Depression, Anxiety and Stress among Undergraduate Medical Students during the COVID-19 Pandemic

Introduction: Depression, anxiety, and stress among medical undergraduate students are often under- recognized and undertreated. Prolonged online classes in the backdrop of COVID-19 pandemic have resulted in tremendous psychological stress among students. Objective: To assess the prevalence of stress, anxiety and depression among medical students during the COVID pandemic and the associated factors. Method: A cross-sectional study was conducted among undergraduate students in a medical college in Delhi. A self-administrated questionnaire, containing general information (on-screen time, death or hospitalization in family due to COVID) and the DASS-21 version, was circulated to students enrolled before 2020. Data collected was tabulated in Microsoft Excel and analysed using SPSS version 23. Results: Out of 550 students, 345 (62.7%) participated in the study, of which 341 gave consent. High frequencies of depression 214 (62.8%), anxiety 199 (58.3%) and stress 150 (43.7%) were reported. Significant association was found between the determinants like hectic online classes and curbs on travelling and socializing. Conclusion: The high burden of depression, anxiety and stress detected among the students is a pointer towards a negative impact of online classes that can negatively impact academic performance, professionalism and empathy towards patients

Feasibility and Effectiveness of Objective Structured Clinical Examination for Assessment of Field Visits in Community Medicine for Undergraduate Medical Students

Introduction : The Graduate Medical Education Regulation (GMR) 2019 in the curricular reforms recommends that “Shows How” level of the Miller's Pyramid is assessed through long case, Objective Structured Clinical Examination and Mini-Clinical Evaluation Exercise (Mini CEX). Objectives : 1. To utilize OSCE for assessing Field Visits carried out by Undergraduate medical students as formative assessment. 2. To find out the feasibility and effectiveness of Objective Structured Clinical Examination (OSCE) in Community Medicine. Method : An Educational Innovation Pilot Project was carried out in the department rdof Community Medicine of a Medical College in India. A pilot (18) of 3 MBBS students were assessed through Objective Structured Clinical Examination (OSCE) for epidemiological case study of malaria assigned to the author faculty. These students were also exposed to the oral viva. The analysis of the assessment was through assessment of codes of the procedure stations through checklists and mean scores of procedure and response stations. Qualitative analysis of emerging themes and quantitative analysis as likert scale were utilized for evaluation of the exam were used. Results : The mean score of all response stations was 5.1. Almost all students felt that OSCE was better than the conventional oral viva in assessing skills. Furthermore, almost all students and faculties suggested that it should gradually become a part of curriculum and scaled to entire and other batches with suggested modifications. The residents who participated as simulated cases found it to be a novel experience and a different kind of learning process. Conclusion : It is feasible to introduce OSCE with some modifications in assessing skills acquired in field visits in Community Case Management

A cross-sectional study of attitude towards psychiatry among undergraduate medical students

Background: Psychiatric disorders are common, affecting millions of population worldwide. Patients with psychiatric disorders, psychiatrists as professionals, and psychiatry as a subject are seen in negative attitudes. Prejudices and negative attitudes exist among medical professionals as well. Aims: This study aims to know the attitude of undergraduate medical students towards psychiatry and compare the attitude among students with or without exposure to clinical psychiatry postings. Materials and methods: This is a descriptive, cross-sectional study conducted at a medical college, Karnataka, South India. Undergraduate students belonging to all phases and consenting for the study were the participants. They were considered into two groups, students not exposed to psychiatry clinical posting and students exposed to psychiatry clinical postings, respectively. Apart from collecting sociodemographic details, a self-administered Attitude Towards Psychiatry?30 items questionnaire was used and t-test, chi-square/Fisher’s exact test were used for statistical analyses. Result: The sample consisted of 484 students, of which 52.3% vs 47.7% of students were not exposed to psychiatry vs exposed to psychiatry clinical postings respectively. Overall students reported having a positive attitude towards psychiatry. We found 96.1% of students with clinical exposure to psychiatry have a better attitude compared to 86.9% of students not exposed to psychiatry clinical postings. Conclusion: A positive attitude towards psychiatry is necessary for better care of patients as well as to reduce stigma regarding mental illness. As clinical exposure improves the positive attitude, there is always a scope for improvements in the form of better psychiatry training at the undergraduate level.

