Trends in medical students' health over 5 years: Does a wellbeing curriculum make a difference?

BACKGROUND: Trends in New Zealand (NZ) medical students' health and the influence of a wellbeing curricula are unknown. METHODS: The author's collected self-report data from NZ medical students on 'Graduation Day' from 2014 to 2018, using a serial cross-sectional survey design with validated scales assessing psychological health, stigma, coping, and lifestyle. Comparisons were made with NZ general population same-age peers. Analyses examined trends, differences between 'cohorts' of students receiving different exposures to a wellbeing curriculum, and correlations between students' own lifestyle practices and their frequency of talking with patients about those topics. RESULTS: Of 1,062 students, 886 participated. The authors found statistically significant self-reported increases from 2014 to 2018 for negative psychological indices, including scores for distress and burnout, suicidal thoughts in the preceding year, and the likelihood of being diagnosed with an anxiety disorder. There was a significant increase in numbers of students reporting having their own doctor as well as increased healthy coping strategies and a significant decrease in stigma scores. Academic cohorts of students who had completed a wellbeing curriculum were more likely to report high distress levels, having been diagnosed with a mood disorder, and being non-drinkers than students without wellbeing training. When compared to NZ peers, medical students smoked less, exercised more, and were less likely to have diagnosed mood and anxiety disorders, but reported more distress. The authors found a significant correlation between the amount of exercise students undertook and their likelihood to discuss exercise with patients. CONCLUSIONS: NZ medical students have better physical health than general population peers and are more likely to discuss exercise with patients if exercising themselves. However, cohorts of graduating students report increasing distress despite the implementation of a wellbeing curriculum. Research is needed into mechanisms between students' self-awareness, willingness to report distress, stigma, mind-set, coping, and psychological outcomes, to inform curriculum developers.

Blended-eLearning Improves Alcohol Use Care in Kenya: Pragmatic Randomized Control Trial Results and Parallel Qualitative Study Implications.

Alcohol use is the 5th most important risk factor contributing to the global burden of diseases, with stigma and a lack of trained health workers as the main barriers to adequate care. This study assesses the impact of providing blended-eLearning courses teaching the alcohol, smoking, and substance involvement screening test (ASSIST) screening and its linked brief intervention (BI). In public and private facilities, two randomized control trials (RCTs) showed large and similar decreases in alcohol use in those receiving the BI compared to those receiving only the ASSIST feedback. Qualitative findings confirm a meaningful reduction in alcohol consumption; decrease in stigma and significant practice change, suggesting lay health workers and clinicians can learn effective interventions through blended-eLearning; and significantly improve alcohol use care in a low- and middle-income country (LMIC) context. In addition, our study provides insight into why lay health workers feedback led to a similar decrease in alcohol consumption compared to those who also received a BI by clinicians. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-022-00841-x.

Implementing and Sustaining Brief Addiction Medicine Interventions with the Support of a Quality Improvement Blended-eLearning Course: Learner Experiences and Meaningful Outcomes in Kenya.

Quality improvement methods could assist in achieving needed health systems improvements to address mental health and substance use, especially in low-middle-income countries (LMICs). Online learning is a promising avenue to deliver quality improvement training. This Computer-based Drug and Alcohol Training Assessment in Kenya (eDATA-K) study assessed users' experience and outcome of a blended-eLearning quality improvement course and collaborative learning sessions. A theory of change, developed with decision-makers, identified relevant indicators of success. Data, analyzed using descriptive statistics and thematic analysis, were collected through extensive field observations, the eLearning platform, focus group discussions, and key informant interviews. The results showed that 22 community health workers and clinicians in five facilities developed competencies enabling them to form quality improvement teams and sustain the new substance-use services for the 8 months of the study, resulting in 4591 people screened, of which 575 received a brief intervention. Factors promoting course completion included personal motivation, prior positive experience with NextGenU.org's courses, and a certificate. Significant challenges included workload and network issues. The findings support the effectiveness of the blended-eLearning model to assist health workers in sustaining new services, in a supportive environment, even in a LMIC peri-urban and rural settings.

