[Stress in Medical Students: A Cross-Sectional Study on the Relevance of Attachment Style and Structural Integration]. / Stresserleben bei Medizinstudierenden: Welche Rolle spielen Bindungserleben und Persönlichkeitsaspekte?

INTRODUCTION: From year one of studying medicine an increase of psychological stress is found. The relationship between the occurrence of this stress and attachment patterns or structural personality functions remains unclear. The present study aimed at investigating whether a relationship between the enduring personality variables, attachment style and level of structural integration of the personality, and acute stress experience at the beginning of medical students' studies exists. MATERIAL & METHODS: In this study, all students in the first semester of medicine were invited to participate in a study to identify stress factors via questionnaire (MBI-SS, PSQ, PHQ-9, GAD-7) in the WS 2013/2014. Simultaneously, the predominant attachment style (RQ-2) and structural abilities (OPD-SFK) were evaluated. RESULTS: The study included 293 students (return: 91.3%). Securely attached students experienced significantly less stress than insecurely attached students (p=0.019). Students with a high level of structural integration showed significantly less stress burden (p<0.001) and lower exhaustion- (p<0.001) and cynicism values (p<0.001), while showing a higher experience of self-efficacy (p<0.001). The influence of attachment behavior on stress experience is mediated by the level of the structural integration of the personality. DISCUSSION: Significant correlations exist between attachment style and the level of structural integration of the personality, and burnout risk as well as stress burden. The level of structural integration of the personality mediates the relationship between the attachment-related "model of self" and stress experience, i. e. a positive "model of self" can have a stress-protective effect when good structural abilities are present. Practical implication: An insecure attachment style and a low level of structural integration may be associated with higher stress experience when transitioning to study. The results suggest that the enduring personality variable attachment style, mediated by the level of structural integration of the personality, leads to higher stress and burnout experience. Affected students could be supported by early preventive measures enabling the sustainable preparation for this transitional period. Longitudinal prospective studies are needed to explore if the assumption is applicable that pre-existing vulnerabilities in school are exacerbated at this transitional stage.

Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients.

BACKGROUND: Physical clinical examination is a core clinical competence of medical doctors. In this regard, digital rectal examination (DRE) plays a central role in the detection of abnormalities of the anus and rectum. However, studies in undergraduate medical students as well as newly graduated doctors show that they are insufficiently prepared for performing DRE. Training units with Standardized Patients (SP) represent one method to deliver DRE skills. As yet, however, it is little known about SPs' attitudes. METHODS: This is a qualitative study using a grounded theory approach. Interviews were conducted with 4 standardized patients about their experiences before, during and after structured SP training to deliver DRE competencies to medical students. The resulting data were subjected to thematic content analysis. RESULTS: Results show that SPs do not have any predominant motives for DRE program participation. They participate in the SP training sessions with relatively little prejudice and do not anticipate feeling highly vulnerable within teaching sessions with undergraduate medical students. CONCLUSIONS: The current study examined SPs' motives, views, expectations and experiences regarding a DRE program during their first SP training experiences. The results enabled us to derive distinct action guidelines for the recruitment, informing and briefing of SPs who are willing to participate in a DRE program.

Workplace learning: an analysis of students' expectations of learning on the ward in the Department of Internal Medicine.

BACKGROUND: Learning on the ward as a practice-oriented preparation for the future workplace plays a crucial role in the medical education of future physicians. However, students' ward internship is partially problematic due to condensed workflows on the ward and the high workload of supervising physicians. For the first time in a German-speaking setting, students' expectations and concerns about their internship on the ward are examined in a qualitative analysis regarding their internal medicine rotation within clinical medical education. METHODS: Of a total of 168 medical students in their 6th semester at the Medical Faculty of Heidelberg, 28 students (m=8, f=20, Ø 23.6 years) took part in focus group interviews 3 to 5 days prior to their internship on the internal medicine ward within their clinical internal medicine rotation. Students were divided into four different focus groups. The protocols were transcribed and a content analysis was conducted based on grounded theory. RESULTS: We gathered a total of 489 relevant individual statements. The students hope for a successful integration within the ward team, reliable and supportive supervisors and supervision in small groups. They expect to face the most common diseases, to train the most important medical skills, to assume full responsibility for their own patients and to acquire their own medical identity. The students fear an insufficient time frame to achieve their aims. They are also concerned they will have too little contact with patients and inadequate supervision. CONCLUSION: For the development and standardization of effective student internships, the greatest relevance should be attributed to guidance and supervision by professionally trained and well-prepared medical teachers, entailing a significant increase in staff and costs. A structural framework is required in order to transfer the responsibility for the treatment of patients to the students at an early stage in medical education and in a longitudinal manner. The data suggest that the development and establishment of guidelines for medical teachers associated with clearly defined learning objectives for the students' internships are urgently needed. Based on our findings, we provide first recommendations and suggest possible solutions.

Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis.

BACKGROUND: Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. PURPOSE: To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors. METHODS: A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. RESULTS: The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. CONCLUSION: On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor-student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians.