An untapped potential: Curiosity in medical school.

BACKGROUND: There seems to be a common perception among medical educators that curiosity is untapped or even subjugated in medical education. This review aims to summarize research on curiosity across the fields of psychology, neuroscience, and education and report its potential to advance medical education. METHODS: For this narrative review multiple online libraries were searched using variations of the terms curiosity and school/education/learning. Additional studies were reviewed using the reference lists of included studies, and all studies were assessed for quality and relevance. RESULTS: This review of previous research on curiosity shows that curiosity can significantly impact characteristics relevant to medical education, particularly mental health and learning. In addition, the authors outline how curiosity is linked to other epistemic emotions such as anxiety, novelty, surprise, and uncertainty. Finally, an epistemic-emotion-framework (EEF) is proposed to help educators encourage curiosity in medical students. CONCLUSION: By drawing from other research fields, medical educators can learn valuable lessons about the importance of curiosity and how to influence it. This review provides an overview of current research and a framework for how the potential of curiosity can be harnessed to play an important role in students' medical education.

Understanding Alveolar echinococcosis patients' psychosocial burden and coping strategies-A qualitative interview study.

BACKGROUND: Alveolar echinococcosis (AE) is a serious parasitic zoonotic disease that resembles malignancy with clinically silent infiltrative growth predominantly involving the liver. AE patients show high levels of comorbid psychological burden and fear of disease progression. This study aimed to examine AE patients' perspective on their disease-related psychosocial burden using qualitative methods. METHODS: We conducted N = 12 semi-structured interviews with AE patients focusing on their disease-related psychosocial burden, coping strategies, information seeking behavior, and subjective illness concepts. To this end, AE patients from a previous quantitative cross-sectional study were invited to participate. After verbatim transcription, interviews were analyzed thematically. RESULTS: After analysis, data was grouped into five main themes: A) Perceived disease-related burden, B) Coping with disease-related burden, C) Disease-related impact on their social environment, D) Facing the future with the disease, and E) Disease-related information seeking behavior and subjective illness concepts. All participants perceived AE as a severe disease with inextricably linked biological, psychological, and social effects. Key positive influences reported included the provision of information and access to informal and formal support, including the ability to lead active personal and professional lives for as long as possible. Self-directed, web-based information seeking often led to increased feelings of hopelessness and anxiety. CONCLUSION: Our findings underscore the need to consider psychosocial morbidity in AE patient management. To reduce psychological burden, address disease-related apprehensions, and to prevent stigmatization, health professionals need to provide AE patients with comprehensive disease-related information to improve patient and social awareness.

Measuring an understudied factor in medical education - development and validation of the medical curiosity scale.

Curiosity, which has been called the third pillar of academic achievement and positively predicts academic performance (von Stumm et al., 2011), is widely recognized as an important factor in acquiring knowledge and skills in medical training, and may be critical for students´ sound mental health. Medical educators have advocated that curiosity should play a more significant role in medical training and have criticized didactic barriers impeding student curiosity. However, in medical training, curiosity is understudied partly due to a lack of methods for measuring curiosity. Therefore, this study was designed to develop and validate a scale to measure medical curiosity. After reviewing the literature and interviewing a panel of experts (n = 7), 25 preliminary items assessing medical curiosity were developed and administered to n = 305 medical students (n = 163 female and n = 142 male) at Heidelberg University across all medical school years. Following exploratory factor analysis (EFA) with oblique (promax) rotation, we measured medical curiosity in a medical student sample. We have identified two distinct factors: intellectual medical curiosity (IMC) and social medical curiosity (SMC). IMC describes the desire to acquire medical knowledge for curiosity's sake, while SMC refers to curiosity about human nature and, in particular, patient health. Both factors showed good psychometric properties, with eigenvalues of 6.7 and 3.5, explaining 26.6% and 14.0% of the variance and internal consistencies of 0.796 and 0.866, respectively, and high convergent and discriminant validity. While first-year students showed significantly higher IMC scores than final-year medical students, SMC scores remained stable and tended to increase throughout medical school. This study has succeeded in developing the first scale to measure aspects of medical curiosity and, thus, lays the groundwork for future studies examining medical students' curiosity. A deeper understanding of medical students' curiosity can help to foster this curiosity effectively.

Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis.

Due to pre-, peri- and post-migratory stress factors, refugees often experience higher levels of psychological stress than the general population. Post-traumatic stress disorder, in particular, has an increased prevalence in the refugee population. However, living conditions in the early post-migratory phase are characterized by many challenges. In the present qualitative study, 14 refugees with symptoms of PTSD from temporary accommodations in Germany were interviewed in semi-structured interviews about their individual experiences of the impact of their trauma sequelae symptoms on their current living conditions and interactions. Participants reported dealing with post-traumatic symptoms primarily through distraction strategies, such as working or learning the language or social interaction. Many reported a sense of mistrust as a result of traumatic experiences. Current stress factors cited included uncertain asylum status, worry about family members and lack of ability to influence living situations. The interactions between the post-traumatic symptoms and the living conditions of the refugees were highlighted. The effects of the symptomatology of trauma sequelae and the framework conditions under which refugees live can lead to aggravated psychological distress. Therefore, special attention must be paid to refugee mental health care.

The psychological burden of volunteers in psychosocial emergency care - a qualitative interview study.

Psychosocial emergency care personnel provide voluntary psychological support directly after potentially traumatic events. During emergency responses, they experience challenging situations. However, previous quantitative studies suggest that the psychological burden of psychosocial emergency care personnel does not exceed that of the general population. This study aimed to obtain an in-depth analysis of the volunteers' psychological reactions and resources regarding emergency responses. 36 psychosocial emergency care volunteers (12 pre-training, 12 post-training, 12 experienced) were invited to participate in semi-structured interviews. The volunteers were selected from previous cross-sectional and longitudinal studies on secondary traumatization in psychosocial emergency care volunteers. A qualitative content analysis of the transcribed interviews was performed following the principles of summary and inductive category development. We identified 845 codes which we summarized in three overarching categories: (I) reactions to emergency responses, (II) psychosocial emergency care work related resources and (III) experiences and changes in life perspective related to working in psychosocial emergency care. The volunteers described both emotional and physical reactions to emergency responses. While they perceived social support as a key coping resource and reported a greater appreciation of their own lives and their families due to their work, many volunteers also felt increased concern that something could happen to them. The volunteers' reactions and symptoms are reasonable responses to stress and not indicative of serious impairment. Nevertheless, emergency responses are both emotionally and physically challenging. Volunteers should be carefully selected, receive regular supervision and determine the frequency of emergency responses.

Maternal mental healthcare needs of refugee women in a State Registration and Reception Centre in Germany: A descriptive study.

Pregnant refugees and new mothers are at high risk of developing mental health problems. Previous research has highlighted an increase in adverse pre-, peri- and postpartum outcomes in refugee women and their newborns. This descriptive study aimed to present the characteristics and needs of refugee women who attended a psychosocial walk-in clinic addressing pregnant refugees' and new mothers' maternity mental healthcare needs in a state registration and reception centre in Germany. We assessed all patients that consulted the clinic and received interventions during the first 28 weeks after it opened, collecting information on symptoms, diagnoses, attitudes towards and experience of pregnancy, birth, obstetric care and applied psychosocial interventions during consultations. Between November 2017 and May 2018, N = 120 pregnant refugees and new mothers attended the clinic. Most patients were diagnosed with post-traumatic stress-, adjustment- or depressive disorder. While 69.6% of the women reported physical and mental health problems during pregnancy, 87.4% experienced obstetric complications. Trauma-informed and psychoeducational interventions were primarily used during counselling sessions. Our data underpin the glaring disparities in refugee maternal healthcare in Germany. Maternal care designed to meet the specific needs of pregnant refugees and mothers is essential. More targeted, evidence-based and cost-effective interventions are needed. Our psychosocial walk-in clinic is a first step towards ensuring primary care delivery for refugee women during the particularly vulnerable period of pregnancy and early motherhood.

Medical students' mental burden and experiences of voluntary work in COVID-19 patient support and treatment services: a qualitative analysis.

