Willingness to practice medicine and related influential factors among medical undergraduates during COVID-19: a cross-sectional study.

BACKGROUND: As the medical undergraduates constitute the future workforce in China, their career preferences hold a significant bearing on the quality of healthcare services, particularly in light of the ongoing COVID-19 pandemic. We aim to understand the current state of the willingness to practice medicine among medical undergraduates and to analyze the related influential factors. METHODS: During the COVID-19 epidemic, we conducted a cross-sectional survey via an online platform from February 15, 2022, to May 31, 2022, to collect participants' demographic information, psychology, and factors influencing their career choices. The general self-efficacy scale (GSES) was used to evaluate medical students' perceptions of their self-efficacy. Futhermore, we conducted multivariate logistic regression analyses to explore the influencing factors of medical undergraduates' willingness to pursure a caree in medicine. RESULTS: A total of 2348 valid questionnaires were included, and 1573 (66.99%) were willing to practice medicine for medical undergraduates after graduation. The mean GESE scores in the willingness group (2.87 ± 0.54) were significantly higher than those of the unwillingness group (2.73 ± 0.49). The multiple logistic regression showed that several factors were positively associated with willingness to practice medicine as a career, including students' GSES score (OR = 1.87), current major, household income, personal ideals (OR = 1.97), family support (OR = 1.44), high income (OR = 1.77), and social respect (OR = 2.19). Compared with those who were very afraid of COVID-19, students who did not express any fear towards the COVID-19 pandemic had a higher preference for choosing the medical profession as a career. Conversely, students thinking of high tension in the doctor-patient relationship, heavy workload, and long training were less likely to choose medical work after graduation. CONCLUSIONS: The study highlights a noteworthy prevalence of medical undergraduates who expressed their willingness to pursue medicine as a career post-graduation. Several factors, including but not limited to current major, household income, psychological factors, personal preferences, and career needs or preferences, were significantly associated with this willingness. Moreover, the impact of the COVID-19 pandemic on medical students' career choices cannot be overlooked.

Perceived a community with shared future for doctor-patient and benefit finding: a moderated mediation model.

BACKGROUND: Under the background that the concept of a community with shared future for mankind has been advocated, the doctor-patient relationship has rapidly sublimated into a community with shared future for doctor-patient. The purpose of this study was to analyze the changes and relationships of anxiety, perceived a community with shared future for doctor-patient (PCSF), health self-consciousness (HSC) and benefit finding (BF) in the outbreak stage of COVID-19 and in the stable stage of COVID-19. METHODS: The questionnaire consisted of a self-designed health self-consciousness scale, perceived a community with shared future for doctor-patient scale, revised 7-item generalized anxiety disorder scale and benefit finding scale. Questionnaires were administered in the outbreak stage of COVID-19 and in the stable stage of COVID-19 to address public anxiety, BF, and trust between medical staff and patients. RESULTS: Risk perception will increase anxiety in public, and the public who trust medical staff and the ability of the government to prevent and control the epidemic will have a higher PCSF. Compared with those in the outbreak stage of COVID-19, PCSF, HSC and BF all decreased in the stable stage of COVID-19. HSC partly plays a mediating role in the process of the influence of PCSF and BF (95% CI = [0.3785, 0.5007], [0.2357, 0.3695], P < .001). The R-value of the model in the outbreak stage of COVID-19 and in the stable stage of COVID-19 were 0.555 and 0.429, and the value of R2 was 0.308 and 0.184 respectively (P < .001). In the stable stage of COVID-19, the coefficient of anxiety ✕ PCSF is negative. The B values of anxiety and PCSF are positive, and the moderating effect is negative (P = .038). Anxiety has a negative moderating effect between PCSF and HSC, indicating that anxiety will weaken the positive impact of PCSF on HSC. It means that there exists a substitution relationship between anxiety and PCSF. CONCLUSIONS: The common goal of medical staff and patients is health, and health is the premise of the meaning of life. Vigorously advocating for PCSF can not only promote a harmonious doctor-patient relationship, but also establish a good HSC and improve the understanding of the meaning of life in the public. Furthermore, if the common concept of a community with a shared future for doctor-patient is integrated into the values of life, it may be more stable and long-term to maintain a good doctor-patient relationship. In addition, we should guard against the influence of high-level anxiety on the path of meaning perception.

Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points.

In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.

How the use of an online healthcare community affects the doctor-patient relationship: An empirical study in China.

Possible improvements to the doctor-patient relationship are an important subject confronting national healthcare policy and health institutions. In recent years, online healthcare communities have changed the ways in which doctors and patients communicate, especially during the COVID-19 pandemic. However, previous research on how usage of online healthcare communities has affected the doctor-patient relationship is rather limited. This paper proposes a research model to investigate the relationship between online healthcare community usage and the doctor-patient relationship. An analysis of 313 patients' data using structural equation modeling showed the following. First, the use of an online healthcare community has a positive impact on doctor-patient communication, helps improve the performance of healthcare procedures, and reduces healthcare costs. Second, doctor-patient communication and healthcare costs have a positive impact on patients' emotional dependence and patients' perception of healthcare quality, while healthcare procedures do not have this impact. Finally, patients' emotional dependence and perception of healthcare quality have a positive effect on doctor-patient relationship through the mediator of patients' satisfaction.

Understanding peer support: a qualitative interview study of doctors one year after seeking support.

BACKGROUND: Doctors' health is of importance for the quality and development of health care and to doctors themselves. As doctors are hesitant to seek medical treatment, peer support services, with an alleged lower threshold for seeking help, is provided in many countries. Peer support services may be the first place to which doctors turn when they search for support and advice relating to their own health and private or professional well-being. This paper explores how doctors perceive the peer support service and how it can meet their needs. MATERIALS AND METHODS: Twelve doctors were interviewed a year after attending a peer support service which is accessible to all doctors in Norway. The qualitative, semi-structured interviews took place by on-line video meetings or over the phone (due to the COVID-19 pandemic) during 2020 and were audiotaped. Analysis was data-driven, and systematic text condensation was used as strategy for the qualitative analysis. The empirical material was further interpreted with the use of theories of organizational culture by Edgar Schein. RESULTS: The doctors sought peer support due to a range of different needs including both occupational and personal challenges. They attended peer support to engage in dialogue with a fellow doctor outside of the workplace, some were in search of a combination of dialogue and mental health care. The doctors wanted peer support to have a different quality from that of a regular doctor/patient appointment. The doctors expressed they needed and got psychological safety and an open conversation in a flexible and informal setting. Some of these qualities are related to the formal structure of the service, whereas others are based on the way the service is practised. CONCLUSIONS: Peer support seems to provide psychological safety through its flexible, informal, and confidential characteristics. The service thus offers doctors in need of support a valued and suitable space that is clearly distinct from a doctor/patient relationship. The doctors' needs are met to a high extent by the peer-support service, through such conditions that the doctors experience as beneficial.

Influencing factors of work stress of medical workers in clinical laboratory during COVID-19 pandemic: Working hours, compensatory leave, job satisfaction.

Background: The COVID-19 pandemic continues to pose unprecedented threats and challenges to global public health. Hospital Clinical Laboratory and public health institutions have been playing an important role in case detection, epidemic research and decision-making, and epidemic prevention and control. Objective: To explore the current situation and influencing factors of work stress of medical workers in hospital clinical laboratory in fighting against COVID-19. Methods: A cluster random sampling method was used to select seven hospitals from 14 tertiary hospitals in Xiamen, and medical workers in the selected hospitals were investigated by self-administered questionnaire. A total of 150 medical workers inclinical laboratory participated in this survey, 138 valid questionnaires were collected, with a response rate of 92%. Results: The work stress scores of the medical workers in the clinical laboratory of hospital in the COVID-19 epidemic were collected (55.22 ± 11.48); The top three dimensions of work stress score were work stress (work load), external environment and doctor-patient relationship. The results of multiple stepwise regression analysis showed that the working hours per day, whether overtime and night shift can get compensatory leave and Job satisfaction with the work of the clinical laboratory were the main factors affecting the work stress level of medical workers in the clinical laboratory of hospital during COVID-19 epidemic. Conclusion: The COVID-19 has caused great harm to the physical and mental health of the public. Medical staff are in the front line of prevention and control of the epidemic, so medical workers in hospital clinical laboratory exposed to a high level of stress at work. Laboratory leaders and hospital managers should take active and effective measures to reduce the working hours of the medical staff in clinical laboratory, optimize the arrangement of night shift and overtime working, strengthen the training of group and individual pressure management, reduce the work stress of the medical staff, improve the overall happiness of the medical staff in clinical laboratory, and stabilize the clinical laboratory team, improve the physical and mental health of medical workers in clinical laboratory.

Strengthening Doctor-Patient Relationships Through Hospital-Based Violence Interventions.

PROBLEM: Violence in Chicago has been persistently high in low-income communities of color. Recent attention has focused on how structural inequities weaken protective factors that help keep communities healthy and safe. Spikes in community violence seen in Chicago since the COVID-19 pandemic further expose the lack of social service, health care, economic, and political safety nets in low-income communities and the apparent dearth of faith in those systems. APPROACH: The authors contend that a comprehensive, collaborative approach to violence prevention that prioritizes treatment and community partnerships is needed to address social determinants of health and structural characteristics that often provide the context for interpersonal violence. One strategy to address decreasing faith in systems like hospitals is foregrounding frontline paraprofessional prevention workers who possess cultural capital based on their experiences navigating interpersonal and structural violence. Hospital-based violence intervention programs help professionalize these prevention workers by providing a framework for patient-centered crisis intervention and assertive case management. The authors describe how the Violence Recovery Program (VRP), a multidisciplinary hospital-based violence intervention model, leverages the cultural capital of credible messengers to use teachable moments to promote trauma-informed care to violently injured patients, assess their immediate risk for reinjury and retaliation, and connect them to wrap-around services to help aid comprehensive recovery. OUTCOMES: Violence recovery specialists have engaged over 6,000 victims of violence since the program's launch in 2018. Three-quarters of patients expressed social determinants of health needs. Over the past year, specialists have connected over one-third of engaged patients to mental health referrals and community-based social services. NEXT STEPS: High violence rates in Chicago limited case management opportunities in the emergency room. In fall 2022, the VRP began to establish collaborative agreements with community-based street outreach programs and medical-legal partnerships to address structural determinants of health.

Does the Doctor-Patient Relationship Affect Enrollment in Clinical Research?

PURPOSE: Recruiting patients for clinical research is challenging, especially for underrepresented populations, and may be influenced by patients' relationships with their physicians, care experiences, and engagement with care. This study sought to understand predictors of enrollment in a research study among socioeconomically diverse participants in studies of care models that promote continuity in the doctor-patient relationship. METHOD: A study of the effects of vitamin D levels and supplementation on COVID-19 risk and outcomes was implemented from 2020 to 2022 within 2 studies of care models at the University of Chicago that promoted continuity of inpatient and outpatient care from the same physician. Hypothesized predictors of vitamin D study enrollment included patient-reported measures of the care experience (quality of relationship with the doctor and their staff, timely receipt of care), engagement in care (scheduling and completing outpatient visits), and engagement with these "parent" studies (follow-up survey completion). The authors used univariate tests and multivariable logistic regression to examine the association of these predictors with enrollment in the vitamin D study among participants in the parent study intervention arms. RESULTS: Among 773 eligible participants, 351/561 (63%) in the parent study intervention arms enrolled in the vitamin D study, versus 35/212 (17%) in the control arms. Among intervention arm participants, vitamin D study enrollment was not associated with reported quality of communication with or trust in the doctor, or helpful/respectful office staff, but was associated with report of receiving timely care, more completed clinic visits, and higher parent study follow-up survey completion. CONCLUSIONS: Study enrollment may be high in care models with high levels of continuity in the doctor-patient relationship. Rates of clinic involvement, parent study engagement, and experience of receiving timely access to care may better predict enrollment than quality of the doctor-patient relationship.

Differences in Perception of Healthcare Management between Patients and Professionals.

