A clustered-randomized controlled trial of a self-reflection resilience-strengthening intervention and novel mediators.

This study tests the efficacy of a unique resilience-strengthening intervention using a clustered-randomized controlled trial. It was hypothesized that the training, which encourages adaptive self-reflection on stressor events and the effectiveness of coping strategies and resources, would exert a positive effect on mental health outcomes via increased reflection and decreased brooding. The trial was conducted during a significant stressor period with a final sample of 204 second-class Officer Cadets from the Royal Military College, Australia. Platoons of Cadets were randomly allocated to either Self-Reflection Resilience Training (SRT; n = 96) or an exposure-matched active control group that received training as usual (i.e., cognitive-behavioral skill development training) and communication skills seminars (n = 108). Compared to the active control group, SRT was more effective at preventing the onset of depression symptoms and promoting stable levels of perceived stress during a period of increased exposure to training stressors, consistent with a resilient trajectory. The Self-Reflection group unexpectedly demonstrated higher anxiety symptoms than the Control group at immediate follow-up, but these symptoms returned to baseline levels at longer term follow-up. In contrast, the Control group experienced increasing anxiety symptoms between immediate and longer term follow-up. Mediation analyses supported an indirect effect of SRT on all three outcome measures via brooding, but not via reflection. This study provides support for the capacity of a practical, sustainable, and scalable intervention based on self-reflection to strengthen resilience in the military training setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The change from UMAT to UCAT for undergraduate medical school applicants: impact on selection outcomes.

OBJECTIVES: To assess whether the change from the Undergraduate Medical and Health Sciences Admissions Test (UMAT; 1991-2019) to the University Clinical Aptitude Test (UCAT) for the 2020 New South Wales undergraduate medical degree intake was associated with changes in the impact of sex, socio-economic status and remoteness of residence, and professional coaching upon selection for interview. DESIGN, SETTING, PARTICIPANTS: Cross-sectional study of applicants for the three NSW undergraduate medical programs for entry in 2019 (4114 applicants) or 2020 (4270); 703 people applied for both intakes. Applicants selected for interview were surveyed about whether they had received professional coaching for the selection test. MAIN OUTCOME MEASURES: Scores on the three sections of the UMAT (2019 entry cohort) and the five subtests of the UCAT (2020 entry); total UMAT and UCAT scores. RESULTS: Mean scores for UMAT 1 and 3 and for all four UCAT cognitive subtests were higher for men than women; the differences were statistically significant after adjusting for age, socio-economic status, and remoteness. The effect size for sex was 0.24 (95% CI, 0.18-0.30) for UMAT total score, 0.38 (95% CI, 0.32-0.44) for UCAT total score. For the 2020 intake, 2303 of 4270 applicants (53.9%) and 476 of 1074 interviewees (44.3%) were women. The effect size for socio-economic status was 0.47 (95% CI, 0.39-0.54) for UMAT, 0.43 (95% CI, 0.35-0.50) for UCAT total score; the effect size for remoteness was 0.54 (95% CI, 0.45-0.63) for UMAT, 0.48 (95% CI, 0.39-0.58) for UCAT total score. The impact of professional coaching on UCAT performance was not statistically significant among those accepted for interview. CONCLUSIONS: Women and people from areas outside major cities or of lower socio-economic status perform less well on the UCAT than other applicants. Reviewing the test and applicant quotas may be needed to achieve selection equity.

Strengthening resilience in over 50's: a nested clustered-randomized controlled trial of adaptive systematic self-reflection.

Background and objectives: This study investigated the efficacy of guided self-reflection to strengthen resilience in adults over 50 by exploring the effects of the training on mental health and positive emotional outcomes. Design: A nested clustered-randomized controlled trial was conducted to test the efficacy of the training. Measures occurred at pre-intervention, post-intervention, and at four to five months follow-up. Method: Two samples of participants were recruited. First, older employees from a consumer goods company took part in the clustered-randomized controlled trial. Ninety-three employees (mean age = 54.02 years; 36.56% females) were assigned to the intervention (n = 52) or active control (n = 41) group. Second, older adults from the community (n = 51) were recruited (mean age = 58.63 years; 80.40% female) and assigned to the intervention only. Results: Improvements were observed in the community sample, compared to the active control group, across a range of wellbeing outcomes. When training engagement was used as a moderator, positive benefits for the corporate intervention group emerged for highly engaged participants. Mediation analyses indicated that stress-as-enhancing mindset, stressor benefit, and coping self-efficacy acted as possible mechanisms for change in primary outcomes. Conclusions: Findings provide support for the use of guided self-reflection for resilience training with older adults.

Elicitation interview study to identify salient beliefs about exercise participation in adults with cystic fibrosis.

OBJECTIVES: Conduct an elicitation study, using the Theory of Planned Behaviour framework, to identify salient beliefs about exercise participation in adults with cystic fibrosis (CF). Specifically, identify attitudes on advantages and disadvantages of exercise (behavioural beliefs); individuals and groups who apply social pressure to exercise (normative beliefs); and perceived control over facilitators and barriers to exercise (control beliefs) for adults with CF. DESIGN: Qualitative interviews using open-ended, structured questions. SETTING: Adult CF clinic in a large Australian hospital. PARTICIPANTS: Sixteen adults with CF, three relatives/friends of adults with CF and six CF clinic staff. RESULTS: The most common positive attitudes about exercise were to keep fit and healthy (68%) and feel better and happier (60%), and negative attitude was to feel breathless (36%). Social pressure to exercise mainly came from parents/family (72%) and friends (52%), and 60% of participants reported that no-one discourages exercise. Having someone to exercise with (44%) and be encouraged (36%) were the most common facilitators of perceived control to exercise, whereas being unwell (96%) and not having sufficient time (56%) were the most common barriers. CONCLUSIONS: Attitudes, social pressure and perceived control to exercise for adults with CF were similar to beliefs previously reported by the general population and some patient groups. A number of CF-specific exercise beliefs, mainly related to pulmonary function, were also reported. These findings can help develop questionnaires for larger groups of adults with CF, interpret relationships between exercise beliefs and participation, and inform clinicians to target interventions to increase exercise participation.

A review of the factors related to burnout at the early-career stage of medicine.

Background: Globally, burnout is an increasingly prevalent problem amongst young medical professionals. This review aims to understand the factors related to burnout in the early-career stage of medicine. Drawing on the widely used Job Demands-Resources Model, the antecedents of burnout were distinguished from its outcomes.Methods: The review adopted the PRISMA guidelines. Using specific search terms, peer-reviewed articles were obtained from a range of databases and assessed against selection criteria. To meet inclusion requirements, the study had to be published between 2000 and 2018, include a validated measure of burnout, and undertake empirical assessment of factors related to burnout in medical students and/or junior medical officers/residents. Additional studies were obtained and reviewed from the reference lists of selected articles.Results: Out of the 3796 studies that were initially found, 585 were assessed against the eligibility criteria leaving 113 studies for review. These studies highlighted the negative consequences of burnout in the early medical career. Also identified were work-specific and person-specific demands that likely lead to burnout and, work and person resources that appear to reduce burnout.Conclusion: This review provides a framework to explain the growing problem of burnout amongst early-career medical professionals. However, further research is necessary to overcome the current reliance on cross-sectional designs and small sample sizes.

Parental career expectations: effect on medical students' career attitudes over time.

