Einstellungen zu alten Menschen zu Beginn und am Ende des Medizinstudiums

In der vorliegenden Studie wurden 188 Medizinstudenten des ersten und 120 des sechsten Studienjahres der Universität Zürich hinsichtlich ihrer Einstellungen zum Alter, ihrem Wissen zu alterspezifischen Vorgängen, ihren Erfahrungen mit alten Menschen und ihren eigenen Erwartungen an das Alter befragt. Eingesetzt wurden voll strukturierte, standardisierte Fragebögen. Die Auswertung erfolgte mittels uni- und multivariater statistischer Methoden. Die Ergebnisse zeigen, weitgehend unabhängig von Geschlecht und Studienjahr, ein positives Altersbild der Studierenden. Ihre positiven Erfahrungen mit alten Menschen und ihre positiven Erwartungen an das eigene Alter betreffen vor allem die eigene psychische Gesundheit. Für die Vermittlung von gerontologischem und geriatrischem Wissen in der Ausbildung von Medizinstudenten sollte diesen überwiegend positiven Einstellungen gegenüber älteren Menschen Rechnung getragen werden und sowohl auf Risiko- als auch auf protektive Faktoren für die Entstehung und Behandlung alterstypischer gesundheitlicher Störungen hingewiesen werden. = In the present study, 188 first year and 120 sixth year students of the University of Zurich were questioned about their attitudes towards older people, their knowledge concerning aging specific developments, their experiences with older people and their own expectations concerning old age. Structured and standardized questionnaires were used. The data were analyzed using univariate and multivariate statistical methods. The results show a positive image of old age independent of gender and point in time of education. Their positive experiences with older people and their positive expectations concern their own aging refer, above all, to their own mental health. For the transfer of gerontological and geriatric knowledge in the education of medical students, these mainly positive attitudes towards older people should be taken into account. Risk factors as well as protective factors concerning the development and treatment of diseases which are characteristic for old age should be pointed out

Einstellungen zu alten Menschen zu Beginn und am Ende des Medizinstudiums

Zusammenfassung: In der vorliegenden Studie wurden 188 Medizinstudenten des ersten und 120 des sechsten Studienjahres der Universität Zürich hinsichtlich ihrer Einstellungen zum Alter, ihrem Wissen zu alterspezifischen Vorgängen, ihren Erfahrungen mit alten Menschen und ihren eigenen Erwartungen an das Alter befragt. Eingesetzt wurden voll strukturierte, standardisierte Fragebögen. Die Auswertung erfolgte mittels uni- und multivariater statistischer Methoden. Die Ergebnisse zeigen, weitgehend unabhängig von Geschlecht und Studienjahr, ein positives Altersbild der Studierenden. Ihre positiven Erfahrungen mit alten Menschen und ihre positiven Erwartungen an das eigene Alter betreffen vor allem die eigene psychische Gesundheit. Für die Vermittlung von gerontologischem und geriatrischem Wissen in der Ausbildung von Medizinstudenten sollte diesen überwiegend positiven Einstellungen gegenüber älteren Menschen Rechnung getragen werden und sowohl auf Risiko- als auch auf protektive Faktoren für die Entstehung und Behandlung alterstypischer gesundheitlicher Störungen hingewiesen werde

Mentoring programs for medical students - a review of the PubMed literature 2000 - 2008

Abstract Background Although mentoring is acknowledged as a key to successful and satisfying careers in medicine, formal mentoring programs for medical students are lacking in most countries. Within the framework of planning a mentoring program for medical students at Zurich University, an investigation was carried out into what types of programs exist, what the objectives pursued by such programs are, and what effects are reported. Methods A PubMed literature search was conducted for 2000 - 2008 using the following keywords or their combinations: mentoring, mentoring program, medical student, mentor, mentee, protégé, mentorship. Although a total of 438 publications were identified, only 25 papers met the selection criteria for structured programs and student mentoring surveys. Results The mentoring programs reported in 14 papers aim to provide career counseling, develop professionalism, increase students' interest in research, and support them in their personal growth. There are both one-to-one and group mentorships, established in the first two years of medical school and continuing through graduation. The personal student-faculty relationship is important in that it helps students to feel that they are benefiting from individual advice and encourages them to give more thought to their career choices. Other benefits are an increase in research productivity and improved medical school performance in general. Mentored students also rate their overall well-being as higher. - The 11 surveys address the requirements for being an effective mentor as well as a successful mentee. A mentor should empower and encourage the mentee, be a role model, build a professional network, and assist in the mentee's personal development. A mentee should set agendas, follow through, accept criticism, and be able to assess performance and the benefits derived from the mentoring relationship. Conclusion Mentoring is obviously an important career advancement tool for medical students. In Europe, more mentoring programs should be developed, but would need to be rigorously assessed based on evidence of their value in terms of both their impact on the career paths of juniors and their benefit for the mentors. Medical schools could then be monitored with respect to the provision of mentorships as a quality characteristic.</p