Association between substance use and professional outcomes among medical students: Findings from a Canadian cross-sectional survey.

Background: While substance use is common among medical students, there is limited research on this topic involving Canadian medical students or exploring its associations with professional outcomes. The present study examines the association between Canadian medical students' substance use and related counselling attitudes and practices, career satisfaction, academic/clinical workload, and the medical school environment. Methods: We sent an electronic cross-sectional survey to students attending all 17 Canadian medical schools between November 2015 and March 2016. A total of 4,438 participants completed the survey across four years of study, with a participation rate of 40.2%. We considered four categories of substance use: cannabis, alcohol, non-medical use of prescription stimulants (NPS), and cigarettes. Covariates included professional attitudes (e.g., career satisfaction, distress, patient counselling on alcohol or smoking cessation), specialty of interest, learner mistreatment, and perceived medical school support. We used multivariate logistic regression models, generating adjusted odds ratios (AORs), to examine covariates associated with substance use and how substance use (as a covariate) was associated with different professional outcomes. Results: Individuals more interested in "lifestyle" specialties (AOR, 1.81; 95% CI, 1.08-3.05) and surgical specialties (AOR, 1.69; 95% CI, 1.16-2.47) were more likely to report excessive alcohol use. Those interested in primary care were more likely to report cannabis use in the past 12 months (AOR, 1.85; 95% CI, 1.14-3.00). We did not identify significant associations between specialty of interest and current cigarette or NPS use in the past 12 months. However, excessive alcohol use was associated with greater career satisfaction (AOR, 1.24; 95% CI: 1.04-1.49), whereas NPS in the past 12 months was associated with poorer career satisfaction (AOR, 0.63; 95% CI: 0.42-0.93). In addition, there was a negative association between NPS use and the ability to handle workloads due to physical (AOR, 0.31; 95% CI, 0.18-0.54) or mental health issues (AOR, 0.46; 95% CI, 0.30-0.71), but not for other substances. We also found significant negative associations between current cigarette use and the perceived relevance of smoking cessation counselling (AOR, 0.48; 95% CI: 0.29-0.80) and alcohol cessation counselling (AOR, 0.42; 95% CI: 0.25-0.70). Conclusions: These findings suggest that specific patterns of substance use in medical students appeared to be significantly associated with some professional outcomes, specialty of interest, and attitudes towards addiction-related clinical practice. Encouraging medical students to practise healthy habits, including minimizing harmful substance use behaviours, could be an important target for improving medical students' health and their patient care.