On innovative practice training of scientific research for medical undergraduates / 中华医学教育探索杂志

Xuzhou Medical University, relying on the National Demonstration Center for Experimental Basic Medical Science Education and the scientific research platform of Jiangsu Key Laboratory of Brain Disease Bio-information, organizes clinical medical undergraduates to participate in the innovative training program of scientific research practice. Taking the research on signal transduction of ischemic nerve cell injury as an example, this paper studies the innovative practice training on experimental ability and scientific research thinking of medical undergraduates, and preliminarily discusses the promoting effect of innovative practice training on teaching reform of biochemistry and molecular biology. Innovative training in scientific research practice provides a new teaching method, which effectively promotes the cultivation of scientific research quality of medical undergraduates and the teaching reform of theoretical courses.

Association of mental and physical health of first year undergraduate students with ABO blood groups in an Indian urban medical college

Background: Medical students tend to have greater stress levels than the general population. Present study aims to explore mental and physical health of first year medical undergraduate students and association with different ABO blood groups.Methods: In this cross-sectional study, 99 first year students were segregated on the basis of ABO blood groups. Mental health was assessed using validated General Health Questionnaire (GHQ-12). For physical health, height and weight of each student were measured and Body Mass Index (BMI) was calculated.Results: Study shows higher prevalence of stress (GHQ-12 scores) of 54.6%. There was no statistically significant association of stress levels (GHQ-12 scores) and BMI with various ABO Blood groups using Pearson Chi Square test. On comparison GHQ-12 scores were highest for O blood group students and BMI values were greater in blood group B and O, but not significant. AB blood group had least GHQ-12 scores and BMI. On correlation of GHQ-12 scores with BMI, there was weak positive correlation.Conclusions: Blood groups have no association with mental and physical health status. Interventions in early phase to reduce stress in medical students will reduce incidence of obesity and related health disorders in future.

Role of Clinical Electives on Academic Career: A Cross Sectional Study

Introduction: Clinical Health Electives are an important part of academic curriculum in medical universities throughout the world. Electives are useful in developing personal and professional growth among students. Hence understanding the importance of electives among medical undergraduates on their academic life is important.Materials and Methods: A cross-sectional based study was conducted among medical undergraduates in Karachi, Pakistan. A total number of 300 students from 3rd, 4thand 5thyear of MBBS were taken as a sample. Consent was taken from the participants and questionnaire was filled from everyone. Study population was selected who did at least one clinical elective in their whole academic period.Results: According to our analysed results, undergraduate students from both private and public sector medical institutes perceived clinical electives as an advantage to themselves. Majority of the students saw their clinical and academic performances to be on a higher level. This shows tha opting for electives regardless of its type (local or international) have proven to be fruitful for the undergraduates’ personal growth and academic career, allowing more scope for understudies to practice and enhance their skills they have only done a limited number of times, which inevitably leads to a steep learning curve.Conclusion: There was a positive influence of clinical electives observed among the students. Overall the academic and clinical performance of theundergraduates enhanced by opting clinical electives and has positive impact on them

A Study on Association between Sleep Habits and Academic Performance among Medical Undergraduates in Maharaja Agrasen Medical College Agroha.

Introduction: Good quality and adequate amount of sleepis necessary for being healthy. Medical students are proneto more stress due to their academic demands. The sleepamong students is characterized by inadequate sleeping hours,delayed sleep onset, and mid day nap. Current research aimedto study sleep habits among medical students and to findrelationship between sleep habits and stress with academicperformance of students.Material and Methods: This cross–sectional study wascarried out among 139 medical students of third semester,seventh semester and interns enrolled at Maharaja AgrasenMedical College, Agroha (Dist. Hisar), Haryana. Primarytool in this study was a predesigned and semi-structuredquestionnaire. Epworth Sleepiness Scale (ESS) was used toassess daytime sleepiness. Collected data was analysed usingfrequencies, percentages and chi square test.Results: Out of 139 students, 38.8% were considered tohave excessive daytime sleepiness (EDS score >10). Femalestudents (43.1%) were found to have more abnormal EDS scoreas compare to male students(35.1%). Out of total, 70 studentssecured marks between 60-70 percent in which maximumnumber of students (61.42%) were stress free during examsand 54% had sleep duration of 7-10 hours. Good health wasfound to be strongly significant with academic performanceof the students. Duration of study hours was found to besignificant with academic performance of students. Delayedsleep onset was found to be more in female students (55%).Mid day nap was found in 76.25% of students.Conclusion: The negative effects of sleep difficulties havebeen well documented. EDS was more in female students.Also, good health had significant association with academicperformance so the knowledge of importance of good qualityand adequate amount of sleep and its impact on health shouldbe emphasized and translated into practice.