"Medikamente sind Bomben" - zum Metapherngebrauch von Lungentransplantations-Patienten mit guter oder ungenügender Compliance

Fragestellung: Nach einer Organtransplantation finden komplexe psychologische Verarbeitungsprozesse statt. In der vorliegenden Studie wurde untersucht, welche Metaphern im Zusammenhang mit Transplantationserfahrungen verwendet werden, und ob Unterschiede zwischen Patienten mit guter bzw. ungenügender Compliance im Gebrauch dieser Metaphern bestehen. Methode: 14 lungentransplantierte Patienten wurden in einem halbstrukturierten Interview zu ihren Transplantationserfahrungen befragt. Ihre Compliance wurde von den behandelnden Ärzten eingeschätzt. Die Auswertung der Interviews erfolgte anhand einer Metaphernanalyse, welche Hinweise auf vor- und unbewusste Vorstellungen der Patienten liefert. Die Interraterreliabilität über die Metapherngruppen war Cohen’s Kappa K = 0.8. Ergebnisse: Die Patienten konzeptualisierten ihren Körper, aber auch ihr Selbst als ein “Gefäß”, dass sowohl materielle (z.B. die Lunge) wie immaterielle Objekte (z.B. Gedanken an den Spender, Affekte) enthält. Der wichtigste Unterschied zwischen den Compliance-Gruppen bestand darin, dass Patienten mit ungenügender Compliance eine grössere Distanz zur transplantierten Lunge erlebten. Auch konzeptualisierten sie ihren Körper bzw. ihr Selbst nicht als ein Gefäß, das die Lunge enthält. Diskussion: Die Ergebnisse zeigen, dass gute Compliance mit einer erfolgreichen Organintegration assoziiert ist, welche die Zugehörigkeit der Lunge in einem als Gefäß konzeptualisierten Körper bzw. Selbst umfasst. Patienten mit ungenügender Compliance nehmen die Lunge eher als Fremdkörper wahr. Diese Verarbeitungsprozesse sind teils bewusster, teils vor- und unbewusster Natur

Swiss residents' speciality choices – impact of gender, personality traits, career motivation and life goals

BACKGROUND: The medical specialities chosen by doctors for their careers play an important part in the development of health-care services. This study aimed to investigate the influence of gender, personality traits, career motivation and life goal aspirations on the choice of medical speciality. METHODS: As part of a prospective cohort study of Swiss medical school graduates on career development, 522 fourth-year residents were asked in what speciality they wanted to qualify. They also assessed their career motivation and life goal aspirations. Data concerning personality traits such as sense of coherence, self-esteem, and gender role orientation were collected at the first assessment, four years earlier, in their final year of medical school. Data analyses were conducted by univariate and multivariate analyses of variance and covariance. RESULTS: In their fourth year of residency 439 (84.1%) participants had made their speciality choice. Of these, 45 (8.6%) subjects aspired to primary care, 126 (24.1%) to internal medicine, 68 (13.0%) to surgical specialities, 31 (5.9%) to gynaecology & obstetrics (G&O), 40 (7.7%) to anaesthesiology/intensive care, 44 (8.4%) to paediatrics, 25 (4.8%) to psychiatry and 60 (11.5%) to other specialities. Female residents tended to choose G&O, paediatrics, and anaesthesiology, males more often surgical specialities; the other specialities did not show gender-relevant differences of frequency distribution. Gender had the strongest significant influence on speciality choice, followed by career motivation, personality traits, and life goals. Multivariate analyses of covariance indicated that career motivation and life goals mediated the influence of personality on career choice. Personality traits were no longer significant after controlling for career motivation and life goals as covariates. The effect of gender remained significant after controlling for personality traits, career motivation and life goals. CONCLUSION: Gender had the greatest impact on speciality and career choice, but there were also two other relevant influencing factors, namely career motivation and life goals. Senior physicians mentoring junior physicians should pay special attention to these aspects. Motivational guidance throughout medical training should not only focus on the professional career but also consider the personal life goals of those being mentored

Patient well‐being after general anaesthesia: a prospective, randomized, controlled multi‐centre trial comparing intravenous and inhalation anaesthesia