Contexte: Bien que la consommation d'alcool et de drogues soit courante chez les étudiants en médecine, peu d'études sur ce sujet ont été menées auprès d'étudiants canadiens en médecine ou ont exploré ses liens avec les résultats professionnels. La présente étude examine l'association entre la consommation de substances psychoactives des étudiants canadiens en médecine et les comportements et habitudes en matière de suivi psychologique, la satisfaction à l'égard de la carrière, la charge de travail universitaire/en clinique et l'environnement de la faculté de médecine. Méthodes: Nous avons fait parvenir une enquête transversale électronique aux étudiants fréquentant les 17 facultés de médecine canadiennes entre novembre 2015 et mars 2016. Au total, 4 438 participants ont répondu à l'enquête sur quatre années d'études, avec un taux de participation de 40,2 %. Nous avons considéré quatre catégories de consommation de substances : le cannabis, l'alcool, l'utilisation non médicale de stimulants sur ordonnance (NSO) et les cigarettes. Les covariables comprenaient les attitudes professionnelles (par exemple, la satisfaction professionnelle, la détresse, les conseils aux patients sur l'arrêt de l'alcool ou du tabac), la spécialité choisie, les maltraitances infligées aux étudiants et le soutien perçu de la faculté de médecine. Nous avons utilisé des modèles de régression logistique multivariés, générant des rapports de cotes ajustés (RCA), pour examiner les covariables associées à la consommation de substances et la façon dont la consommation de substances (en tant que covariable) était associée à différents résultats professionnels. Résultats: Les personnes plus intéressées par les spécialités "mode de vie" (RCA, 1,81 ; IC 95 %, 1,08-3,05) et les spécialités chirurgicales (RCA, 1,69 ; IC 95 %, 1,16-2,47) étaient plus susceptibles de déclarer une consommation excessive d'alcool. Les personnes intéressées par les soins primaires étaient plus susceptibles de déclarer avoir consommé du cannabis au cours des 12 derniers mois (RCA, 1,85 ; IC à 95 %, 1,14-3,00). Nous n'avons pas identifié d'associations significatives entre la spécialité choisie et la consommation de cigarettes ou de NSO au cours des 12 derniers mois. Toutefois, la consommation excessive d'alcool était associée à une plus grande satisfaction professionnelle (RCA, 1,24 ; IC à 95 % : 1,04-1,49), tandis que la consommation de NSO au cours des 12 derniers mois était associé à une plus faible satisfaction professionnelle (RCA, 0,63 ; IC à 95 % : 0,42-0,93). En outre, il existe une association négative entre la consommation de NSO et la capacité à gérer la charge de travail en raison de problèmes de santé physique (RCA, 0,31 ; IC à 95%, 0,18-0,54) ou mentale (RCA, 0,46 ; IC à 95%, 0,30-0,71), mais pas pour les autres substances. Nous avons également constaté des associations négatives significatives entre l'usage de la cigarette et la pertinence perçue des conseils en matière d'arrêt du tabac (RCA, 0,48 ; IC 95 % : 0,29-0,80) et des conseils en matière d'arrêt de l'alcool (RCA, 0,42 ; IC 95 % : 0,25-0,70). Conclusions: Ces résultats suggèrent que des modèles spécifiques de consommation de substances psychoactives chez les étudiants en médecine semblent être significativement associés à certains résultats professionnels, à la spécialité choisie et aux attitudes envers la pratique clinique liée à la dépendance. Encourager les étudiants en médecine à adopter des habitudes saines, notamment en minimisant les comportements nocifs liés à la consommation de substances, pourrait être un objectif important pour améliorer la santé des étudiants en médecine et les soins aux patients. Motsclés: Consommation de substances psychoactives ; Étudiants en médecine ; Enquête ; Canada.

Perception of Medical Student Mistreatment: Does Specialty Matter?

PURPOSE: Medical student mistreatment is pervasive, yet whether all physicians have a shared understanding of the problem is unclear. The authors presented professionally designed trigger videos to physicians from 6 different specialties to determine if they perceive mistreatment and its severity similarly. METHOD: From October 2016 to August 2018, resident and attending physicians from 10 U.S. medical schools viewed 5 trigger videos showing behaviors that could be perceived as mistreatment. They completed a survey exploring their perceptions. The authors compared perceptions of mistreatment across specialties and, for each scenario, evaluated the relationship between specialty and perception of mistreatment. RESULTS: Six-hundred fifty resident and attending physicians participated. There were statistically significant differences in perception of mistreatment across specialties for 3 of the 5 scenarios: aggressive questioning (range, 74.1%-91.2%), negative feedback (range, 25.4%-63.7%), and assignment of inappropriate tasks (range, 5.5%-25.5%) (P ≤ .001, for all). After adjusting for gender, race, professional role, and prior mistreatment, physicians in surgery viewed 3 scenarios (aggressive questioning, negative feedback, and inappropriate tasks) as less likely to represent mistreatment compared with internal medicine physicians. Physicians from obstetrics-gynecology and "other" specialties perceived less mistreatment in 2 scenarios (aggressive questioning and negative feedback), while family physicians perceived more mistreatment in 1 scenario (negative feedback) compared with internal medicine physicians. The mean severity of perceived mistreatment on a 1 to 7 scale (7 most serious) also varied statistically significantly across the specialties for 3 scenarios: aggressive questioning (range, 4.4-5.4; P < .001), ethnic insensitivity (range, 5.1-6.1; P = .001), and sexual harassment (range, 5.5-6.3; P = .004). CONCLUSIONS: Specialty was associated with differences in the perception of mistreatment and rating of its severity. Further investigation is needed to understand why these perceptions of mistreatment vary among specialties and how to address these differences.