Internet addiction among medical undergraduates in a medical college of West Bengal- a cross-sectional study

Background: The era of 21st century is burdened with internet usage worldwide specially in the developing countries such as India. Internet addiction has been related to physical, social, psychological impairment. Aim& Objectives: To find out the prevalence of internet addiction among the medical students and the effect of internet addiction on health status among them. Settings and Design: This was an observational descriptive study of cross-sectional design conducted in a tertiary medical college of West Bengal. Material & Methods: All the undergraduate medical students were approached and interview was done using interview schedule consisting of sociodemographic characteristics, Young’s criteria of internet addiction test and Duke’s health profile screening test. Statistical analysis used: Data was analysed using SPSS version 20&presented in percentages, mean with standard deviation, ANOVA with Tukey’s Post-hoc test. Results: Total of 201 participants responded giving a response rate of about 50%. The distribution of respondents as per Young’s criteria of internet addiction which showed that majority of the respondents were mild addicted (58.7%) & moderate addicted (15%).Comparison of Duke health profile score across various internet addicts where physical health score differs significantly among the non-addicted (81.42+20.02) vs mildly addicted (67+20.36)& moderately addicted (63.31+ 20.15) participants (p=0.00). Mental health score also differs considerably among the non-addicts (78.16+18.36) vs mildly addicts (67+18.28) & moderately addicts (61.87+18.33) (p= 0.00). Conclusions: A good number of medical students were addicted to internet that requires timely remedial action. Educational institutions had to formulate strategies so that proper action could be taken.

Internet gaming disorder: a public health concern

Background: Internet gaming disorder is the public health concern globally due to its detrimental effects on the youth to an extreme of provoking them to suicide. As we lack studies in India highlighting this issue we have taken up a study to assess internet gaming disorder among medical graduates and validate the Internet gaming disorder-20 (IGD-20) scale. Methods: A cross-sectional study done on 200 first and second year medical students of Kurnool Medical College, Kurnool during February and March, 2019 using self-administered questionnaire containing IGD-20 which satisfies Griffith’s biopsychosocial component model and questions to assess socio behaviour changes. Data entered and analysed using SPSS version 23. Descriptive analysis, reliability tests, correlation and other appropriate significant tests used. Results: Prevalence of internet gaming disorder was 10%, more in male and who spend more than 30 hours per week on gaming which was statistically significant. Internal consistency of the IGD-20 was 0.91 Cronbach’s alpha. Socio-behavioural changes like aggressiveness, irritability and change in food patterns were significantly associated with excessive disordered gaming habit. Conclusions: Advanced technology as electronic gadgets, easily accessible networks are attracting the generation and making them addicted to it. Stress of the competitive world, loneliness is triggering this behaviour. Timely detection and management of the disordered gamers, scrutiny of parents on the internet gaming usage pattern of their kids, self-realisation and motivation towards physical games could help the youth to succumb the internet gaming disorder.

Analysis of Bangladeshi Medical Undergraduates Ability to Retain Anatomical Information by Using Mnemonics

Anatomy forms the fundamental base for the medical undergraduates during the earlier period of MBBS course. It is a vast subject and it always needs some specialized approach to teaching-learning. For easier retrieval of recalled anatomical information, medical undergraduates use different mnemonics. But the effectiveness of different mnemonic techniques like ‘Rhyme’ and ‘Storytelling’ has not been addressed systematically. Methods: This cross sectional analytical study was conducted in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2017 to February 2018 and sample was collected from two public medical colleges in Dhaka City. Total 93 first year medical undergraduates of both sex were selected and divided into three groups (‘Rhyme’, ‘Storytelling’ and control) in the ‘memory tests’ on Neuronantomy. The effectiveness in memorizing anatomical information was determined and differences between effectiveness detected by comparing the performances of medical undergraduates. Results: Judging by the performances of the medical undergraduates, ‘Rhyme’ was found significantly more effective in memorizing anatomical information than ‘Storytelling’ and control group. Conclusion: The idea regarding the effectiveness of specific mnemonic techniques should be helpful in deciding on where and how to use or avoid the use of mnemonics according to their actual potentials.

