Associations between medical students' stress, academic burnout and moral courage efficacy.

BACKGROUND: Medical students, especially during the clinical years, are often exposed to breaches of safety and professionalism. These contradict personal and professional values exposing them to moral distress and to the dilemma of whether and how to act. Acting requires moral courage, i.e., overcoming fear to maintain one's core values and professional obligations. It includes speaking up and "doing the right thing" despite stressors and risks (e.g., humiliation). Acting morally courageously is difficult, and ways to enhance it are needed. Though moral courage efficacy, i.e., individuals' belief in their capability to act morally, might play a significant role, there is little empirical research on the factors contributing to students' moral courage efficacy. Therefore, this study examined the associations between perceived stress, academic burnout, and moral courage efficacy. METHODS: A cross-sectional study among 239 medical students who completed self-reported questionnaires measuring perceived stress, academic burnout ('exhaustion,' 'cynicism,' 'reduced professional efficacy'), and moral courage efficacy (toward others' actions and toward self-actions). Data analysis via Pearson's correlations, regression-based PROCESS macro, and independent t-tests for group differences. RESULTS: The burnout dimension of 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward others' actions. The burnout dimensions 'exhaustion' and 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward self-actions. CONCLUSIONS: The results emphasize the importance of promoting medical students' well-being-in terms of stress and burnout-to enhance their moral courage efficacy. Medical education interventions should focus on improving medical students' professional efficacy since it affects both their moral courage efficacy toward others and their self-actions. This can help create a safer and more appropriate medical culture.

Food-seeking behavior is triggered by skin ultraviolet exposure in males.

Sexual dimorphisms are responsible for profound metabolic differences in health and behavior. Whether males and females react differently to environmental cues, such as solar ultraviolet (UV) exposure, is unknown. Here we show that solar exposure induces food-seeking behavior, food intake, and food-seeking behavior and food intake in men, but not in women, through epidemiological evidence of approximately 3,000 individuals throughout the year. In mice, UVB exposure leads to increased food-seeking behavior, food intake and weight gain, with a sexual dimorphism towards males. In both mice and human males, increased appetite is correlated with elevated levels of circulating ghrelin. Specifically, UVB irradiation leads to p53 transcriptional activation of ghrelin in skin adipocytes, while a conditional p53-knockout in mice abolishes UVB-induced ghrelin expression and food-seeking behavior. In females, estrogen interferes with the p53-chromatin interaction on the ghrelin promoter, thus blocking ghrelin and food-seeking behavior in response to UVB exposure. These results identify the skin as a major mediator of energy homeostasis and may lead to therapeutic opportunities for sex-based treatments of endocrine-related diseases.

Skin exposure to UVB light induces a skin-brain-gonad axis and sexual behavior.

Ultraviolet (UV) light affects endocrinological and behavioral aspects of sexuality via an unknown mechanism. Here we discover that ultraviolet B (UVB) exposure enhances the levels of sex-steroid hormones and sexual behavior, which are mediated by the skin. In female mice, UVB exposure increases hypothalamus-pituitary-gonadal axis hormone levels, resulting in larger ovaries; extends estrus days; and increases anti-Mullerian hormone (AMH) expression. UVB exposure also enhances the sexual responsiveness and attractiveness of females and male-female interactions. Conditional knockout of p53 specifically in skin keratinocytes abolishes the effects of UVB. Thus, UVB triggers a skin-brain-gonadal axis through skin p53 activation. In humans, solar exposure enhances romantic passion in both genders and aggressiveness in men, as seen in analysis of individual questionaries, and positively correlates with testosterone level. Our findings suggest opportunities for treatment of sex-steroid-related dysfunctions.

The associations between reflective ability and communication skills among medical students.

OBJECTIVES: Assess associations between medical students' reflective ability demonstrated in written narratives, and communication skills demonstrated later in simulated-patient breaking bad news interactions. METHODS: We analyzed 66 medical students' reflective ability, using 'REFLECT' rubric and four newly developed parameters: Noticing Explanations provided to patients, Noticing Emotions, Remoteness/Connectedness in their writing, and mentioning Self-Emotions. 'BAS' and 'SPIKES' questionnaires measured students' communication skills. Spearman and Chi-square tests examined correlations among all variables. Multiple regressions examined associations between reflective ability and demographic variables with communication skills. RESULTS: Significant positive correlations between students' reflective ability, measured by REFLECT and three of the new parameters, and global communication skill scores. Reflective ability of Noticing Explanations in writing was associated with ability to tailoring information to patients' needs and address emotions. CONCLUSIONS: High reflective ability may improve communication skills. Specifically, ability to notice explanations to patients may enhance later capability to tailor information to patients and address emotions empathically. PRACTICE IMPLICATIONS: Encourage educational interventions enhancing reflective ability; specifically observation and detailed writing about how explanations are given to patients and patients' reactions to them. This process may help students develop competency to share and tailor difficult information sensitively-a critical skill when communicating bad news.

Relationship Dynamics and Intimate Partner Violence Among Israeli College Students: The Moderating Effect of Communication Problems.

The present study, based on data from the International Dating Violence Study obtained in 2004 (N = 465) and on data obtained in 2015 (N = 392), estimated the prevalence of intimate partner violence (IPV) victimization and perpetration among Israeli college students. The main purpose of the study was to investigate whether communication problems (i.e., avoidant communication and disrespectful communication) intensify the effects of relationship dynamics (dominance, partner's controlling behavior, and jealousy) on physical IPV. A series of χ2 analyses, independent t tests, and logistic regressions was conducted separately for each sample. Results revealed that in 2015, approximately 20% of the participants reported being a victim of at least one act of physical violence and more than 10% of the participants reported severely attacking a partner. Although there was a significant decline in the prevalence of the severe type of sexual violence victimization, most of the differences between the samples were not significant. The findings further showed that regardless of gender or age, dominance significantly increased the odds of physical violence perpetration, and partner's controlling behavior significantly increased the odds of physical violence victimization. Finally, the interaction effects that were found suggest that when relationships are characterized by an imbalance of power, communication problems may increase the risk of physical violence. The current study provides initial support for the idea that communication difficulties may contribute to conflict escalation and exacerbate the effects of relationship risk factors on physical IPV.

Students' patient-centered-care attitudes: The contribution of self-efficacy, communication, and empathy.

OBJECTIVES: Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but research on perceptions and attitudes that contribute to PCC attitudes is limited. We tested a new model, assessing whether the association between self-efficacy and PCC attitudes is mediated by communication and empathy attitudes. Furthermore, we assessed medical-school-stage and gender differences in these variables. METHODS: Medical/dentistry students (N = 653) completed self-reported questionnaires. Analyses were performed using Pearson's-correlations, PROCESS macro, and independent samples t-tests. RESULTS: The association between communication self-efficacy and PCC attitudes was completely mediated by communication and empathy attitudes. Students in clinical years had more positive attitudes toward PCC and empathy, and higher communication self-efficacy. Females had more positive attitudes toward PCC, communication, and empathy. CONCLUSIONS: The results emphasize the importance of communication self-efficacy and the mediating role of communication and empathy attitudes in enhancing PCC attitudes. This highlights the need to focus on learners' affective matter (what they feel/think) about their competencies and attitudes. PRACTICE IMPLICATIONS: Educational interventions should improve understanding of the benefits of applying good communication skills, of learning the importance of empathy and its relevance to patient care, and strengthening students' confidence in applying these skills. Attention to these is important for enhancing students' PCC attitudes.

What you "see" is how you communicate: Medical students' meaning making of a patient's vignette.

OBJECTIVES: To examine how medical students notice issues in a vignette and construct their meaning, and how this construction influences their plan to communicate with the patient. METHODS: Following a breaking bad news course for 112 senior medical students, we qualitatively analyzed the participants' written descriptions of the issues they noticed as requiring special attention, using an Immersion/Crystallization iterative consensus process. RESULTS: Different students noticed different issues, but no-one noticed all 19 planted issues (Mean of issues noticed by students = 6.77; SD = 2.29). The students wrote about the issues in 46 different ways, representing the diverse meanings they ascribed, ranging from identifying, through inferring, to interpreting while jumping to conclusions. Moreover, for some issues, some students focused on the patient whereas others focused on the physician or the physician-patient relationship. Noticing issues led to preparing for communication with the patient. CONCLUSIONS: Noticing the issues and the subsequent meaning-making process facilitated the preparation to address them in the envisioned encounter. PRACTICE IMPLICATIONS: When teaching communication skills, it would be helpful to focus on increasing students' awareness of the issues they notice or fail to notice and their personal meaning-making process. This might reduce bias and enhance their preparation for effective patient-centered communication.