Changes in cannabis use, exposure, and health perceptions following legalization of adult recreational cannabis use in California: a prospective observational study.

BACKGROUND: Most U.S. states have legalized cannabis for medical and/or recreational use. In a 6-month prospective observational study, we examined changes in adult cannabis use patterns and health perceptions following broadened legalization of cannabis use from medical to recreational purposes in California. METHODS: Respondents were part of Stanford University's WELL for Life registry, an online adult cohort concentrated in Northern California. Surveys were administered online in the 10 days prior to state legalization of recreational use (1/1/18) and 1-month (2/1/18-2/15/18) and 6-months (7/1/2018-7/15/18) following the change in state policy. Online surveys assessed self-reported past 30-day cannabis use, exposure to others' cannabis use, and health perceptions of cannabis use. Logistic regression models and generalized estimating equations (GEE) examined associations between participant characteristics and cannabis use pre- to 1-month and 6-months post-legalization. RESULTS: The sample (N = 429, 51% female, 55% non-Hispanic White, age mean = 56 ± 14.6) voted 58% in favor of state legalization of recreational cannabis use, with 26% opposed, and 16% abstained. Cannabis use in the past 30-days significantly increased from pre-legalization (17%) to 1-month post-legalization (21%; odds ratio (OR) = 1.28, p-value (p) = .01) and stayed elevated over pre-legalization levels at 6-months post-legalization (20%; OR = 1.28, p = .01). Exposure to others' cannabis use in the past 30 days did not change significantly over time: 41% pre-legalization, 44% 1-month post-legalization (OR = 1.18, p = .11), and 42% 6-months post-legalization (OR = 1.08, p = .61). Perceptions of health benefits of cannabis use increased from pre-legalization to 6-months post-legalization (OR = 1.19, p = .02). Younger adults, those with fewer years of education, and those reporting histories of depression were more likely to report recent cannabis use pre- and post-legalization. Other mental illness was associated with cannabis use at post-legalization only. In a multivariate GEE adjusted for sociodemographic characteristics and diagnoses, favoring legalization and the interaction of time and positive health perceptions were associated with a greater likelihood of using cannabis. CONCLUSIONS: Legalized recreational cannabis use was associated with greater self-reported past 30-day use post-legalization, and with more-positive health perceptions of cannabis use. Future research is needed to examine longer-term perceptions and behavioral patterns following legalization of recreational cannabis use, especially among those with mental illness.

A nationwide assessment of lifestyle medicine counseling: knowledge, attitudes, and confidence of Israeli senior family medicine residents.

BACKGROUND: Non-communicable diseases are the leading causes of death, largely due to the last century's often-unhealthy lifestyles. Family medicine (FM) and other physicians can improve patients' lifestyle behaviors, yet FM residency programs in Israel and other countries do not uniformly deliver lifestyle medicine (LM) training. The readiness of FM residents to counsel on lifestyle issues is not known. The purpose of this study is to assess knowledge, attitudes, and confidence levels of senior Israeli FM residents regarding LM counseling, and to evaluate the influence of LM training and personal health behaviors on residents' LM knowledge, attitudes, and confidence. METHODS: From May to June 2017, we surveyed all senior Israeli FM residents regarding their knowledge, attitudes, confidence, and personal health behaviors. We compared health behaviors, attitudes, and confidence in counselling between: 1) trained residents vs. untrained residents; 2) physically active residents vs. not physically active residents; 3) residents with a BMI < 25 vs. those with a BMI > 25; and 4) residents who eat a Mediterranean diet vs. those who do not. RESULTS: A total of 169 senior Israeli FM residents were surveyed, and 143 completed the survey, a response rate of 84.6%. Senior FM residents said they considered LM counseling to be an integral part of their role and an effective tool by which to improve a patient's health. Yet, their knowledge of LM and their confidence in delivering LM counseling are low. Compared with untrained residents (n = 84), LM-trained residents (n = 55) had higher knowledge scores (30.9% vs. 13.1%, p = 0.016) and were more confident in their ability to impact their patients' behaviors (53.7% vs. 34.5%, p = 0.004). Residents' positive personal health behaviors correlated with a higher level of confidence to provide LM counseling. CONCLUSIONS: FM physicians can play a key role in the management of patients with chronic diseases. Israeli FM residents consider counseling patients about a healthy lifestyle to be an integral part of their work, but do not feel well prepared to do so. Dedicated LM training and resident's personal health promotion may improve critically important levels of LM counseling and patient outcomes, and this training should therefore become a higher priority.