Aim: Medical training is undergoing a dramatic shift toward alternative training methods due to the SARS-CoV-2 pandemic. This study is the first to examine medical students' expectations, experiences, and mental burden related to volunteering in COVID-19 patient support and treatment services using semi-structured interviews. Methods: In May 2020, all 194 Heidelberg University Medical School students involved in volunteer COVID-19 support and treatment services were invited to participate in a cross-sectional, qualitative interview study. The semi-structured interviews were digitally recorded, transcribed, and then analyzed using Mayring's principles for content analysis. Results: We interviewed 12 medical students (8 female, mean age 23.2 years, mean medical training 3.7 years) working in Heidelberg COVID-19 crises management services, i.e., the Heidelberg Medical Hospital COVID-19 inpatient and outpatient units. The analysis revealed two key themes: "Expectations and structural barriers" and "Experiences and mental burden". The participants reported uncertainty and apprehension before starting their voluntary work. Although they initially found volunteering to be somewhat disorganized, their roles became clearer with time. In addition, they reported good team cohesion, which helped reduce initial concerns and uncertainties. The participants also felt that working in the field had helped them maintain their professional identification while standard medical classes and bedside learning were suspended due to the COVID-19 crises. Overall, they reported little volunteer work-related mental burden. Conclusions: The participants felt that volunteering during the COVID-19 crisis had benefited their professional development. A designated liaison person, psychosocial support, and introductory and accompanying courses could help alleviate initial concerns and interim difficulties in future crisis-related assignments.

Teaching patient-centred communication skills during clinical procedural skill training - a preliminary pre-post study comparing international and local medical students.

BACKGROUND: International medical students are frequently confronted with intercultural, psychosocial, and language barriers and often receive lower marks in written, oral, and clinical-practical examinations than fellow local students. Training communication competence in procedural skills, such as blood sampling, is further challenge in this particular group of medical students. This pre-post comparative intervention study aimed to investigate the effects of training communication skills during the performance of procedural skills (taking blood samples from a silicone model) in international and local students as part of their clinical practical medical training. METHODS: Study participants performed blood sampling on an arm prosthesis model (part-task trainer) before and after the communication skills training, focusing on accompanying communication with a simulation patient sitting next to the arm model. The pre- and post-evaluation video was assessed by two independent evaluators using a binary checklist, the Integrated Procedural Performance Instrument (IPPI) and global assessments of clinical professionalism in terms of procedural and communication performance. Linear models with mixed effects were used. Group differences regarding global competence levels were analysed with χ2-tests. RESULTS: International medical students did not perform as well as their local counterparts in the pre- and post-examinations. Both groups improved their performance significantly, whereby the international students improved more than their local counterparts in terms of their communication performance, assessed via binary checklist. Clinical professionalism evaluated via global assessments of procedural and communication performance highlights the intervention's impact insofar as no international student was assessed as clinically not competent after the training. CONCLUSIONS: Our results suggest that already a low-dose intervention can lead to improved communication skills in medical students performing procedural tasks and significantly increase their confidence in patient interaction.

A Qualitative Evaluation of a Mother and Child Center Providing Psychosocial Support to Newly Arrived Female Refugees in a Registration and Reception Center in Germany.

Female refugees are frequently exposed to sexualized, gender-based violence and harassment before, during, and after their flight. Yet female refugee-specific care and protection needs are rarely addressed in host countries. This study aimed to evaluate a mother and child center (MUKI) for female refugees in a reception and registration center in Germany. In 2017, we conducted semi-structured qualitative interviews with 16 female refugees attending the MUKI and with its five main staff members. We asked the participants about the MUKI's relevance, encountered difficulties, and suggestions for improvement. The interviewees appreciated the MUKI's sheltered environment, care services, and socializing opportunities, as well as its women-only concept. Overall, the participants saw overexertion, social engagement-related difficulties, and the MUKI's noisy environment as key attendance barriers. Interviewed staff primarily reported problems regarding the working conditions, including the high staff and attendee turnover and low general service awareness. The participants advocated an expansion of the MUKI program. The MUKI project underlines that providing newly arrived, vulnerable female refugees with sheltered surroundings and psychosocial services is an essential step toward addressing female refugees' specific care needs.

A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective.

