Well prepared for work? Junior doctors' self-assessment after medical education

Background Apart from objective exam results, the overall feeling of preparedness is important for a successful transition process from being a student to becoming a qualified doctor. This study examines the association between self-assessed deficits in medical skills and knowledge and the feeling of preparedness of junior doctors in order to determine which aspects of medical education need to be addressed in more detail in order to improve the quality of this transition phase and in order to increase patient safety. Methods A cohort of 637 doctors with up to two years of clinical work experience was included in this analysis and was asked about the overall feeling of preparedness and self-assessed deficits with regard to clinical knowledge and skills. Three logistic regression models were used to identify medical skills which predict the feeling of preparedness. Results All in all, about 60% of the participating doctors felt poorly prepared for post-graduate training. Self-assessed deficits in ECG interpretation (aOR: 4.39; 95% CI: 2.012-9.578), treatment and therapy planning (aOR: 3.42; 95% CI: 1.366-8.555), and intubation (aOR: 2.10; 95% CI: 1.092-4.049) were found to be independently associated with the overall feeling of preparedness in the final regression model. Conclusions Many junior doctors in Germany felt inadequately prepared for being a doctor. With regard to the contents of medical curricula, our results show that more emphasis on ECG-interpretation, treatment and therapy planning and intubation is required to improve the feeling of preparedness of medical graduates

The PinK Study - Methodology of the Baseline Survey of a Prospective Cohort Study of Couples Undergoing Fertility Treatment

Der Methodenbericht beschreibt die Basiserhebung der PinK-Studie "Paare in Kinderwunschbehandlung". Ziel der Studie ist ein besseres Verständnis der Situation von Paaren mit unerfülltem Kinderwunsch und umfassende Erkenntnisse über die Wege in die Kinderwunschbehandlung. Der Ansatz der Studie ist interdisziplinär. Sie ist als prospektive Kohortenstudie in einem klinischen Umfeld angelegt. Zielgruppe der Studie sind Paare mit unerfülltem Kinderwunsch, die zwischen Juli 2012 und Mai 2013 ein Kinderwunschzentrum in Rheinland-Pfalz oder in der hessischen Landeshauptstadt aufgesucht haben. Als Erhebungsinstrument kamen schriftliche Fragebögen zum Einsatz, die den Patienten durch das Personal der Kinderwunschzentren übergeben wurden. Der finale Datensatz enthält alle bis Ende Juli 2013 zurückgesendete Fragebögen. Es haben 323 Frauen und 242 Männer an der Befragung teilgenommen, darunter 234 Paare, für die vollständige Informationen zu beiden Partnern vorliegen. Der Datensatz ermöglicht damit neben Geschlechtervergleichen auch Paaranalysen. Die Gesamtrücklaufquote liegt bei 31% mit teilweise erheblichen Unterschieden zwischen den Kliniken - mögliche Ursachen und Folgen werden diskutiert. Die Studienpopulation wird hinsichtlich zentraler soziodemografischer Merkmale beschrieben.This paper describes the realization of the baseline survey of the study ‘PinK- Paare in Kinderwunschbehandlung’ (couples undergoing fertility treatment). The study aims at a broader and better understanding of the situation of couples with an unfulfilled desire to have a child and of pathways leading couples to the fertility clinic. The approach of the study is interdisciplinary. It is designed as a prospective cohort study in a clinical setting. The study population consists of couples with an unfulfilled desire to have a child who presented themselves in a fertility clinic in the German state of Rhineland-Palatinate (RP) or in the capital city of the state of Hesse between July 2012 and May 2013. Self-administered questionnaires were used to gather information from patients at fertility clinics. These were handed out to the patients by the staff at the fertility clinics. Questionnaires returned by the end of July 2013 were included in the data set. The final sample consists of 323 female and 242 male respondents. In 234 couples, both partners participated. The overall response rate is 31%, with considerable variation across the clinics - reasons for and consequences of this are discussed. The final sample is described in terms of the distribution of core socio-demographic variables

The PinK Study - Methodology of the Follow-up Survey of a Cohort Study of Couples Undergoing Fertility Treatment

