A national longitudinal cohort study of factors contributing to UK medical students’ mental ill-health symptoms

Background The mental health of current medical students is predictive of their mental health as future doctors. The prevalence of anxiety, depression and burnout is high among medical students, but less is known about the occurrence of other mental ill-health symptoms, such as eating or personality disorders, and factors contributing to mental ill-health. Aims (1) To explore the prevalence of various mental ill-health symptoms in medical students and (2) to investigate what medical school factors and students’ attitudes contribute to these mental ill-health symptoms. Methods Between November 2020 and May 2021, medical students from nine geographically spread medical schools in the UK participated by completing online questionnaires at two points in time, approximately 3 months apart. Results Of the 792 participants who filled in the questionnaire at baseline, over half experienced medium to high somatic symptoms (50.8%; 402) and drank alcohol at hazardous levels (62.4%; 494). Adjusted longitudinal data analysis of 407 students who completed the follow-up questionnaire demonstrated that less supportive educational climates that were more competitive and less centralised around the students, lower feelings of belongingness, greater stigma towards mental ill-health and lower intentions to seek help for mental ill-health, all contributed to students’ mental ill-health symptoms. Conclusions Medical students experience a high prevalence of various mental ill-health symptoms. This study suggests that medical school factors and students’ attitudes towards mental ill-health are significantly associated with students’ mental health

UK medical students' mental health during the COVID-19 pandemic: a qualitative interview study

OBJECTIVES: To understand the impact of COVID-19 on medical students with mental health problems. DESIGN: Qualitative study employing in-depth semistructured interviews with medical students which were analysed using reflexive thematic analysis. SETTING AND PARTICIPANTS: A purposive sample of 20 students originating from 8 geographically spread UK medical schools were selected, representing various mental health issues and demographic characteristics. RESULTS: Three themes were identified: (1) medical schools' response to the pandemic-schools increased awareness-raising of mental health support and increased flexibility in regards to academic requirements; (2) disruption to the medical degree-COVID-19 brought change and uncertainty to medical education and missed learning opportunities reduced students' confidence and (3) psychological consequences of the pandemic-COVID-19 had a negative impact on mental health, most notably raising stress and anxiety but also triggering new or existing conditions. CONCLUSIONS: While there were many negative aspects of the pandemic for medical students experiencing mental ill health, there were also positives. Students felt that the increased focus on mental health support during the pandemic had reduced stigma towards mental health. Given stigma has been identified as a key barrier for help-seeking in medical students, future research should investigate the longer-term impacts of the pandemic and whether medical students are more likely to seek help for mental health difficulties postpandemic

To stay or go? A mixed methods study of psychiatry trainees’ intentions to leave training

This mixed methods research study aimed to test a tailored version of the job demands-resources (JD-R) model to uncover what factors contribute to psychiatry trainees’ intentions to leave their training and how. A Web-based survey measured psychiatry trainees’ work conditions, well-being, occupational commitment, and intentions to leave training. The results were analyzed using structural equation modeling featuring validated constructs. Narrative interviews were analyzed using thematic analysis following the tailored JD-R model. Of 159 current London trainees who completed the questionnaire, 22.1% were thinking a lot about leaving training. Trainees with higher job demands, fewer resources, and less ability to detach from their work experienced higher burnout levels. More engaged and less burned-out trainees were more committed to their occupation and less inclined to leave training. The interviews identified that trainees’ decision to leave was not linear and took time to make. Trainees found their work environment challenging and reported reduced well-being and rethinking their career paths. The JD-R model is a useful tool to understand how medical trainees’ job demands and resources need to be balanced to maintain their well-being and, in turn, how this affects their commitment to the occupation and training

Linking leadership development programs for physicians with organization-level outcomes:a realist review

Background: Hospitals invest in Leadership Development Programs (LDPs) for physicians, assuming they benefit the organization’s performance. Researchers have listed the advantages of LDPs, but knowledge of how and why organization-level outcomes are achieved is missing. Objective: To investigate how, why and under which circumstances LDPs for physicians can impact organization-level outcomes. Methods: We conducted a realist review, following the RAMESES guidelines. Scientific articles and grey literature published between January 2010 and March 2021 evaluating a leadership intervention for physicians in the hospital setting were considered for inclusion. The following databases were searched: Medline, PsycInfo, ERIC, Web of Science, and Academic Search Premier. Based on the included documents, we developed a LDP middle-range program theory (MRPT) consisting of Context-Mechanism-Outcome configurations (CMOs) describing how specific contexts (C) trigger certain mechanisms (M) to generate organization-level outcomes (O). Results: In total, 3904 titles and abstracts and, subsequently, 100 full-text documents were inspected; 38 documents with LDPs from multiple countries informed our MRPT. The MRPT includes five CMOs that describe how LDPs can impact the organization-level outcomes categories ‘culture’, ‘quality improvement’, and ‘the leadership pipeline’: 'Acquiring self-insight and people skills (CMO1)', 'Intentionally building professional networks (CMO2)', 'Supporting quality improvement projects (CMO3)', 'Tailored LDP content prepares physicians (CMO4)', and 'Valuing physician leaders and organizational commitment (CMO5)'. Culture was the outcome of CMO1 and CMO2, quality improvement of CMO2 and CMO3, and the leadership pipeline of CMO2, CMO4, and CMO5. These CMOs operated within an overarching context, the leadership ecosystem, that determined realizing and sustaining organization-level outcomes. Conclusions: LDPs benefit organization-level outcomes through multiple mechanisms. Creating the contexts to trigger these mechanisms depends on the resources invested in LDPs and adequately supporting physicians. LDP providers can use the presented MRPT to guide the development of LDPs when aiming for specific organization-level outcomes.</p