BACKGROUND: Motivation to become a doctor has typically been conceived as arising from personal interests. However, it is not uncommon, particularly amongst those from collectivist cultures, for career choice to be motivated by a desire or need to fulfil parent expectations. Whether or not this motivation has longer term effects on the career satisfaction and performance of medical students is unknown. METHODS: Using three waves of survey data collection, applicants to medical school (n = 370) reported parent career expectations, parent career support and physician career values. Those who gained a student place (n = 90) reported attitudes to their career at the end of their first year of study. Burnout and intentions regarding practice location were assessed during the fifth and final year of study (n = 81). Examination marks in Years 1 and 5 assessed academic performance. RESULTS: Those with more highly educated parents reported more support, but parent support had no relationship with students' academic performance or attitudes to their career. Perceived parent career expectation was higher amongst younger applicants and those from a non-Western background. Expectations had a small positive correlation with applicants' valuing of prestige and a small negative correlation with valuing service. Medical students with high parent expectation at selection had, a year later, more negative attitudes to medicine as a career. Parent expectation had a significant indirect effect on Year-5 burnout. Higher parent expectation was related to lower Year-5 academic grades, but after Year-1 grades were accounted for, this relationship was no longer significant. CONCLUSIONS: Medical students who perceive that their parents expect them to choose a prestigious career in line with family or cultural values may be more ambivalent about their career choice once in medical school. They may also be more likely to experience longer term burnout but there was little evidence that they might have lower academic performance.

The Potential Role of Context-Related Exposure in Explaining Differences in Water Safety Cue Utilization.

OBJECTIVE: To examine whether differences in water safety-related cue utilization might be associated with differences in exposure to water-related recreational contexts. BACKGROUND: A disproportionate number of incidents of drowning were attributable to recent visitors to New South Wales in the 2016-2017 summer swimming season. This was due to their assumed lack of exposure to the water-related recreational settings in which Australians engage and therefore, the absence of cues that are associated with danger. METHOD: In Study 1, the water safety cue utilization of 101 Australian residents and 328 recent visitors to the country was compared using the Expert Intensive Skills Evaluation (EXPERTise 2.0) program. Accounting for differences between the samples, Australian residents demonstrated significantly superior water safety cue utilization. In Study 2, the water safety cue utilization of a sample of 219 Australian residents was examined, the outcomes of which indicated that those participants who learned to swim before the age of 11 years demonstrated superior water safety cue utilization to participants who learned to swim at a later age. RESULTS: Overall, the results suggest that there are individual differences in water safety cue utilization that are explained, in part, by differences in country of residence and the age at which participants first learned to swim. CONCLUSION: Water safety cue utilization is likely to be dependent upon exposure to water-related activities. Identifying individual differences enables the development of more targeted, drowning-prevention strategies.

Retest effects in medical selection interviews.

CONTEXT: Repetition of a cognitive ability test is known to increase scores, but almost no research has examined whether similar improvement occurs with repetition of interviews. Retest effects can change the rank order of candidates and reduce the test's criterion validity. Because interviews are widely used to select medical students and postgraduate trainees, and because applicants apply to multiple programmes and often reapply if unsuccessful, the potential for retest effects needs to be understood. OBJECTIVES: This study was designed to identify if retest improvements occur when candidates undertake multiple interviews and, if so, whether the effect is attributable to general interview experience or specific experience and whether repeat testing affects criterion validity. METHODS: We compared interview scores of applicants who were interviewed for one or more of three independent undergraduate medical programmes in two consecutive years and those who were interviewed in both years for the same programme. Correlations between initial and repeat interview scores and a written test of social understanding were compared. RESULTS: General experience (being interviewed by multiple programmes) did not produce improvement in subsequent interview performance. There was no evidence of method effect (having prior experience of the multiple mini-interview process). Specific experience (being interviewed by the same programme across 2 years) resulted in a significant improvement in scores for which regression to the mean did not fully account. Criterion validity did not appear to be affected. CONCLUSIONS: Unsuccessful candidates for medical school who reapply and are re-interviewed on a subsequent occasion at the same institution are likely to increase their scores. The results of this study suggest the increase is probably not attributable to improved ability.

Applicants to medical school: if at first they don't succeed, who tries again and are they successful?