Providing refugees with psychosocial support is particularly important considering the high level of mental health problems prevalent in this population. A psychosocial walk-in clinic operating within a state reception and registration center in Germany has been supporting mentally burdened refugees since 2016. This study focused on patients' perspectives on their mental health burden, the psychosocial walk-in clinic, and future help seeking. We conducted interviews with n = 22 refugees attending the walk-in clinic from March to May 2019. Qualitative analysis focused on the following four topics: (1) mental burden from the patients' perspective, (2) access to the psychosocial walk-in clinic, (3) perception of counseling sessions, and (4) perception of follow-up treatment. The results show that the majority of interviewees were burdened by psychological and somatic complaints, mostly attributed to past experiences and post-migratory stress. Therapeutic counseling and psychiatric medication were found to be particularly helpful. Most of the participants felt motivated to seek further psychosocial support. Key barriers to seeking psychosocial help included shame, fear of stigma, and lack of information. Overall, the psychosocial walk-in clinic is a highly valued support service for newly arrived refugees with mental health issues.

Medical education and the COVID-19 pandemic - a dress rehearsal for the "climate pandemic"?

In the present commentary, we raise the question whether the COVID-19 pandemic should be seen as just the dress rehearsal for what awaits us in the impending climate crisis. Many factors have helped us navigate the challenge of this coronavirus pandemic and continue to do so. These include: recognizing scientific expertise, medical education, and digitalization as important driving forces, providing us with key information about the SARS-CoV-2 virus, as well as integrating it into our curricula and promoting action-oriented research. However, the "premiere of the climate pandemic" will, in all likelihood, confront us with even greater challenges, difficulties, and threats. Adhering to scientific findings, promoting medical education about the effects of global warming and using the power of digitalization, as well as consciously engaging in our role as medical caregivers and leaders will make a decisive contribution to providing impetus for climate action.

Broken Heartstrings-Post-Traumatic Stress Disorder and Psychological Burden after Acute Mitral Regurgitation Due to Chordae Tendineae Rupture.

Chordae tendineae rupture (CTR) is a potentially life-threatening cardiac event often resulting in Acute mitral regurgitation (AMR). We assessed Post-traumatic stress disorder (PTSD), depression, and anxiety symptoms in n=21 CTR patients with AMR (age 82.3 ± 4.2 years; 66.7% men) and compared them to n=23 CTR patients with Chronic mitral regurgitation (CMR) and n=35 Myocardial infraction (MI) patients. Regression analyses revealed that PTSD scores were significantly higher in CTR patients with AMR than in CTR patients with CMR or MI patients. CTR patients with CMR had the lowest levels of PTSD-symptoms. Depression and anxiety scores were elevated across all three groups. Our results suggest that psychosocial factors need to be considered in CTR patients' care.

Prevalence and risk factors of secondary traumatic stress in emergency call-takers and dispatchers - a cross-sectional study.

Background: Emergency call-takers and dispatchers (ECDs) field emergency calls and dispatch the appropriate emergency services. Exposure to the callers' traumatic experiences can lead to psychological stress and even to secondary traumatic stress (STS). In addition, previous studies suggest that ECDs may also suffer from posttraumatic stress disorder (PTSD), depression and anxiety disorders. Objectives: To investigate the prevalence of STS and to screen for PTSD, depression and anxiety disorders in ECDs. We further aimed to identify sociodemographic variables and attachment styles as possible risk factors for higher STS symptom load in ECDs. Methods: STS and PTSD regarding lifetime traumatic events, as well as depression and anxiety disorders, were investigated in N = 71 ECDs. Multiple regression analysis was performed to identify possible risk factors for higher STS symptom load. Results: The analysis determined a prevalence of 8.5% for moderate STS and 2.8% for severe STS. A total of 11.3% of the ECDs screened positive for PTSD, 15.5% for depression and 7.0% for anxiety disorders. A higher number of children and the absence of a secure attachment style were identified to be significantly associated with higher STS symptom load. Conclusions: STS resulting from exposure to traumatic emergency caller content is a common phenomenon among ECDs. Specific sociodemographic variables and the attachment style are significant risk factors of STS symptom load. ECDs should receive regular psychoeducational interventions and supervision to identify and mitigate mental distress at an early stage.