Comparison of Cardiovascular Risk Factors and Outcomes Among Practicing Physicians vs the General Population in Ontario, Canada.

Importance: Although cardiovascular disease is the leading cause of death in most developed countries, little is known about current physicians' cardiovascular health and outcomes. Objective: To compare cardiac risk factor burden, health services use, and major cardiovascular event incidence between physicians and the general population. Design, Setting, and Participants: This cohort study used data from practicing physicians and nonphysicians without cardiovascular disease aged 40 to 75 years in Ontario, Canada. Cohorts were assembled beginning January 1, 2008, and were followed up to December 31, 2015. Data analysis was performed between November 2017 and September 2019. Exposure: Being a practicing physician. Main Outcomes and Measures: The primary outcome was 8-year incidence of a major cardiovascular event (ie, cardiovascular death or hospitalization for myocardial infarction, stroke, heart failure, or coronary revascularization). Secondary outcomes included health services used, such as physician assessments and guideline-recommended tests. Results: The cohort comprised 17 071 physicians (mean [SD] age, 53.3 [8.8] years; 11 963 [70.1%] men) and 5 306 038 nonphysicians (mean [SD] age, 53.7 [9.5] years; 2 556 044 [48.2%] men). Physicians had significantly lower baseline rates of hypertension (16.9% vs 29.6%), diabetes (5.0% vs 11.3%), and smoking (13.1% vs 21.6%), while having better cholesterol profiles (total cholesterol levels >240 mg/dL, 13.3% vs 16.5%; low-density lipoprotein cholesterol >130 mg/dL, 33.2% vs 36.8%); age- and sex-adjusted differences were even larger. Physicians also had lower rates of periodic health examinations (58.9% [95% CI, 57.5%-60.4%] vs 67.9% [95% CI, 67.8%-67.9%]), hyperlipidemia screening (76.3% [95% CI, 74.7%-78.0%] vs 83.8% [95% CI, 83.7%-83.9%]), and diabetes screening (79.0% [95% CI, 77.3%-80.8%] vs 85.3% [95% CI, 85.2%-85.4%]), but higher rates of cardiologist consultations (25.2% [95% CI, 24.2%-26.3%] vs 19.5% [95% CI, 19.4%-19.5%]). The 8-year age- and sex-standardized primary outcome incidence was 4.4 major cardiovascular events per 1000 person-years for physicians and 7.1 major cardiovascular events per 1000 person-years for the general population. After adjusting for age, sex, socioeconomic status, and cardiac risks and comorbidities, physicians had a 22% lower hazard (hazard ratio, 0.78; 95% CI, 0.72-0.85) of experiencing the primary outcome compared with the general population. Conclusions and Relevance: Practicing physicians in Ontario had fewer cardiovascular risk factors, underwent less preventive testing, and were less likely to experience major adverse cardiovascular outcomes than the general population.

Peer- and Mentor-Enhanced Web-Based Training on Substance Use Disorders: A Promising Approach in Low-Resource Settings.

Stigma and insufficient training contribute significantly to the substance use disorder pandemic. This 2014 study assessed the impact in Kenya of online competency-based courses on peer and mentor interactions, using NextGenU.org, the world's only portal to free and accredited higher education. A total of 99 health care workers participated in one of two courses. Completers (50% of those who logged in) reported significant increases in knowledge about substance use disorders and decreases in stigma. Most (92%) stated that they preferred the NextGenU.org courses over classroom courses. All respondents were very confident that they gained useful knowledge and skills and would recommend the courses to peers. Learners' improvements in knowledge, skills, and stigma-related attitudes were comparable to those seen in "gold-standard," contact-intensive, and costly educational models. Free, accredited, easily scalable, clinically interactive, Web-based training courses can teach knowledge and skills while reducing stigma, even in low-resource settings.

Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey.

PURPOSE: To provide national data on Canadian medical students' mental health and show how their mental health compares with that of similarly aged postsecondary graduates from the general population. METHOD: In 2015-2016, the authors conducted a survey of medical students in all years of study at all 17 Canadian medical schools. The surveys included validated items and instruments to assess for psychological distress, suicidal ideation, and diagnosed mood and anxiety disorders. Comparative analyses were performed between medical students and similarly aged postsecondary graduates using data from the Canadian Community Health Survey-Mental Health 2012. RESULTS: The participation rate across all medical students was 40.2% (4,613/11,469). Relative to the general population of postsecondary graduates aged 20-34, medical students aged 20-34 had significantly higher rates of diagnosed mood disorders, diagnosed anxiety disorders, suicidal ideation, and psychological distress. Among medical students, being female was associated with having a mood or anxiety disorder, lifetime suicidal ideation, moderate or severe psychological distress, and higher mean Kessler Psychological Distress Scale 6-item summative scores. Being in clinical training was associated with having suicidal ideation, moderate or severe psychological distress, and mood and anxiety disorders. CONCLUSIONS: Compared with postsecondary graduates from the general population, medical student respondents had significantly higher rates of psychological distress, suicidal ideation, and mood and anxiety disorders. Further research is needed to understand the factors that are contributing to these higher rates.

What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement.

OBJECTIVE: Physician wellness (well-being) is recognized for its intrinsic importance and impact on patient care, but it is a construct that lacks conceptual clarity. The authors conducted a systematic review to characterize the conceptualization of physician wellness in the literature by synthesizing definitions and measures used to operationalize the construct. METHODS: A total of 3057 references identified from PubMed, Web of Science, and a manual reference check were reviewed for studies that quantitatively assessed the "wellness" or "well-being" of physicians. Definitions of physician wellness were thematically synthesized. Measures of physician wellness were classified based on their dimensional, contextual, and valence attributes, and changes in the operationalization of physician wellness were assessed over time (1989-2015). RESULTS: Only 14% of included papers (11/78) explicitly defined physician wellness. At least one measure of mental, social, physical, and integrated well-being was present in 89, 50, 49, and 37% of papers, respectively. The number of papers operationalizing physician wellness using integrated, general-life well-being measures (e.g., meaning in life) increased [X 2 = 5.08, p = 0.02] over time. Changes in measurement across mental, physical, and social domains remained stable over time. CONCLUSIONS: Conceptualizations of physician wellness varied widely, with greatest emphasis on negative moods/emotions (e.g., burnout). Clarity and consensus regarding the conceptual definition of physician wellness is needed to advance the development of valid and reliable physician wellness measures, improve the consistency by which the construct is operationalized, and increase comparability of findings across studies. To guide future physician wellness assessments and interventions, the authors propose a holistic definition.

Factors for and against establishing and working in private practice correlated with work-related behavior and experience patterns of Ferman physicians in Schleswig-Holstein: A 2-year longitudinal study.