Comparative assessment of antibiotic resistance among first and second year undergraduate medical students in a tertiary care teaching hospital

Background: Antibiotics are one of the commonest prescribing drugs in day to day practice. However indiscriminate and irrational use of antibiotics has given rise to the emergence of antibiotic resistance. Thus, intervention in the form of educating students and making them aware about this important concept should be initiated at the gross root level right from the beginning of medical profession. Objective was to assess the comparative awareness regarding antimicrobial resistance between first and second year MBBS students.Methods: This was a comparative, cross-sectional questionnaire based study. Two forty six undergraduate medical students, 118 students from 1st year and 129 students from 2nd year MBBS were included in the study to assess the extent of knowledge and about the problem of antibiotic resistance. Self-administered questionnaire was used to collect the data from respondents. The questionnaires of both the groups were analyzed for the responses of the students and were compared using student ‘t’ test and chi-square test.Results: Majority of the participants 63.6% and 72.9% had completed the full course of antibiotics as prescribed by the physician. Statistically significant difference (p<0.05) was found between the two groups where in 58.4% of the first year and 16.3% of the second year students were of the view that antibiotics can be used for viral illnesses. Only 44.1% students of first year knew the reasons for antibiotic resistance.Conclusions: It can be concluded from the present study that second year medical students were more aware regarding antimicrobial resistance as compared to first year MBBS students who represented the general public. Thus, it is very important to educate the students in a practical manner about this concept as they are the future health care givers who can promote the rational use of antibiotics in near future.

A study to assess and develop injection administration skill in medical undergraduates of GMC, Bhopal

Background: Injections are one of the vital route of drug administration in emergency medical practice. WHO has estimated that out of 12 billion injections administered worldwide annually 50% are unsafe and 75% are unnecessary. Despite of humungous efforts medical students still lack the confidence in injecting drugs due to stress for post graduation selection. The objectives of the study were to assess the knowledge of students regarding administration of I.M. and I.V. injections; to make students confident and skilful about administration of I.M. and I.V. injections and to assess the proportion of students who can skilfully administer I.V. and I.M. before and after this intervention.Methods: This was a Quasi experimental study carried out on 150 students of junior final medical students of GMC Bhopal for a period of three months.Results: Out of effective 136 students, 93.4% had ever seen I.M./ I.V. administration. 29.4% have administered I.M. and 16.9% I.V. injection ever. A significant increase in knowledge regarding I.M. and I.V. administration technique is observed following interventional training of the participants. Significant gain in self confidence among the students was perceived.Conclusions: There was a convincing increase in skillful knowledge and self-confidence for parenteral injection technique among medical undergraduates.

Perception of patient safety among medical graduates in a Tertiary Health Centre of West Bengal

Background: Providing patients with a safe medical environment is an important responsibility of health care organizations worldwide. However, most of these initiatives targeted doctors, managers and other healthcare professionals and rather less attention has been paid to medical students, who are the next generation doctors. This study attempts to assess medical students’ perceptions of patient safety culture thus providing evidence relating to patient safety for the medical school curriculum. Methodology: A cross-sectional study using Modified Medical Study Safety Attitude and professionalism survey consisting of safety culture, team culture, error disclosure culture, safety behaviour intention, over-all patient safety grade was done among the medical undergraduates of final year and internees as they are widely exposed to the patients’ dealings directly. One to one interview was conducted and data were analysed using SPSS software version 20. Results: Out of 163 participants about 76 were females rest were males. The mean age group of study population was 24 +3 years. About 61% of the study population strongly agreed to have followed standard operating procedures, guidelines and protocols for patient safety. Though 79.5% of the participants concerned with the fact that patient safety practices were excellent, almost 30% responded neutral. Majority of our study population 92% agreed to the fact that medical errors are handled properly. Approximately 8% members responded that they would not feel safe being treated here as a patient and 18% remained neutral about it. About 90% of the population supported that quality of care received by the patients is impacted by teamwork. Regarding error disclosure culture 21.5% of the study population disagreed that when errors are made are to be disclosed to patients and their families and 33.74% remained neutral. More than 80% expect to participate in quality improvement initiatives. Conclusion: Positive patient safety attitude existed in this institute but poor attitude existed about medical error disclosure. Educators must begin to recognize the potential effects of the informal and hidden curriculum of patient safety encountered by trainees as they leave the classroom and enter the clinical environment.