Assessing an Intervention Focused on Enhancing Interpersonal Communication Skills and Humor: A Multi-Method Quasi-Experiential Study Among Medical Students.

Teaching and applying interpersonal communication skills (ICS) and humor in medicine is challenging. The present study assessed an innovative course focused on enhancing ICS and humor based on the Four Habits Model and theater concepts. Medical students enrolled in the course (the study group) were assessed pre- and post-intervention, as well as compared with their peers (the control group) using quantitative methods to measure attitudes, self-efficacy, and behaviors. Qualitative methods were used to learn about students' change in perceptions related to ICS and humor following the course, as well as their experiences of developing these skills during the course. Post-intervention study group participants scored significantly higher on all ICS measurements and on humor behavior compared with pre-intervention, and significantly higher on all humor measurements compared with control group participants. Interviews indicated students' increased understanding and difficulties in learning these skills. Analyses showed how framing humor as one possible ICS and focusing on specific parts of the medical encounter can promote patient-centered care.

Social comparisons and well-being following widowhood and divorce.

A sample of 196 participants (mean age 45.94 years, 54% women) completed inventories assessing upward and downward positive and negative social comparisons and general well-being. Widows and widowers were higher on upward negative comparisons than divorced or married persons while being lower on well-being measures of life satisfaction and psychosocial adjustment. The divorced were higher than the widowed or married people on upward or downward positive social comparisons. Upward negative social comparisons were associated with lower levels of well-being measures whereas upward positive social comparisons showed an opposite tendency. Upward negative comparisons were found to mediate the effects of widowhood on well-being. It is concluded that cognitive adaptation contributes to the well-being of widowed and divorced persons.

Burnout, social support, and coping at work among social workers, psychologists, and nurses: the role of challenge/control appraisals.

The purpose of this study is twofold: (1) to compare stress appraisals, coping strategies, social resources, and burnout at work between social workers, psychologists and nurses; and (2) to assess the effectiveness of appraisals and support in reducing burnout and enhancing effective coping strategies. Questionnaires containing assessments of work stress appraisals, coping strategies used to deal with problems at work, and social support at work, as well as burnout measures of exhaustion, depersonalization, and accomplishment were completed by 249 female professionals (age range 25-61). No differences were observed between the three professions on most psychological measures, except for the depersonalization outcome of burnout, which was significantly lower among psychologists than among nurses or social workers. High challenge/control appraisal of the job was directly related to all burnout outcomes, contributing to less exhaustion and depersonalization and to more personal accomplishment. The challenge/control appraisal was also negatively associated with emotion-focused coping. By comparison, the stress/load appraisal contributed to more exhaustion at work, while emotion-focused coping contributed to higher depersonalization. Social support was associated with higher challenge/control appraisal, with the latter mediating support effects on burnout. These data suggest that the perception of challenge/control in one's work may be an important factor in preventing work burnout in the three professions tested in the study.

Risk-taking among adolescents: associations with social and affective factors.

The research investigated the associations of social and affective factors with risk-taking in male and female adolescents. A sample of 269 Israeli adolescents completed questionnaires measuring frequency of involvement in risk-taking behaviours, relationships with parents, orientation towards peer group, depressive mood, and aggressive behaviour. Correlations and multiple regression analyses showed that risk behaviour among male adolescents was mainly related to orientation towards peer group, while for female adolescents relationships with parents was the prominent factor in risk behaviour. The parental factor also contributed to the depressive mood of both genders in the sample. However, depressive mood showed only a weak association with risk taking. These results underscore the differential associations of relationships with parents vs. peers among adolescent boys and girls, respectively, in regard to risk taking.