Assessment of medical student burnout: toward an implicit measure to address current issues.

The feasibility of implicitly assessing medical student burnout was explored, using the Implicit Relational Assessment Procedure (IRAP), to measure longitudinal student burnout over the first two years of medical school and directly comparing it with an existing explicit measure of burnout (Maslach Burnout Inventory; MBI). Three successive cohorts of medical students completed both implicit and explicit measures of burnout at several time points during their first two years of medical school. Both assessments were conducted via the internet within a one-week period during the first week of medical school, the end of the first year of medical school, and the end of the second year, though not all cohorts were able to complete the assessments at all time points. Mixed linear models were used to compare the two measures directly, as well as to evaluate changes over time in each measure separately. Minimal correspondence was observed between the implicit and explicit measures of burnout on a within-subject basis. However, when analyzed separately, all subscales of both measures detected significant change over time in the direction of greater levels of burnout, particularly during the first year of medical school. These results provide preliminary evidence the IRAP is able to assess implicit attitudes related to burnout among medical students, though additional research is needed. The IRAP detected consistent improvements in positive implicit attitudes toward medical training during students' second year of medical school, which was not detected by the MBI. Possible implications of these findings are discussed.

The Microaggressions Triangle Model: A Humanistic Approach to Navigating Microaggressions in Health Professions Schools.

Microaggressions are types of interactions that create a cognitive load that can impede a health professions student's ability to perform well in their program. This paper discusses the Microaggressions Triangle Model, which is a framework for understanding microaggressions from a human interaction standpoint. At each point in the model, the authors provide approaches designed to help recipients, sources, and bystanders construct responses that may allow for rebuilding. From a restorative justice standpoint, rebuilding gives all people involved the opportunity to restore their reputations and repair relationships. Rebuilding is about individuals and communities acknowledging and learning from the interaction as a way to promote a climate of inclusion in their organization.

A deeper look at implicit weight bias in medical students.

The Implicit Relational Assessment Procedure (IRAP, Barnes-Holmes et al. in Psychol Rec 60:527-542, 2010) was utilized as a relatively new tool to measure implicit weight bias in first- and third-year medical students. To date, only two studies (Miller et al. in Acad Med 88:978-982, 2013; Phelan et al. in Med Educ 49:983-992, 2015) have investigated implicit weight bias with medical students and both have found pro-thin/anti-fat implicit attitudes, on average, using the Implicit Association Test (IAT, Greenwald and Banaji in Psychol Rev 102:4-27, 1995) as the assessment tool. The IRAP, however, allows for a deeper analysis of implicit attitudes with respect to both thin and fat in isolation, and it was found that medical students are, on average, actually both pro-thin and pro-fat, and on average are more pro-thin than pro-fat, as opposed to anti-fat. Additionally, it was found that medical students' implicit weight bias against fat/obese individuals improved over the first 2 years of medical training, and this improvement was specifically driven by improved implicit attitudes toward overweight and obese, while implicit attitudes toward thin remained constant over that time. The implications of more sensitive implicit bias assessment and specific changes in bias over time are discussed within the context of medical education curriculum development.

Web-based treatment for infertility-related psychological distress.

Infertility has been associated with stigma and negative psychosocial functioning. However, only a small proportion of this population actually receives care. Fertility patients predominantly use the Internet for information gathering, social support, and assistance with decision-making; yet, available web resources are unreliable sources of mental health care. Web-based alternatives also have the potential to assist with intervention access difficulties and may be of significant lower cost. This study evaluated the efficacy of a web-based approach to providing a cognitive behavioral intervention with 31 infertile women seeking medical reproductive technologies. Following randomized assignment, participants using the web-based intervention were compared with those in a wait-list control condition on general and infertility-related psychological stress measures. Results were mixed regarding intervention efficacy. Significant declines in general stress were evidenced in the experimental group compared with a wait-list control group. However, website access did not result in statistically significant improvements on a measure of infertility-specific stress. These findings add to the literature on psychological interventions for women experiencing fertility problems. Moreover, despite the widespread use of the Internet by this population, the present study is one of the first to investigate the usefulness of the Internet to attenuate stress in this population. Preliminary results suggest general stress may be significantly reduced in infertile women using an online cognitive behavioral approach.