A study on knowledge and practices of over the counter medications among 1st year medical students

Background: Self-medication is widely practiced worldwide and often considered as a component of self-care. Selfmedication assumes a special significance among the medical students as they are the future medical practitioners and have a potential role in counselling the patients about the advantages and disadvantages of self-medication. Self-medication assumes a special significance among the medical students as they are the future medical practitioners. Medical students also differ from the general population because they are well-exposed to the knowledge about diseases and drugs. Therefore the present study was taken up to assess the extent of knowledge and practices of over the counter (OTC) drugs among the first year medical students in a tertiary care teaching hospital.Methods: A descriptive, cross sectional, non-interventional, observational study was conducted from November 2017 to January 2018 among 246 first year medical students. The data analyzed using descriptive statistics with percentages and averages using Statistical Package for Social Science (SPSS).Results: In the present study, it was found that 86% students practiced self-medication. Most common conditions for taking self-medication with OTC was fever (89%) followed by cough and cold (75%). 15% of them experienced adverse reactions on OTC self-medicated drugs. The main source of information during self-medication was reading material (56.3%) followed by advice from seniors/pharmacist (43.7%).Conclusions: Self-medication is widely practiced among undergraduate medical students. In this situation, we should educate the students about advantages and disadvantages of self-medication of over the counter drugs.

A comparative study to assess the awareness of antibiotic resistance amongst first and second year medical undergraduate students in a medical college

Background: With the rising instances of antibiotic resistance and decline in the discovery of newer antibiotics, it is high time to prevent the emergence of antibiotic resistance. One of the best measures regarding the above problem is education and creating awareness regarding antibiotic resistance, and that too primarily among healthcare professionals. The initiation should start at the basic level and that too in the early days of medical profession, so that there is greater awareness and strong foundation for antibiotic prescribing pattern. The present study is taken up to compare awareness among 1st year and 2nd year medical students in a private medical college with 2nd year medical students having prior education regarding antibiotics resistance and first year students representing general public without any education regarding antibiotics resistance.Methods: This study was a comparative, cross-sectional, questionnaire based study. The questionnaire was validated for face validity and content validity from subject experts. The two groups selected were 1st year and 2nd year medical undergraduates. Data was analysed using simple descriptive statistics.Results: 136 students from 1st year and 88 students from 2nd year participated in the study. In both the groups studied, majority of the respondents completed the full course of antibiotics. 77% of 1st year and all 2nd year students were aware of the antibiotic resistance. 99% of 2nd year students and only 49% of the 1st year students were aware of the reasons for it (p<0.01). Awareness regarding prophylactic usage of antibiotics, usage for simple common cold and usage of higher antibiotics for mid infection leading to Antibiotic Resistance was significantly less among first year students. 2nd year students were well aware of consequences of antibiotic resistance like ineffective treatment, prolongation of illness, emergence of bacterial resistance and additional cost burden than 1st year students. Awareness regarding other aspects of antibiotic resistance was not significant between two groups.Conclusions: Stressing upon awareness and education regarding antibiotic resistance in the early days of medical curriculum will help in change of behaviour and habits of antibiotic usage and rational prescribing of antibiotics by the future doctors.