Antecedentes: Los Operadores y Despachadores de Llamadas de Emergencia (ECD, en su sigla en inglés) reciben llamadas de emergencia y despachan los servicios de emergencia apropiados. La exposición a las experiencias traumáticas de las personas que llaman puede conducir a estrés psicológico e incluso a estrés traumático secundario (ETS). Además, estudios previos sugieren que los ECD pueden también sufrir de trastorno de estrés postraumático (TEPT), depresión y trastornos de ansiedad.Objetivos: Investigar la prevalencia de ETS y detectar TEPT, depresión y trastornos ansiosos en los ECD. Además, buscamos identificar las variables sociodemográficas y estilos de apego como posibles factores de riesgo para carga sintomática de ETS más alta en los ECD.Método: Se investigó los ETS y el TEPT relacionados a eventos traumáticos a lo largo de la vida, así como depresión y trastornos de ansiedad en N = 71 ECD. Se condujo análisis de regresión múltiple para identificar posibles factores de riesgo para carga sintomática de ETS más alta.Resultados: El análisis determinó una prevalencia del 8.5% para ETS moderado y de 2.8% para ETS grave. Un total de 11.3% de los ECD dieron positivo para TEPT, 15.5% para depresión y 7.0% para trastornos de ansiedad. Se identificó que un mayor número de hijos y la ausencia de un estilo de apego seguro están significativamente asociados con una mayor carga sintomática de ETS.Conclusiones: Variables sociodemográficas específicas y el estilo de apego son factores de riesgo significativos de la carga sintomática de ETS. Los ECD deberían recibir intervenciones y supervisión psicoeducativas periódicas para identificar y mitigar el estrés mental en una etapa temprana.

Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study.

BACKGROUND: Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees' emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. OBJECTIVE: This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. METHODS: From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. RESULTS: At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique "The Inner Safe Place" was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. CONCLUSIONS: The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, "The Inner Safe Place" technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.

Effects of MitraClip on cognitive and psychological function in heart failure patients: the sicker the better.

PURPOSE: Cognitive impairment and reduced quality of life is a common condition in patients with heart failure (HF). Percutaneous mitral valve repair using (PMVR) MitraClip (MC) has emerged as a promising interventional tool, reducing all-cause mortality and hospitalization as well as increasing cognitive functioning and quality of life. However, the benefit of HF patients with severely depressed cognitive functioning remains unknown. METHODS: We assessed cognitive functioning (figural memory-FGT, executive function-TOL, TMT B), psychosocial functioning (depression-PHQ-9, quality of life-SF36), and clinical parameters (echocardiography, 6-min walk test distance, and cardiac biomarkers) 1 day before (t0) and 6 weeks after (t1) MC intervention in HF patients (n = 40). First, paired sample t tests were conducted to uncover improvements in cognitive functioning post-MC intervention. Second, the COGBAT Norm-sample, a representative age-matched healthy sample, was used to compare participants' individual scores. Third, bivariate linear regressions were calculated for all key predictors of the detected improvements in cognitive functioning post-MC intervention (t1-t0). RESULTS: Following the MC intervention, we found significant improvements in figural memory, executive functioning, and psychosocial functioning. Most of the patients with depressed executive functioning before the MC intervention showed post-intervention test scores within the normal range (> 50th percentile; t0 22.5% vs. t1 60%) as compared to the normative COGBAT sample. Regression analyses revealed that lower baseline scores in planning ability before the MC intervention (t0) were associated with greater planning ability (TOL; B = - 0.78, 95% CI - 1.04 to - 0.53), figural memory (FGT; B = - 0.26, 95% CI - 0.44 to - 0.07), and cognitive flexibility (TMT B; B = - 0.36, 95% CI - 0.50 to - 0.23) improvement post-MC intervention (t1-t0). Psychosocial functioning and age were not associated with these improvements. CONCLUSIONS: Patients with depressed executive functioning showed the greatest benefit from the MC intervention regarding cognitive functioning. Age and psychological functioning seem less important for cognitive performance improvements post-MC intervention. Hence, severely depressed cognitive functioning in patients is not a contraindication for PMVR using MitraClip.