Medical Student Reactions to Disaster after the 2011 Great East Japan Earthquake: Motivation and Posttraumatic Growth.

Medical students often become involved as post-disaster emergency responders despite incomplete training, and in doing so may suppress their immediate experiences as victims and survivors. This experience, however, may lead them to increase their motivation to help others. We examined how cognitive and emotional reactions to disaster correlated with posttraumatic growth (PTG) in medical students in Fukushima, Japan after the Great East Japan Earthquake of March 11, 2011. To date, Fukushima continues to suffer from radiation concerns following the nuclear power plant meltdown. In a survey three years after the onset of a long-term disaster, with a cross-sectional research design, medical students (N = 494) reported their negative post-disaster reactions, desire to help, and demonstrations of capability, and completed the Posttraumatic Growth Inventory (PTGI). We conducted hierarchical regression analyses and found that the addition of variables pertaining to negative post-disaster reactions (e.g. confusion, anger, and sadness) led to the largest increase in predictive value for PTGI scores; students reporting a past traumatic experience were also more likely to experience PTG. Our results indicate that weathering stressful disaster circumstances created opportunities for positive personal growth and reinforcement at a crucial time in medical students' professional development.

Post-traumatic Stress and Growth Among Medical Student Volunteers After the March 2011 Disaster in Fukushima, Japan: Implications for Student Involvement with Future Disasters.

The March 2011 "triple disaster" (earthquake, tsunami, and nuclear accident) had a profound effect on northern Japan. Many medical students at Fukushima Medical University volunteered in the relief effort. We aimed to investigate the nature of students' post-disaster involvement and examine the psychological impact of their experiences using a survey containing elements from the Davidson Trauma Scale and Posttraumatic Growth Inventory. We collected 494 surveys (70 % response rate), of which 132 students (26.7 %) had volunteered. Volunteers were more likely to be older, have witnessed the disaster in person, had their hometowns affected, and had a family member or close friend injured. In the month after 3/11, volunteers were more likely to want to help, feel capable of helping, and report an increased desire to become a physician. Both in the month after 3/11 and the most recent month before the survey, there were no significant differences in distressing symptoms, such as confusion, anger, or sadness, between volunteers and non-volunteers. Volunteers reported a significantly higher level of posttraumatic growth than non-volunteers. Participating in a greater variety of volunteer activities was associated with a higher level of posttraumatic growth, particularly in the Personal Strength domain. There may be self-selection in some criteria, since students who were likely to be resistant to confusion/anxiety/sadness may have felt more capable of helping and been predisposed to volunteer. However, participation in post-disaster relief efforts did not appear to have a harmful effect on medical students, an important consideration for mobilizing volunteers after future disasters.

The interclerkship ambulatory care track: attributes of a longitudinal integrated clerkship that inspire medical students to pursue careers in primary care and work with underserved.

This article was migrated. The article was marked as recommended. Few longitudinal integrated clerkships (LICs) have increased the proportion of students who choose to go into primary care or work with underserved populations. A mixed-methods questionnaire was developed and sent to alumni (2006-2016) of the Interclerkship Ambulatory Care Tract (InterACT), a third-year clerkship in which students apply evidence-based medicine and chronic care model principles to outpatient longitudinal care. A likert scale was utilized for quantitative questions. Descriptive and thematic analyses were performed on the qualitative responses using a constant comparative approach. A majority (80%; 49/61) responded. Of the 44 physicians who responded to questions about current specialty, 75% indicated pediatrics, family medicine, or internal medicine. The majority of respondents (89%) reported that they care for patients considered to be medically underserved. Alumni overwhelmingly felt that the clerkship impacted the following: their specialty choice (71%, 34/48), and the population of patients they chose to take care of (80%, 39/49). The following attributes emerged from the qualitative questions as key determinants of future decisions regarding specialty and patient population: holistic patient care, strong mentorship, longitudinal patient relationships, and care of the homebound. These key attributes, if implemented in other LICs, may be a means to increase the number of medical students that choose to work in primary care fields and/or with underserved populations.

Predictors of Place of Death of Individuals in a Home-Based Primary and Palliative Care Program.

OBJECTIVES: To investigate factors associated with place of death of individuals in the Mount Sinai Visiting Doctors Program (MSVD). DESIGN: A retrospective chart review was performed of all MSVD participants who died in 2012 to assess predictors of place of death in the last month of life. SETTING: MSVD, a home-based primary and palliative care program in New York. PARTICIPANTS: MSVD participants who were discharged from the program because of death between January 2012 and December 2012 and died at home, in inpatient hospice, or in the hospital (N = 183). MEASUREMENTS: Electronic medical records were reviewed to collect information on demographic characteristics, physician visits, and end-of-life conversations. RESULTS: Of 183 participants, 103 (56%) died at home, approximately twice the national average; 28 (15%) died in inpatient hospice; and 52 (28%) died in the hospital. Bivariate analyses showed that participants who were white, aged 90 and older, non-Medicaid, or had a recorded preference for place of death were more likely to die outside the hospital. Diagnoses and living situation were not significantly associated with place of death. Multivariate logistic regression analysis showed no statistical association between place of death and home visits in the last month of life (odds ratio = 1.21, 95% confidence interval = 0.52-2.77). CONCLUSION: Home-based primary and palliative care results in a high likelihood of nonhospital death, although certain demographic characteristics are strong predictors of death in the hospital. For MSVD participants, home visits in the last month of life were not associated with death outside the hospital.