Burnout in Israeli medical students:a national survey

INTRODUCTION: Professional burnout is characterized by loss of enthusiasm for work, cynicism, and a low sense of personal efficacy. Burnout may adversely affect medical professionalism. Burnout is common in clinicians and varying rates have been reported in medical students. No data exist regarding the prevalence of burnout among Israeli medical students. The aims of this study were to assess the rate of burnout in Israeli medical students and to identify students who were particularly susceptible to burnout. METHODS: A cross-sectional questionnaire design was employed, gathering data from medical students in all years of study across three medical schools. Burnout was measured using the Maslach Burnout Inventory Student Survey (MBI-SS), translated into Hebrew. RESULTS: Of the 2160 students in the participating medical schools, 966 (44.7%) completed MBI-SS and demographic questionnaires. The overall burnout rate was 50.6%. Multivariate logistic regression analysis yielded that female gender, age under 25, advanced year of study, studying at a specific medical school and not being a parent are all significantly correlated with higher levels of burnout. CONCLUSIONS: A high rate of burnout was found. The identification of young women who are not parents during advanced years of studies as being at-risk is important, in order to guide the development of burnout prevention interventions

Deepening the teaching and learning of clinical communication: The importance of reflection and feedback in health education

Aims: clinical communication (CC) relates to health professionals’ interaction with patients/families. CC is fundamental for the physicians’ role. This paper aims to contribute to the discussion about reflection and feedback for meaningful teaching and learning of CC.Methods: the authors provided a short review and conceptual discussion of the history and nature of CC teaching, followed by exploring the role of reflection and feedback in teaching CC.Results: communicating well can be challenging as it requires medical students and professionals to adapt their communication to each patient/family while obtaining all the needed information, conveying trustworthiness, care, and compassion. The teaching of CC to medical students involves deepening the doctor-patient relationship’s technical, relational, and emotional elements. CC requires teaching that is flexible and tailored to the participants’ needs. Therefore, teaching CC must go beyond asking the appropriate question or applying specific checklist-based behaviours. In teaching CC, it is crucial to give medical students support to discuss personal and institutional barriers and attitudes and explore how to transfer their learning to clinical practice. To that end, reflection should be encouraged to allow students to express difficulties and feelings and enhance their understanding of themselves and others. Within this process, feedback is essential to moving beyond skill-based teaching to reflection-based learning.Conclusion: the move from skills-based learning requires using reflective processes and feedback to allow students to learn about their communication tendencies and needs to become more flexible and attuned to different patient’s needs in clinical encounters.Objetivos: a comunicação clínica (CC) está relacionada à interação entre profissionais de saúde e pacientes ou familiares, sendo fundamental para prática médica. Este artigo tem como objetivo contribuir para a discussão sobre reflexão e feedback no ensino e aprendizagem significativos de CC.Métodos: os autores realizaram uma breve revisão e discussão conceitual da história e da natureza do ensino do CC, seguida pela exploração do papel da reflexão e do feedback no ensino de CC.Resultados: comunicar-se bem pode ser desafiador, pois exige que os estudantes de medicina e profissionais adaptem sua comunicação a cada paciente/família enquanto obtêm todas as informações necessárias, transmitindo confiabilidade, cuidado e compaixão. O ensino do CC para estudantes de medicina envolve o aprofundamento de elementos técnicos, relacionais e emocionais da relação médico-paciente. A CC requer um ensino flexível e adaptado às necessidades dos estudantes. Portanto, ensinar CC deve ir além de fazer a pergunta apropriada ou aplicar comportamentos específicos baseados em listas de verificação. No ensino do CC, é crucial dar aos estudantes de medicina apoio para discutir as barreiras e atitudes pessoais e institucionais e explorar como transferir seu aprendizado para a prática clínica. Para tanto, deve-se estimular a reflexão para permitir que os alunos expressem dificuldades e sentimentos e ampliem sua compreensão de si e dos outros. Nesse processo, o feedback é essencial para ir além do ensino baseado em habilidades para o aprendizado baseado em reflexão.Conclusão: a mudança de uma aprendizagem baseada em habilidades requer o uso de um processo reflexivo e feedback para permitir que os alunos aprendam sobre si, assim como, sobre se tornarem mais flexíveis e sintonizados com as diferentes necessidades do paciente nos encontros clínicos

Automated video analysis of non-verbal communication in a medical setting

Non-verbal communication plays a significant role in establishing good rapport between physicians and patients and influences patient’s health outcomes. Therefore, it is important to measure and analyze non-verbal communication in medical settings. Current approaches to measure non-verbal interactions in medicine employ coding by human raters. Such tools are labor intensive and hence limit the scale of possible studies. Here, we present an automated video analysis tool of non-verbal interactions in a medical setting. We test the tool using videos of subjects that interact with an actor portraying a doctor performing one of two scripted scenarios of interviewing the subjects: in one scenario the actor was focused on his computer and briefly engaged with the subject. The second scenario included active listening by the doctor and heavy focus on the subject. We analyze the cross correlation in total kinetic energy of the two people in the dyad, and also characterize the frequency spectrum of their motion. We find large differences in interpersonal motion synchrony and entrainment between the two performance scenarios. The active listening scenario shows more synchrony and more symmetric followership than the other scenario. Moreover, the active listening scenario shows more high frequency motion termed jitter that has been recently suggested to be a marker of followership. The present approach may be useful for analyzing physician-patient interactions in terms of synchrony and dominance in a wide range of medical settings

Medical students' and trainees' country-by-gender profiles : Hofstede's cultural dimensions across sixteen diverse countries

PURPOSE : The global mobility of medical student and trainee populations has drawn researchers’ attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede’s cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede’s six-dimensional perspective. In doing so we examine medical students’ and trainees’ country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede’s general population data. METHODS : We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede’s 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months’ clinical training using school-specific methods including emails, announcements, and snowballing. RESULTS : We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede’s general population data. CONCLUSIONS : Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.Ministry of Science and Technology, Taiwan (Grant No. MOST 106-2511-S-182-012- MY2).http://frontiersin.org/Medicinedm2022School of Health Systems and Public Health (SHSPH