This study compared the profile of those who, after initial failure to be selected, choose to reapply to study medicine with those who did not reapply. It also evaluates the chance of a successful outcome for re-applicants. In 2013, 4007 applicants to undergraduate medical schools in the largest state in Australia were unsuccessful. Those who chose to reapply (n = 665) were compared to those who did not reapply (n = 3342). Results showed that the odds of re-applying to medicine were 55% less for those from rural areas, and 39% more for those from academically-selective schools. Those who had higher cognitive ability and high school academic performance scores in 2013 were also more likely to re-apply. Socioeconomic status was not related to re-application choice. Re-applicants' showed significant improvements in selection test scores and had a 34% greater probability of selection than first-time applicants who were also interviewed in the same selection round. The findings of this study indicate that re-testing and re-application improves one's chance of selection into an undergraduate medical degree, but may further reduce the diversity of medical student cohorts in terms of rural background and educational background.

Multiple mini interviews: revealing similarities across institutions.

BACKGROUND: Across the globe multiple mini interviews (MMIs) have rapidly replaced the use of panel interviews in the selection of medical students and other health professionals. MMIs typically demonstrate better reliability and validity than panel interviews but there is limited research on whether these different types of interview process measure the same or different constructs. Our research aims to ascertain if MMIs are multidimensional or unidimensional, and whether MMIs conducted at different institutions assess the same or different constructs to each other or to panel interviews. METHODS: Participants were applicants to medical degrees who were shortlisted for interviews at three different institutions in 2013 (n = 165) and 2014 (n = 128). Two institutions used a bespoke MMI developed independently from each other and the third used a panel interview. Stations scores and overall (mean) interview scores were examined. RESULTS: Exploratory principal components analysis and confirmatory factor analysis showed similar results in both years' data, supporting a unidimensional model. The two overall MMI scores were more strongly correlated to each other (r = .56 and .64 in 2013 and 2014 respectively) than either were to the panel interview scores (r = .07 and .15 in 2013; .39 and .48 in 2014). CONCLUSIONS: It appears that both MMIs panel interviews tap a single latent construct, but not the same construct. We suggest that the MMI methodology might allow the measurement of an emergent construct such as adaptability.

Operators who readily acquire patterns and cues, risk being miscued in routinized settings.

The detection of critical cues is a hallmark of expert performance, and in high-risk settings, it can prevent serious incidents. A sensitivity to cues and a proclivity to rapidly acquire patterns during routinized tasks, however, can miscue performance when these patterns change. In the present study, 75 university students undertook an assessment of cue utilization and engaged in a 24-min rail control simulation. The rail control task involved monitoring with periodic interventions to reroute trains, according to a train-track matching rule. A hidden pattern in the sequencing of trains presented an opportunity to predict train movements and reduce the workload. This pattern was programmed to abruptly change 3 times during the rail task. Based on the response latency performance of participants and their detection of the rail task pattern (verbal descriptions), the results suggested that individuals who are sensitive to cues and who also detect patterns of dynamic stimuli (following limited exposure) experience a relatively greater risk of misapplying rules or misdiagnosing situations in routinized environments when stimuli change. Following a temporary decline in performance, however, if there are continued pattern changes, the performance of these individuals will remain unaffected. The implications are discussed for training and system design. (PsycINFO Database Record

Predicting patterns of change and stability in student performance across a medical degree.

