavior can be complex and time-intensive. There are many decisions to make and factors to consider when coding nonverbal behaviors. METHODS: Based on our experience conducting nonverbal behavior research in clinical interactions, we developed practical advice and strategies for coding nonverbal behavior in clinical communication, including a checklist of questions to consider for any nonverbal coding project. RESULTS: We provide suggestions for beginning the nonverbal coding process, operationalizing the coding approach, and conducting the coding. CONCLUSION: A key to decision-making around nonverbal behavior coding is establishing clear research questions and using these to guide the process. PRACTICE IMPLICATIONS: The field needs more coding of nonverbal behavior to better describe what happens in clinical interactions, to understand why nonverbal behaviors occur, and to determine the predictors and consequences of nonverbal behaviors in clinical interactions. A larger evidence base can inform better teaching practices and communication interventions.

How Do Different Ways of Measuring Individual Differences in Zero-Acquaintance Personality Judgment Accuracy Correlate With Each Other?

OBJECTIVE: This research compares two different approaches that are commonly used to measure accuracy of personality judgment: the trait accuracy approach wherein participants discriminate among targets on a given trait, thus making intertarget comparisons, and the profile accuracy approach wherein participants discriminate between traits for a given target, thus making intratarget comparisons. We examined correlations between these methods as well as correlations among accuracies for judging specific traits. METHOD: The present article documents relations among these approaches based on meta-analysis of five studies of zero-acquaintance impressions of the Big Five traits. RESULTS: Trait accuracies correlated only weakly with overall and normative profile accuracy. Substantial convergence between the trait and profile accuracy methods was only found when an aggregate of all five trait accuracies was correlated with distinctive profile accuracy. Importantly, however, correlations between the trait and profile accuracy approaches were reduced to negligibility when statistical overlap was corrected by removing the respective trait from the profile correlations. Moreover, correlations of the separate trait accuracies with each other were very weak. CONCLUSIONS: Different ways of measuring individual differences in personality judgment accuracy are not conceptually and empirically the same, but rather represent distinct abilities that rely on different judgment processes.

Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences.

A physician who communicates in a patient-centered way is a physician who adapts his or her communication style to what each patient needs. In order to do so, the physician has to (1) accurately assess each patient's states and traits (interpersonal accuracy) and (2) possess a behavioral repertoire to choose from in order to actually adapt his or her behavior to different patients (behavioral adaptability). Physician behavioral adaptability describes the change in verbal or nonverbal behavior a physician shows when interacting with patients who have different preferences in terms of how the physician should interact with them. We hypothesized that physician behavioral adaptability to their patients' preferences would lead to better patient outcomes and that physician interpersonal accuracy was positively related to behavioral adaptability. To test these hypotheses, we recruited 61 physicians who completed an interpersonal accuracy test before being videotaped during four consultations with different patients. The 244 participating patients indicated their preferences for their physician's interaction style prior to the consultation and filled in a consultation outcomes questionnaire directly after the consultation. We coded the physician's verbal and nonverbal behavior for each of the consultations and compared it to the patients' preferences to obtain a measure of physician behavioral adaptability. Results partially confirmed our hypotheses in that female physicians who adapted their nonverbal (but not their verbal) behavior had patients who reported more positive consultation outcomes. Moreover, the more female physicians were accurate interpersonally, the more they showed verbal and nonverbal behavioral adaptability. For male physicians, more interpersonal accuracy was linked to less nonverbal adaptability.

Individual training at the undergraduate level to promote competence in breaking bad news in oncology.

OBJECTIVE: Training medical students in breaking bad news (BBN) in oncology may be key to improve patient care in an area where many physicians tend to be uncomfortable. Given the lack of evidence in the literature, this study aimed to assess empirically the impact of 2 teaching strategies to prepare students for the task of BBN in oncology: one-to-one simulated patient (SP) training with individual feedback (intervention group) vs small-group SP training with collective feedback (comparison group). METHODS: Fourth-year students (N = 236) were randomly assigned to the intervention or comparison group. The SP videotaped interviews were analyzed with respect to BBN communication performance, rated using the Calgary-Cambridge checklist of teaching objectives for BBN; verbal interaction behaviors, coded with the Roter interaction analysis system; and 7 nonverbal behaviors. RESULTS: Students in the intervention group scored significantly higher after than before the training on the overall evaluation of the interview (P < .001) as well as on process skills (P < .001); they also obtained significantly higher scores compared to students in the comparison group on the overall evaluation of the interview (P < .001) and on process skills (P < .001). CONCLUSIONS: This study supports an individualized BBN teaching strategy and contributes to efforts to find the best way to train and reach the largest number of future physicians to improve communication competences in oncology.