Patient perception and the organizational and safety culture of health professionals are an indirect indicator of the quality of care. Both patient and health professional perceptions were evaluated, and their degree of coincidence was measured in the context of a mutual insurance company (MC Mutual). This study was based on the secondary analysis of routine data available in databases of patients' perceptions and professionals' evaluations of the quality of care provided by MC Mutual during the period 2017-2019, prior to the COVID-19 pandemic. Eight dimensions were considered: the results of care, coordination of professionals, trust-based care, clinical and administrative information, facilities and technical means, confidence in diagnosis, and confidence in treatment. The patients and professionals agreed on the dimension of confidence in treatment (good), and the dimensions of coordination and confidence in diagnosis (poor). They diverged on confidence in treatment, which was rated worse by patients than by professionals, and on results, information and infrastructure, which were rated worse by professionals only. This implies that care managers have to reinforce the training and supervision activities of the positive coincident aspects (therapy) for their maintenance, as well as the negative coincident ones (coordination and diagnostic) for the improvement of both perceptions. Reviewing patient and professional surveys is very useful for the supervision of health quality in the context of an occupational mutual insurance company.

Patients and general practitioners agree that wearing masks during consultations complicates physician--patient relationships: An exploratory, qualitative study.

BACKGROUND: The physician--patient relationship plays a critical role in the quality of primary care management. The generalised wearing of surgical masks in enclosed spaces - common during the COVID-19 pandemic -- could change the communication between patients and healthcare professionals. OBJECTIVES: To assess how general practitioners (GPs) and patients feel about wearing masks during a consultation and its influences on physician--patient relationship. To evaluate methods healthcare professionals could use to compensate for mask wearing during a consultation. METHODS: A qualitative study using semi-structured interviews based on a literature-based interview guide with GPs and patients in Brittany, France. Recruitment took place from January to October 2021 until data saturation. Two independent investigators performed an open and thematic coding and then discussed their results with a consensus procedure. RESULTS: Thirteen GPs and 11 patients were included. It appears that wearing masks complicates consultations by creating distance, impairing communication, mainly non-verbal and altering relationship quality. However, GPs and patients believed relationships were preserved, especially those with a solid foundation prior to the pandemic. GPs described having to adapt to maintain relationship. Patients worried about misunderstandings or diagnostic errors but saw the mask as a protective factor. GPs and patients described similar populations requiring vigilance, including geriatric and paediatric populations, and people with hearing impairments or learning difficulties. According to GPs, possible adaptations include speaking clearly, exaggerating non-verbal communication, temporarily removing mask while maintaining safe distance and identifying patients who need increased vigilance. CONCLUSION: Wearing masks makes the doctor--patient relationship more complex. GPs adjusted their practice to compensate.

Breaking Bad News: Integrating the Spikes Model into Medical School Curriculum.

INTRODUCTION: Breaking bad news to patients is a daunting yet inevitable task for most physicians. When done poorly, physicians can cause further pain to the patients while creating great distress for themselves; therefore, it is important medical students learn effective and compassionate techniques. The SPIKES model was created as a guiding framework for providers to use when breaking bad news. The objective of this project was to create a sustainable method to integrate use of the SPIKES model for giving bad news to patients into the curriculum for the University of South Dakota Sanford School of Medicine (SSOM). METHODS: The changes to the curriculum occurred in three phases - one for each Pillar of the University of South Dakota SSOM's curriculum. The first session was a lecture format introducing and defining the SPIKES model for the first-year students. The second lesson was both didactic and interactive, as students were able to practice the SPIKES model through role-playing with colleagues. Prior to COVID, the final lesson was planned to be a standardized patient encounter for the graduating students; however, this lesson ended up in a virtual lecture format. A pre- and post-survey was given for each lesson to determine the usefulness of the SPIKES model in preparing students for handling these challenging conversations. RESULTS: 197 students completed the pre-test survey, and 157 students completed the post-test survey. Overall, a statistically significant improvement was found in students' self-reported confidence, preparedness, and comfort. When the data was broken down based upon year of training, not all cohorts had statistically significant improvement in all three categories. CONCLUSIONS: The SPIKES model serves as a good framework for students to use and tailor to the specific patient encounters. It was evident these lessons greatly improved the student's confidence, comfort, and plan of action. The next step would be to study whether improvement is noted from a patient's perspective and what mode of instruction was most effective.

E-páciensek Magyarországon: Digitális egészséggel kapcsolatos ismeretek, szokások egy országos reprezentatív felmérés tükrében.