The paper describes the follow-up survey of the PinK study 'Paare in Kinderwunschbehandlung' (couples undergoing fertility treatment). This interdisciplinary study aims at a broader and better understanding of the situation of couples with an unfulfilled desire to have a child. The focus in the follow-up survey is on the situation of the couples one year after their first visit to a fertility clinic in Rhineland-Palatinate or in the capital of Hesse, Wiesbaden. Approximately one year after the baseline survey, self-administered questionnaires were sent to respondents who had signed a written agreement to remain in the study. The field period lasted from June 2013 to August 2014. The final sample consists of 140 women and 93 men. In 89 couples both partners participated. The longitudinal data set includes 224 respondents. The share of baseline survey participants who also participated in the follow-up is 39.6 %. This report describes the study design and materials for the follow-up as well as the sample and analyses the selectivity of dropouts from the baseline sample

Who is the gate keeper for treatment in a fertility clinic in Germany? -baseline results of a prospective cohort study (PinK study)-

Abstract Background It is estimated that 5-15% of all couples in industrialised nations are infertile. A perceived unfulfilled desire for a child or self-identification as infertile can lead to psychological strain and social isolation. About 53.000 women underwent assisted reproduction treatments in Germany in 2014. Little is known about the first medical consultation and patient needs prior to the first visit in a fertility clinic in Germany. The baseline survey of the prospective cohort study on couples undergoing fertility treatment in Germany (PinK Study) provides first results on this topic for Germany. Methods The baseline survey was conducted between 2012 and 2013. Self-administered questionnaires were handed out to patients of six fertility clinics at the beginning of treatment by clinic staff. At a participation rate of 31.0%, we were able to analyse data on 323 women and 242 men. Results 92.6% of the women had their initial medical consultation on their unfulfilled desire for a child with a gynaecologist. After the urologist (44.2%), the general practitioner (12.0%) was the second most approached initial contact person for men. 36.4% of all men had no medical consultation on the unfulfilled desire for a child before visiting a fertility clinic. 46.9% of the respondents expressed the wish that the conversation about infertility should be initiated by a physician. Prior to their first visit to a fertility clinic, 11.2% of the men and 24.8% of the women were informed by a physician that infertility treatment can cause emotional strain. Conclusion While almost all women consult a gynaecologist prior to the first visit in a fertility centre, one out of three men do not consult any physician at that stage. For the remaining group of men, urologists and general practitioners are the most important contact persons. Gender-specific health care needs are evident. In order to close the health care gap for men in Germany, more opportunities for discreet access to consultation should be offered. Due to its low threshold and family-oriented approach, general practice could make an important contribution to this effect

Association between over-indebtedness and antidepressant use: A cross-sectional analysis.

BackgroundBurden of disease caused by depression and its association with socioeconomic status is well documented. However, research on over-indebtedness is scarce although millions of European citizens in all socioeconomic positions are over-indebted. Prior studies suggested that over-indebtedness is associated with poor physical and mental health.AimsInvestigate the association between over-indebtedness and antidepressant use in Germany.MethodA cross-sectional survey among debt advice agencies' clients was conducted in North Rhine-Westphalia, Germany, in 2017 (OID). Data were merged with the first wave of the German Health Interview and Examination Survey for Adults (DEGS1). Descriptive statistics and logistic regression analysis were used to examine antidepressant use in the previous 7 days (OID: n = 699; DEGS1: n = 7115).ResultsPrevalence of antidepressant use was higher in the over-indebted (12.3%) than the general population (5.0%). The over-indebted were significantly more likely to use antidepressants than the general population even after controlling for other socioeconomic, demographic and health factors (adjusted odds ratio 1.83; 95% confidence interval 1.35-2.48).ConclusionsStakeholders in health care, debt counselling, research and social policy should consider the link between over-indebtedness and mental illness to advance the understanding of health inequalities and to help those who have mental health and debt problems

Patient-physician communication about financial problems:A cross-sectional study among over-indebted individuals

