Examining stress and response to stress in medical students and new medical graduates

MOST MEMBERS OF THE MEDICAL PROFESSION feel stressed at some time. If stress is ongoing, impairment may occur (defined as being unable to safely or reliably perform one’s role). A continuum appears to exist between functioning well, being distressed and becoming impaired, with external (environment-related) and internal (personalrelated) stressors determining where an individual will lie on the continuum. We are conducting a study which aims to determine whether distress in new medical graduates can be predicted before the graduates become impaired and unable to safely or reliably perform their role. Study commencement Our study, which commenced in 1997, initially looked at predictors for “troubled” and “troublesome” interns. Hospital- based focus groups comprising interns (postgraduate Year 1), resident medical officers (postgraduate Year 2 and above), ward-based nursing staff and medical administrators reported on internal and external stressors for junior medical staff. Residents and nurses reported similar external stressors, whereas the internal stressors reported by the two groups were quite different (Box 1). Residents tended to report issues relating to “troubled” interns (eg, poor support, few outside interests), whereas nurses identified factors relating more to “troublesome” interns (eg, poor attitude, unprofessionalism). In other words, resident staff seemed to be able to identify their stressed and at-risk peers before effects on performance were observed (Box 1)

The emotional well-being of young people having a parent with younger onset dementia

Younger onset dementia (YOD) not only affects the person with the diagnosis but the whole family, which often includes young people. A limited body of research on this group of young people indicates that they experience varying degrees of emotional trauma. We explored the lived experiences of young people having a parent with YOD from the perspective of the social model of disability. Data were available from semi-structured interviews with 12 young people who had a parent with YOD looking at their lived experiences between 8 and 24 years. Thematic analysis identified four main themes: the emotional toll of caring, keeping the family together, grief and loss and psychological distress. The social model of disability theory provides a helpful framework for these families who experience significant emotional distress, demonstrating that the disability is often socially constructed by a society, which marginalizes and excludes them. A ‘whole family’ approach is proposed, where the needs of young people and their parents are respected and responded to age appropriately.Doris Whiting Trust Fun

Burnout and psychiatric morbidity in new medical graduates

OBJECTIVE: To determine the prevalence of psychiatric morbidity and burnout in final-year medical students, and changes in these measures during the intern year. DESIGN: Prospective longitudinal cohort study over 18 months, with assessment of psychiatric morbidity and burnout on six occasions. PARTICIPANTS: All 117 students in the first graduating cohort of the University of Sydney Graduate Medical Program were invited to participate in the study; 110 consented. OUTCOME MEASURES: Psychiatric morbidity assessed with the 28-item General Health Questionnaire and burnout assessed with the Maslach Burnout Inventory. RESULTS: The point prevalence of participants meeting criteria for psychiatric morbidity and burnout rose steadily throughout the study period. CONCLUSIONS: Internship remains a stressful time for medical graduates, despite initiatives to better support them during this period. The implications for the doctors themselves and for the communities they serve warrant further attention, including programs specifically aimed at reducing the rate of psychological morbidity and burnout during internship.NHMR

Longitudinal integrated rural placements: a social learning systems perspective

OBJECTIVES There is currently little theoretically informed exploration of how non-traditional clinical placement programmes that are longitudinal, immersive, based on community-engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio-cultural underpinnings of student learning within a longitudinal, integrated, community-engaged rural placement. METHODS Data collected using semi-structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs). RESULTS In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity. CONCLUSIONS Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning

Social learning in a longitudinal integrated clinical placement

Abstract Recent research has demonstrated that longitudinal integrated placements (LICs) are an alternative mode of clinical education to traditional placements. Extended student engagement in community settings provide the advantages of educational continuity as well as increased service provision in underserved areas. Developing and maintaining LICs require a differing approach to student learning than that for traditional placements. There has been little theoretically informed empirical research that has offered explanations of which are the important factors that promote student learning in LICs and the relationships between those factors. We explored the relationship between student learning, student perceptions of preparedness for practice and student engagement, in the context of a rural LIC. We used a sequential qualitative design employing thematic, comparative and relational analysis of data from student interviews (n = 18) to understand possible processes and mechanisms of student learning in the LIC. Through the theoretical lens of social learning systems, we identified two major themes; connectivity and preparedness for practice. Connectivity described engagement and relationship building by students, across formal and informal learning experiences, interprofessional interactions, social interactions with colleagues, interaction with patients outside of the clinical setting, and the extent of integration in the wider community. Preparedness for practice, reflected students’ perceptions of having sufficient depth in clinical skills, personal and professional development, cultural awareness and understanding of the health system, to work in that system. A comparative analysis compared the nature and variation of learning across students. In a relational analysis, there was a positive association between connectivity and preparedness for practice. Connectivity is a powerful enabler of students’ agentic engagement, collaboration, and learning within an LIC. It is related to student perceptions of preparedness for practice. These findings provide insight for institutions wishing to develop similar programmes, by encouraging health professional educators to consider all of the potential elements of the placements, which most promote connectivity

Empowerment of young people who have a parent living with dementia: a social model perspective

Objectives: Socially constructed disablement has marginalised young people in families where a parent has younger onset dementia (YOD). This has contributed to inadequate societal support for their complex situation. Impacts on such young people include significant involvement with mental health services for themselves. In this paper we explored the young people’s lived experiences in these families and the influencing factors to enable these young people to be included and supported within their community. Methods: In this qualitative research study the social model of disability was used as the theoretical framework in conducting a thematic analysis of interviews with 12 participants. Results: Three themes emerged; invisibility highlighting the issues of marginalisation; connectivity foregrounding the engagement of young people with family, friends and their social networks, and being empowered through claiming their basic human right to receive the age appropriate support they needed. Conclusion: The current plight of young people living with a parent with YOD demands a fundamental shift by society in developing inclusive cross-sectorial cooperation linking service providers across youth and dementia sectors. This requires working in partnership with the service users responding to the identified needs of individual family members

Total Lipids, Lipid Classes, and Fatty Acids of Newly Settled Red King Crab (Paralithodes camtschaticus): Comparison of hatchery-cultured and wild crabs

Little is known about the nutrition or lipid metabolism of cold-water crabs, particularly in the North Pacific. We undertook a 2-part study to understand more completely the energetics and nutritional requirements of juvenile red king crab (RKC; Paralithodes canusehaticus). First, we investigated changes in proximate composition, total lipids (TLs), lipid classes, and fatty acids (FAs) throughout a molt cycle (C4-C5). Trends in lipid parameters were described by a 3-pari, piecewise linear regression with 3 distinct stages: (I) a postmolt phase (similar to 0-7 days), (2) an intramolt stage (similar to 7-24 days), and (3) a premolt stage (similar to 24-33 days). Significant intramolt differences in TLs indicated that caution should be taken when comparing crabs of unknown molt stage in future aquaculture and ecological experiments. However, little variability was found in the proportional FA composition of crabs, indicating that the intramolt stage has little effect on the interpretation of FA biomarkers. During a second investigation, we examined differences in lipid classes and FAs from cultured and wild RKC. We found significantly higher proportions of the essential fatty acids (EFAs) 20:5n-3 (EPA) and 20:4n-6 (AA) in wild crabs compared with cultured animals at the same stage. Furthermore, higher proportions of bacterial markers and lower proportions of zooplankton FA markers were found in wild than in hatchery-reared crabs. Here, we provide the first baseline data for future dietary studies on juvenile cold-water crabs. We suggest that an initial EFA ratio for DHA:EPA:AA of 5:8:1 could be used as a starting point for controlled dietary studies on the effect of EFAs on juvenile growth, molt success, and survival.Keywords: Lipids, Nutrition, Red king crab, Paralithodes camtschaticus, Fatty acids, Mol