INTRODUCTION: The impact of digitalisation on healthcare has become one of the most important research areas in recent years. The COVID-19 epidemic has been a major driver in this process. OBJECTIVE: In our nationally representative, population-based survey (n = 1500), we sought to find out how patients in Hungary use digital health tools, what the advantages and disadvantages of introducing and using these technologies are, and how this is transforming the doctor-patient relationship. METHODS: We conducted a national representative telephone questionnaire survey (CATI). The sample is representative of the adult population of Hungary in terms of gender, age, type of settlement and education. RESULTS: 81.3% of the respondents use the internet - 87.6% of whom use it in relation to health and illness, too. This is 71.2% of the total sample. Websites (76.3%) and social media (47.3%) are the main sources of information on the internet; e-prescription and online appointment booking are the most known by patients (92.6% and 85.2%, respectively), while almost half of the respondents would like to try telehealth and would welcome a recommendation from their doctor on reliable websites, apps and sensors. Our results highlighted that the effect of the type of settlement on access to digital health is not significant, but that the effect of age, education and gender is decisive. CONCLUSION: Data from our national representative population survey indicate that the use of digital health solutions is already an integral part of care and that there is a strong demand for further digital options. Orv Hetil. 2022; 163(29): 1159-1165.

The art of shared decision making.

ABSTRACT: Now more than ever, we know that there is uncertainty in medicine. Over the past 2 years, we have witnessed the evolution of knowledge that occurs in medicine and how this informs medical recommendations. Similarly, we have learned that patients have varying levels of risk tolerance, goals, and values. Although this is not a new reality, the COVID-19 pandemic has put it on display. Shared decision making is a tool for clinicians to use that recognizes this reality, honors the individuality of each patient, and guides us to the best decision for each patient.

Interaction with Patients as a Budding Doctor: An Experience.

Every medical student amidst COVID-19 missed out on an integral part of medical education which is interaction with patients as all the physical classes were postponed for months. Effective interaction with patients is the heart of medicine and it provides a synergistic effect on the delivery of high-quality care to the patient. However many medical students underestimate the art of communication. This article highlights the importance of basic communication skills; also encourages reflecting upon the whole experience and extracting the learning to apply to any further interactions. Keywords: communication; empathy; medical students; healthcare quality.

Access to general practice during COVID-19: a cross-sectional view of the opinions of adults who use social media.

Background/Aim: Since the onset of the COVID-19 pandemic, virtual consultations have become commonplace, and access to healthcare more complex. The study was designed to examine the impact COVID-19 has had on access to general practice care in Ireland. Methods: A 25-question online survey was designed in Qualtrics®. Adult patients of Irish general practices were recruited via social media between October 2020 and February 2021 and volunteered their opinions. Results: 670 persons participated. Half of all doctor-patient consultations were now completed virtually-predominantly via telephone. Overall, 497 (78%) participants accessed their healthcare teams as scheduled, and without disruption. 18% of participants (n=104) reported difficulty in accessing their long-term medications; those who are younger, and those who typically attend general practice quarterly or more, were associated most with this disruption (p<0.05). Fifty-nine instances where a new health concern was subject to an appointment cancellation or rescheduling were reported. Conclusions: Despite the COVID-19 pandemic, Irish general practice has maintained its schedule for appointments in 78% of cases despite the challenges of the pandemic. Half of consultations were provided virtually; teleconsultation use was very infrequent. Maintaining the supply chain for long-term medications for patients remains a challenge during a pandemic. Authors accept that study participants were confined to those who use social media. A protocol may need to be designed by each practice to optimize the continuation of care and of medication schedules during any future pandemics.

Visual Communication and Creative Processes Within the Primary Care Consultation.

Discussion of the value of image, metaphor and creative principles to good consulting skill and patient education within the Primary Care setting is important in enhancing improved patient-physician interactions. A broad-based view of the techniques used in undergraduate and postgraduate teaching within Medical Education in the UK and US are canvassed to establish the best practices and efficacy of using drawings and images as communication tools between physicians and patients. A descriptive analysis of the author's use of image and metaphor is analysed to assess how such convey medical information and help in the improvement of consultation and patient understanding.