BACKGROUND:About every tenth household across Europe is unable to meet payment obligations and living expenses on an ongoing basis and is thus considered over-indebted. Previous research suggests that over-indebtedness reflects a potential cause and consequence of psychosomatic health problems and limited access to care. However, it is unclear whether those affected discuss their financial problems with general practitioners. Therefore, this study examined patient-physician communication about financial problems in general practice among over-indebted individuals. METHODS:We conducted a cross-sectional survey among clients of 70 debt advice agencies in North Rhine-Westphalia, Germany, in 2017. We assessed the prevalence of patient-physician communication about financial problems and its association with patient characteristics using descriptive statistics and logistic regression analysis. Of 699 individuals who returned the questionnaire (response rate:50.2%), we included 598 respondents enrolled in statutory health insurance with complete outcome data in the analyses. RESULTS:Conversations about financial problems with general practitioners were reported by 22.6% (n = 135) of respondents. Individuals with a high educational level were less likely to report such conversations than those with medium educational level (aOR 0.11; 95%CI 0.01-0.83) after adjustment for other sociodemographic characteristics, health status and measures of financial distress. Those without a migrant background(aOR 2.09; 95%CI 1.32-3.32), the chronically ill(aOR 1.90; 95%CI 1.16-3.13) and individuals who reported high financial distress(aOR 2.15; 95%CI 1.22-3.78) and cutting on necessities to pay for medications(aOR 1.86; 95%CI 1.12-3.09) were more likely to discuss financial problems than their counterparts. CONCLUSIONS:Few over-indebted individuals discussed financial problems with their general practitioner. Patients' health status, coping strategies and perception of financial distress might contribute to variations in disclosure of financial problems. Thus, enhancing communication and screening by routine assessment of financial problems in clinical practice can help to identify vulnerable patients and promote access to health care and social services and well-being for all

Traumatic Life Events and Association With Depression, Anxiety, and Somatization Symptoms in Female Refugees

Moran JK, Jesuthasan J, Schalinski I, et al. Traumatic Life Events and Association With Depression, Anxiety, and Somatization Symptoms in Female Refugees. JAMA Network Open . 2023;6(7): e2324511.Key Points Question Which traumatic life events are associated with current depression, anxiety, and somatization symptoms in female refugees seeking psychological help? Findings In this cross-sectional study of 620 female refugees, by use of random forest regression, family violence had the highest scores associated with depression, anxiety, and somatization, beyond cumulative trauma exposure. These scores were higher than those for more frequently reported traumatic events, such as war, accident, lack of housing, hunger, and near death. Meaning These findings suggest that even for women with a history of multiple traumatic experiences, understanding the impact and likelihood of family violence is vital in diagnostic assessments and informing treatment strategies. This cross-sectional study examines which traumatic life events are associated with depression, anxiety, and somatization symptoms, beyond cumulative trauma exposure, in a sample of female refugees. Importance Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war and humanitarian crises, who have experienced cumulative trauma exposure during war and forced migration, it is not known whether cumulative trauma or particular events have the greatest impact on symptoms. Objective To examine which traumatic life events are associated with depression, anxiety, and somatization symptoms, compared with the cumulative amount, in a sample of female refugees. Design, Setting, and Participants For this cross-sectional study, data were collected in 2016 as a part of The Study on Female Refugees. The current analysis was conducted in 2022 to 2023. This multicenter study covered 5 provinces in Germany. Participants were recruited at reception centers for refugees. Women volunteered to participate and to be interviewed after information seminars at the different centers. Exposure Traumatic life events experienced by refugees from areas of the world experiencing war and humanitarian crises. Main Outcomes and Measures Demographic variables (age, country of origin, religion, education, relationship status, and children), traumatic and adverse life events, and self-reported depression, anxiety, and somatization symptoms were measured. Random forest regressions simultaneously examined the importance of these variables on symptom scores. Follow-up exploratory mediation models tested potential associative pathways between the identified variables of importance. Results For the final sample of 620 refugee women (mean [SD] age, 32.34 [10.35] years), family violence was most associated with depression (mean [SD] variable of importance [VIM], 2.93 [0.09]), anxiety (mean [SD] VIM, 4.15 [0.11]), and somatization (mean [SD] VIM, 3.99 [0.15]), even though it was less common than other traumatic experiences, including war, accidents, hunger, or lack of housing. Other factors, such as childhood sexual abuse, injury, near-death experiences, and lack of access to health care, were also important. Follow-up analyses showed partial mediation effects between these factors in their association with symptoms, supporting the unique importance of family violence in understanding mental health. Conclusions and Relevance The findings of this cross-sectional study of refugee women who experienced multiple severe traumas related to war in their home countries and danger encountered during their migration suggest that family violence was key to their current mental health problems. Culturally sensitive assessment and treatment need to place special emphasis on these family dynamics