Background. The aim of this study was to assess postoperative patient well‐being after total i.v. anaesthesia compared with inhalation anaesthesia by means of validated psychometric tests. Methods. With ethics committee approval, 305 patients undergoing minor elective gynaecologic or orthopaedic interventions were assigned randomly to total i.v. anaesthesia using propofol or inhalation anaesthesia using sevoflurane. The primary outcome measurement was the actual mental state 90 min and 24 h after anaesthesia assessed by a blinded observer using the Adjective Mood Scale (AMS) and the State‐Trait‐Anxiety Inventory (STAI). Incidence of postoperative nausea and vomiting (PONV) and postoperative pain level were determined by Visual Analogue Scale (VAS) 90 min and 24 h after anaesthesia (secondary outcome measurements). Patient satisfaction was evaluated using a VAS 24 h after anaesthesia. Results. The AMS and STAI scores were significantly better 90 min after total i.v. anaesthesia compared with inhalation anaesthesia (P=0.02, P=0.05, respectively), but equal 24 h after both anaesthetic techniques (P=0.90, P=0.78, respectively); patient satisfaction was comparable (P=0.26). Postoperative pain was comparable in both groups 90 min and 24 h after anaesthesia (P=0.11, P=0.12, respectively). The incidence of postoperative nausea was reduced after total i.v. compared with inhalation anaesthesia at 90 min (7 vs 35%, P<0.001), and 24 h (33 vs 52%, P=0.001). Conclusion. Total i.v. anaesthesia improves early postoperative patient well‐being and reduces the incidence of PONV. Br J Anaesth 2003; 91: 631-

Psychological response and quality of life after transplantation: a comparison between heart, lung, liver and kidney recipients

PRINCIPLES: Various non-specific questionnaires were used to measure quality of life and psychological wellbeing of patients after organ transplantation. At present cross-organ studies dealing specifically with the psychological response to a transplanted organ are non-existent in German-speaking countries. METHODS: The Transplant Effects Questionnaire TxEQ-D and the SF-36 Quality of Life Questionnaire were used to examine the psychological response and quality of life of 370 patients after heart, lung, liver or kidney transplantation. The organ groups were compared with regard to psychosocial parameters. RESULTS: 72% of patients develop a feeling of responsibility for the received organ and its function. This feeling is even stronger towards the patient's key relationships i.e. family, friends, the treatment team and the donor. 11.6% worry about the transplanted organ. Heart and lung patients report significantly fewer concerns than liver and kidney patients. Overall, only a minority of patients report feelings of guilt towards the donor (2.7%), problems in disclosing their transplant to others (2.4%), or difficulties in complying with medical orders (3.5%). Lung transplant patients show significantly better adherence. CONCLUSIONS: A feeling of responsibility towards those one is close to and towards the donor is a common psychological phenomenon after transplantation of an organ. Conscious feelings of guilt and shame are harboured by only a minority of patients. The fact that heart and lung patients worry less about their transplant might have primarily to do with the greater medical and psychosocial support in this group

More mentoring needed? A cross-sectional study of mentoring programs for medical students in Germany

<p>Abstract</p> <p>Background</p> <p>Despite increasing recognition that mentoring is essential early in medical careers, little is known about the prevalence of mentoring programs for medical students. We conducted this study to survey all medical schools in Germany regarding the prevalence of mentoring programs for medical students as well as the characteristics, goals and effectiveness of these programs.</p> <p>Methods</p> <p>A definition of mentoring was established and program inclusion criteria were determined based on a review of the literature. The literature defined mentoring as a steady, long-lasting relationship designed to promote the mentee's overall development. We developed a questionnaire to assess key characteristics of mentoring programs: the advocated mentoring model, the number of participating mentees and mentors, funding and staff, and characteristics of mentees and mentors (e.g., level of training). In addition, the survey characterized the mentee-mentor relationship regarding the frequency of meetings, forms of communication, incentives for mentors, the mode of matching mentors and mentees, and results of program evaluations. Furthermore, participants were asked to characterize the aims of their programs. The questionnaire consisted of 34 questions total, in multiple-choice (17), numeric (7) and free-text (10) format. This questionnaire was sent to deans and medical education faculty in Germany between June and September 2009. For numeric answers, mean, median, and standard deviation were determined. For free-text items, responses were coded into categories using qualitative free text analysis.</p> <p>Results</p> <p>We received responses from all 36 medical schools in Germany. We found that 20 out of 36 medical schools in Germany offer 22 active mentoring programs with a median of 125 and a total of 5,843 medical students (6.9 - 7.4% of all German medical students) enrolled as mentees at the time of the survey. 14 out of 22 programs (63%) have been established within the last 2 years. Six programs (27%) offer mentoring in a one-on-one setting. 18 programs (82%) feature faculty physicians as mentors. Nine programs (41%) involve students as mentors in a peer-mentoring setting. The most commonly reported goals of the mentoring programs include: establishing the mentee's professional network (13 programs, 59%), enhancement of academic performance (11 programs, 50%) and counseling students in difficulties (10 programs, 45%).</p> <p>Conclusions</p> <p>Despite a clear upsurge of mentoring programs for German medical students over recent years, the overall availability of mentoring is still limited. The mentoring models and goals of the existing programs vary considerably. Outcome data from controlled studies are needed to compare the efficiency and effectiveness of different forms of mentoring for medical students.</p