CONTEXT: Evidence of predictive validity is essential for making robust selection decisions in high-stakes contexts such as medical student selection. Currently available evidence is limited to the prediction of academic performance at single points in time with little understanding of the factors that might undermine the predictive validity of tests of academic and non-academic qualities considered important for success. This study addressed these issues by predicting students' changing performance across a medical degree and assessing whether factors outside an institution's control (such as the uptake of commercial coaching) impact validity. METHODS: Three cohorts of students (n = 301) enrolled in an undergraduate medical degree from 2007-2013 were used to identify trajectories of student academic performance using growth mixture modelling. Multinomial logistic regression assessed whether past academic performance, a test of cognitive ability and a multiple mini-interview could predict a student's likely trajectory and whether this predictive validity was different for those who undertook commercial coaching compared with those who didn't. RESULTS: Among the medical students who successfully graduated (n = 268), four unique trajectories of academic performance were identified. In three trajectories, performance changed at the time when learning became more self-directed and focused on clinical specialties. Scores on all selection tests, with the exception of a test of abstract reasoning, significantly affected the odds of following a trajectory that was consistently below average. However, selection tests could not distinguish those whose performance improved across time from those whose performance declined after an average start. Commercial coaching increased the odds of being among the below-average performers, but did not alter the predictive validity of the selection tests. CONCLUSION: Identifying distinct groups of students has important implications for selection, but also for educating medical students. Commercial coaching may result in selecting students who are less suited for coping with the rigours of medical studies.

Opening Editorial: Selection and Recruitment in Medical Education.

This article was migrated. The article was marked as recommended. There is over a century of research on selection and recruitment and the field has both developed and expanded significantly over this time. Previous research has tended to focus on reviewing the effectiveness of selection methods (academic records, references, personal statements, aptitude tests, personality assessments, situational judgement tests, and interviews), where good quality evidence is now emerging. Many challenges remain however, reflecting that selection and recruitment into medical education (both undergraduate and postgraduate) is a complex, multi-dimensional, dynamic phenomenon. For example, issues regarding diversity and fairness in selection have been researched over many years but there remains a huge gap between the research evidence and policy enactment in many parts of the globe. In this opening editorial for our special issue on selection and recruitment in medical education we encourage authors to consider six key question areas (amongst others), including: •how will technology (e.g. social media, big data, artificial intelligence, etc) influence selection research and practices in future?•should selection criteria be reviewed to include creativity, innovation, resilience and adaptability (beyond heavy reliance on prior academic attainment as the main criterion)?•is selection for medical education fair? How do we address issues regarding widening participation and diversity in practice?•to what extent do political, cultural and social factors influence selection philosophy and policies internationally?•what are the risks to effective selection (e.g. access to coaching, legal challenge of poor practices) and,•a new Ottawa consensus on selection and recruitment has been published - to what extent does this statement reflect your experiences of designing and implementing selection systems in your locality? In contributing to the debate, this special issue provides a platform for authors to present the latest research, empirical studies, systematic reviews, reflections, case studies and practical tips on current/future issues in selection and recruitment in medical education.

Closing Editorial: New insights and reflections on the science of selection and recruitment.

This article was migrated. The article was marked as recommended. In this closing editorial we reflect on key topics presented in this special issue on selection and recruitment, with a view to identifying gaps in the literature, and exploring where next. Four key themes have emerged including; (1) the impact of using new technologies in selection and recruitment; (2) addressing social accountability, diversity and fairness issues in selection; (3) increased emphasis on non-academic personal attributes in selection, and (4) attraction and recruitment in postgraduate recruitment. The implications of findings from this collection of studies and opinion pieces are discussed in relation to future research, policy and practice.

The role of cue utilisation in reducing the workload in a train control task.

Skilled performance has been characterised, in part, by the capacity to accurately identify and respond to patterns as cues in the environment. The outcome is a reduction in cognitive load and a greater residual capacity to undertake concurrent tasks. The present study was designed to examine the relationship between cue utilisation and temporal pattern recognition in the context of a simulated, rail control task. Sixty-one university students undertook an assessment of cue utilisation and engaged in a rail control simulation. The appearance and movement of trains followed a consistent but implicit (undisclosed) pattern. Throughout the second half of the rail task, a secondary task was included. The results indicated that participants with relatively higher cue utilisation were more likely to identify the implicit pattern of rail movements, were more accurate and responded more rapidly under increased workload conditions. The results suggest that a propensity to identify patterns as cues may provide an opportunity to reduce cognitive demands, thereby facilitating performance in a novel task. Implications for selection and system design are discussed. Practitioner Summary: This study was designed to explain differences in the way in which people learn, particularly when tasks involve recurring patterns. Using simulated rail control, the results indicated that participants who display behaviour that is indicative of the utilisation of cues also recognise patterns in the movement of simulated trains. This enables them to manage trains more effectively, even while undertaking other tasks.