A comparative study on self medication practices in ACSR Government medical college in Nellore, India

Background: Self medication is rampant in medical undergraduates. There is a need to evaluate the extent and factors that govern self medication. This study was conducted in 7th semester and 5th semester undergraduates to compare the knowledge, attitude and practice regarding self medication.Methods: It is a questionnaire based study in a total of 294 medical students comprising 147 students each belonging to 7th and 5th semesters to assess determinants and practice methods of self medication in the past one year.Results: 100% of 7th semester and 90% of 5th semester students self medicated. Majority followed modern medicine. Awareness of OTC drugs, essential drugs and generic drugs was not optimum. Students self medicated based on old prescriptions and text books for perceived mild illnesses like common cold, fever and headache. Non steroidal anti-inflammatory drugs and antihistamines were most commonly used. Not all students checked package insert prior to use.Conclusions: Self medication practice is more pronounced in 7th semester than in 5th semester students. 7th semester students used diverse drugs compared to 5th semester students who used limited groups of drugs.

Prevalence of Smart Phone Addiction in Medical Undergraduates - A Cross - Sectional Study.

Aim To estimate the prevalence of potential excessive smart phone use in medical undergraduates and the demographic parameters associated with smart phone addiction in male and female students. Materials and methods A cross sectional study using smart phone addiction scale short version (SAS-SV), 150 medical undergraduates aged 18 to 25 years were assessed. Results There is a significant association between males (50%) , management fee /C category students (35.29%) and excessive smart phone use with p < 0.0482 and <0.010 respectively. Smart phone was most commonly used for messenger application ( whatsapp, fb messenger, google hangouts, etc) followed by video streaming websites (youtube). Conclusion Smartphones can be appreciated by the advantages offered however adolescents need to be cautious about its addictive potential that will adversely affects the mental health

The cultivation of long-term-system medical undergraduates' innovative ability with the aid of extracurricular scientific and technological activities / 中华医学教育探索杂志

An auxiliary training system was explored for the development of creativity of long-termsystem medical undergraduates through scientific researches in spare time.In practice,professionals from research groups of different disciplines were recruited for developing wide-scope theoretical and technical bases of the undergraduates through training among these research groups followed by focused researches on topics of the running projects of these professionals.The undergraduates were engaged in a serial of research activities,including the discovery of problems for reasoning out scientific research projects,the writing of their project proposals,the summary of their data and the writing of reports,to develop their creativity and their qualification for scientific researches.

Cultivation of clinical pathological quality of non-pathological-specialty medical undergraduates / 中华医学教育探索杂志

Clinical medical workers should understand the pathology,and the cultivation of the clinical pathological quality needs to start from the undergraduate course of medical students.In the past 6 years,based on the platform of undergraduate pathology science and technology innovation,and histology research platform of Department of Pathology,and through the creation of the clinical pathology elective courses and other forms,the researchers have given medical undergraduates the systematical and standardized training of the concept,knowledge,skills and application of pathology to develop their clinical and pathological quality during basic courses,professional courses and internship stage of a medical undergraduate.Practice shows that the relevant teaching measures enable students to fully understand the importance of clinical pathology,and improve their ability to apply clinical and pathological knowledge to solve clinical problems.

Evaluation of preventive medicine studnent's quality of life and its relationship to training mode in school / 中华医学教育探索杂志

Objective To understand the situation of undergraduates' quality of life and analyze the influence factors in order to offer basis for improving personnel training mode of public health department in Wuhan University. Methods Questionnaire survey has been conducted among all undergraduates of public health department in Wuhan University. The questionnaire includes the level of internationalization, compound and practice innovation activities. At the same time, students' quality of life has been investigated using the WHOQOL-BREF. SPSS13.0 has been used to make statistical analysis. Scores between groups has been compared utilizing t test, analysis of variance has been made and influence factors has been ana-lyzed utilizing multiple linear regression. Results The average of the undergraduate graduates' quality of life total score is(3.54±0.77),with a scoring rate of 70.9%. The dimension with the highest scoring rate is social relations, and its scoring rate is 75.1%. The dimension with the lowest scoring rate is environment, with scoring rate 65.9%. Compared with the norm, the scores of the overall quality of life, physical health, social relations and environment are all above the norm(P<0.05). The result of multiple linear regression indicates that female(t=-2.338, P=0.020), students from high income family(t=3.512, P=0.001) and students with a high degree of practice innovation activity participation(t=3.515, P=0.001) have a high quality of life. Conclusion The students' quality of life from school of public health, Wuhan University is slightly higher than the general population. The quality of life is influenced significantly by part of cultivating ways. There is a need which personnel training mode is innovated in order to improve the quality of cultivation.