OBJECTIVES: To identify factors in favor of or against establishing and working in private practice, to determine the quality of life and work-related behavior and experience patterns of German physicians working in private practice, and to analyze the correlation of those factors. MATERIAL AND METHODS: A representative sample of physicians in private practice in Schleswig-Holstein, Germany, was surveyed according to a 2-year longitudinal design (T1 - 2008, N = 549 and T2 - 2010, N = 414). The study included 22 items regarding the attractiveness of establishing and working in private practice, and the questionnaires: the Short Form-12 Health Survey (SF-12), and Work-related Behavior and Experience Pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster - AVEM). RESULTS: Job satisfaction among those private practitioners decreased over time but their willingness to choose the profession once again remained unchanged. Patient care and the continuity of physician-patient relationship encouraged establishing and working in private practice; state regulation, financial risk, and administrative effort weighed against it. At both T1 and T2, physicians scored significantly lower for mental health than general population. About 20% of physicians showed a healthy behavior and experience pattern but 40% of them showed the pattern of reduced working motivation. About 20% of participants were at elevated risk for overexertion and for burnout. Physical and mental health as well as the total distribution of patterns did not change significantly during the 2-year observation period. Physicians at higher burnout risk rated tasks related to patient care considerably less positively than those with healthy pattern. CONCLUSIONS: In order to improve job satisfaction and quality of life, and to make private practice more attractive, those German physicians require a) improved legislation, b) educational programs that promote the attractiveness of private practice, and c) highly accessible counseling services for the prevention and treatment of stress, overexertion, and burnout. Int J Occup Med Environ Health 2017;30(3):485-498.

FACTORS INFLUENCING LAY AND PROFESSIONAL HEALTH WORKERS' SELF-EFFICACY IN IDENTIFICATION AND INTERVENTION FOR ALCOHOL, TOBACCO, AND OTHER SUBSTANCE USE DISORDERS IN KENYA.

The global burden of substance use disorders (SUDs), including alcohol and tobacco, disproportionately affect low- and middle-income countries (LMICs), considering their rising disease burden and low service capacity. Nested within a Kenyan training program, this study explores factors associated with healthcare providers' self-efficacy to treat SUD. Surveys of 206 healthcare workers were used to perform regression and sensitivity analysis assessing various factors association with self-efficacy. Self-efficacy for SUD was lower in those practicing in public facilities and perceiving a need for alcohol use disorder (AUD) training; while higher self-efficacy correlated with a higher proportion of patients with AUD in one's setting, access to mental health worker support, cannabis use at a moderate risk level, and belief that AUD is manageable in outpatient settings. Increasing awareness about SUD prevalence, identification, and treatment skills could improve the self-efficacy of LMICs' health care providers and therefore the willingness to implement more services for patients with SUDs.

NextGenU.org's Free, Globally Available Online Training in Lifestyle Medicine.

NextGenU.org now uniquely offers a free, accredited, globally-available online training in Lifestyle Medicine. Courses such as Lifestyle Medicine for Primary Care Physicians, Prevention and Treatment of Alcohol Use Disorders/Tobacco Use, Substance Use Disorder Screening, Public Health Nutrition, and more are competency-based and include knowledge transfer, a web-based global peer community of practice, and local, skills-based mentorships. Trainings use existing, expert-created resources from governments, universities, and medical specialty societies thus ensuring their quality and simultaneously making them free of costs, advertisement, and geographic barriers. To offer free credits for these courses, NextGenU.org partners with universities and professional societies. NextGenU.org's comprehensive Lifestyle Medicine Curriculum will launch in early 2017.

A test of the first course (Emergency Medicine) that is globally available for credit and for free.

BACKGROUND: The WHO has called for the use of computer-aided education to train millions of additional health providers. We herein address this appeal with the first globally available, free, accredited, computer-aided, and peer and mentor-guided course. METHODS: The intervention studied was NextGenU.org's first course, "Emergency Medicine (EM) for Senior Medical Students", required for the graduating Classes of 2013 at the University of Missouri (UM) and the U.S. Uniformed Services University of the Health Sciences (USUHS). Control groups were the Class of 2012 at USUHS, and students nationally in the Class of 2013. RESULTS: As of July 2016, there were over 4,000 registered "NextGenUsers" in 145 countries. USUHS NextGenUsers (n=167) averaged 80.3% vs. USUHS control students' 80.9% (n=163, p=0.4) on the Society of Academic EM (SAEM) exam, vs. 71.4% nationally (n=415, p<0·0001). UM NextGenUsers (n=35) averaged 71.2% on the SAEM exam vs. 71.4% nationally (n=415, p=0.8). Both EM Clerkship Directors reported good student satisfaction with these asynchronous, competency-based, site-agnostic readings. CONCLUSIONS: This novel model of a free, accredited course is becoming widely used, and has performed as well as some of the world's most-resourced courses.