Thank goodness it's Friday: weekly pattern of workplace incivility.

BACKGROUND AND OBJECTIVES: Recent research has shown day-level differences in an individual's experience of uncivil behavior; however, it is unknown if that experience follows a consistent weekly change pattern. This study extends incivility theory and research by applying latent growth curve (LGC) modeling to diary study data to understand day-to-day changes in incivility. DESIGN: The authors took a theory-driven approach, reviewing both mood and recovery theory that would support a decrease in incivility over the working week. METHODS: Diary survey methodology was used, with a morning and evening survey completed on five consecutive workdays by 171 (73% of the 235 who initially volunteered, 95% of those who completed any surveys) employees in the legal industry. LGC analysis was used to identify patterns of experienced incivility, mood (both measured after work), and recovery (assessed the following morning). RESULTS: Regardless of job demands and gender, a weekly pattern was identified with the likelihood of experiencing incivility (coded as 0 = none, 1 = some) decreasing from Monday to Friday by .78 each day (p < .001) in a relatively linear fashion with a slope factor of .34 (SE = 0.23; p > .05), indicating invariance between individuals. This weekly pattern was not explained by changes in mood or recovery. CONCLUSIONS: Results emphasize the impact of contextual factors such as time on workplace incivility and the need to consider weekly rhythms of other behaviors that are likely to affect employee well-being and productivity. Although limited to one week of data per person, the findings are likely to be relevant to studies of other forms of interpersonal mistreatment, such as social undermining and interpersonal conflict.

Who do you think you are? Medical student socioeconomic status and intention to work in underserved areas.

A frequently cited rationale for increasing the participation of students from low socioeconomic status (SES) backgrounds is that it will create a workforce who will choose to work in low SES and medically underserviced communities. Two theoretical arguments, one that supports and one that contradicts this assumption, are proposed to explain the practice location intentions of medical students which we examine in a longitudinal analysis. SES background and future intentions of 351 applicants to an undergraduate medical degree were assessed at Time 1, with intentions re-assessed one year later for 96% of those who were enrolled as medical students. Students from very low (and very high) SES backgrounds indicated lower intention to practice in low SES or medically underserviced areas than those from mid-range SES backgrounds. Males and students from non-English speaking backgrounds indicated less desire to work in low SES areas, perhaps explained by high aspirational motivation. SES accounted for a relatively small amount of variance in practice intentions. Alternate predictors of practice location, including individual values and training effects, and their implications for selection practice, are discussed.

Cue Utilization and Cognitive Load in Novel Task Performance.

This study was designed to examine whether differences in cue utilization were associated with differences in performance during a novel, simulated rail control task, and whether these differences reflected a reduction in cognitive load. Two experiments were conducted, the first of which involved the completion of a 20-min rail control simulation that required participants to re-route trains that periodically required a diversion. Participants with a greater level of cue utilization recorded a consistently greater response latency, consistent with a strategy that maintained accuracy, but reduced the demands on cognitive resources. In the second experiment, participants completed the rail task, during which a concurrent, secondary task was introduced. The results revealed an interaction, whereby participants with lesser levels of cue utilization recorded an increase in response latency that exceeded the response latency recorded for participants with greater levels of cue utilization. The relative consistency of response latencies for participants with greater levels of cue utilization, across all blocks, despite the imposition of a secondary task, suggested that those participants with greater levels of cue utilization had adopted a strategy that was effectively minimizing the impact of additional sources of cognitive load on their performance.