Measuring teacher identity of physicians - a validation study of a questionnaire instrument.

BACKGROUND: Teacher identity is defined as a continuum of a person's self-conviction ('Identity is something I have') and a context-dependent action ('Identity is something I do in a context') (Lankveld et al. 2021). It has been identified a relevant contributor to physicians' teaching commitment. In this study, we further improve the currently only existing questionnaire instrument (37 items) measuring physicians' teacher identity. METHODS: Survey data on 147 clinicians at a German university hospital were (1) analyzed by confirmatory factor analysis (CFA). We tested (a) the model fits of the originally suggested scales and (b) potential for improvement of model fits by item reduction. As this could not reveal satisfactory fits for all scales, we (2) applied a principal axis factoring as an exploratory approach. Last, we combined findings from (1) and (2) with a theoretical item content discussion and suggest (3) reassembled scales which were again checked using CFA. FINDINGS: (1a) Two scales from the original instrument were successfully confirmed. (1b) Some scales benefited from item reduction. (2) The exploratory analysis identified three factors that explained at least 5% variance. (3) By integrating confirmatory and exploratory findings with a content analysis of the items, we propose a partially rearranged questionnaire instrument, comprising seven scales: (1) Feeling intrinsic satisfaction from teaching; (2) Feeling responsibility to teach; (3) Exchange of teaching experience; (4) Identification and enjoyment of the teaching role; (5) Development of teaching; (6) Teaching self-concept of ability; (7) Desired rewards for teaching. Four items were kept as single items. CONCLUSION: We suggest that when assessing teacher identity in physicians, all items should be constructed to allow for responses, even from physicians who are presently not actively involved in teaching. The scales benefited from categorizing items based on the continuum of teacher identity as outlined by van Lankveld et al. (2021).

Uncovering heterogeneity in mental health changes among first-year medical students.

INTRODUCTION: The initial year of medical school is linked to a decline in mental health. To assess mental health comprehensively, the dual-factor model posits the consideration of both psychopathology (e.g., depression) and positive mental health (e.g., well-being). Previous mental health research among medical students has primarily examined these two factors independently. This study uses the dual-factor approach for a deeper understanding of mental health changes during the first year of medical school. METHODS: Students from eight German medical schools (N = 450) were surveyed three times (T0 = entering medical school, T1 = end of the first semester, T2 = end of the second semester) regarding depression (PHQ-9), well-being (subscale of FAHW-12), and general life satisfaction (German Single-Item Scale L1). Latent profile analysis was used to identify distinct mental health groups based on their combinations of psychopathology and positive mental health. We then analysed trajectories descriptively by examining the longitudinal stability and dynamics of mental health group membership during the first year of medical school. RESULTS: We identified five mental health groups: (1) complete mental health, (2) moderately mentally healthy, (3) symptomatic but content, (4) vulnerable, and (5) troubled. The examination of change trajectories unveiled diverse paths pointing towards both recovery and deterioration. In comparison to the other groups, students belonging to the complete mental health group exhibited greater stability and a higher potential to recover after initial deteriorations in the first semester. CONCLUSIONS: Our study uncovers distinct mental health trajectories in the first year of medical school, emphasizing the crucial role of initial mental health status. Our findings stress the diverse nature of mental health changes in medical students, underscoring the need for tailored prevention strategies. The implications for research and practice are discussed.

First-year Medical Students' Varying Vulnerability to Developing Depressive Symptoms and Its Predictors: a Latent Profile Analysis.

OBJECTIVE: Previous meta-analytic data have demonstrated the propensity for mental morbidity among medical students (Rotenstein et al. JAMA. 2016;316(21):2214-36). However, there is a lack of research on medical students' varying depression vulnerabilities and predictive factors. The present study aims to gain a better understanding of the development of mental health morbidity and its predictive factors among first-semester medical students. METHODS: In November 2020 and January 2021, 184 first-semester students from two medical schools were surveyed regarding depression (PHQ-9), self-efficacy, resilience, and cognitive self-regulation. Using latent profile analysis, we identified distinct depression development profiles. We applied a multinomial logistic regression analysis to determine how self-efficacy, resilience, and cognitive self-regulation and their changes predicted profile membership. RESULTS: Five profiles of depression development were identified: profile 1, no depression (53.8%); profile 2, mild depression (26.1%); profile 3, depression increase I (9.2%); profile 4, depression increase II (9.8%); and profile 5, persistent depression (1.1%). Students with initially high self-efficacy, resilience, and cognitive self-regulation levels were more likely to belong to the no depression profile. A decrease in self-efficacy and cognitive self-regulation was associated with both depression increase profiles (profiles 3 and 4), and a decrease in resilience was found to be a predictor of profile 4. CONCLUSION: Students who enter medical school have varying states of mental health, and they differ in their vulnerability to developing depressive symptoms. The promotion of resilience, self-efficacy, and cognitive self-regulation strategies may be key in preventing students' depression in the first semester of medical school.

How is modern bedside teaching structured? A video analysis of learning content, social and spatial structures.

BACKGROUND: Bedside teaching (BST) is an essential and traditional clinical teaching format. It has been subject to various impediments and has transformed over time. Besides a decrease in bedside time, there has also been a didactic diversification. In order to use time at the bedside effectively and understand the current design of BST, we here offer an evidence-based insight into how BST is practiced. This may serve as a basis for a refinement of its didactic design. METHODS: In the current study, we investigate the interrelationships between learning content and the social as well as spatial structures of BST. To this end, we have empirically analysed almost 80 hours of video material from a total of 36 BST sessions with good interrater reliability. RESULTS: BST lasted on average 125 min, most of which was spent in plenary and less than a third of the time at the patient's bedside. History taking was primarily practiced at the bedside while case presentations, clinical reasoning and theoretical knowledge were largely taught away from the patient. Clinical examination took place to a similar extent in the patient's room and in the theory room. CONCLUSIONS: Even though the filmed BSTs are not purely "bedside", the teaching format investigated here is a typical example of undergraduate medical education. In order to maximize the teaching time available, a suitable learning space should be provided in addition to the bedside. Moreover, the clinical examination should be revised in its general sequence prior to the BST, and conscious decisions should be made regarding the social structure so as to optimize the potential of small groups and plenary sessions.

Online programs to strengthen the mental health of medical students: A systematic review of the literature.

Medical students have been shown to be vulnerable to mental stress. Strengthening individual protective characteristics can be one cornerstone for promoting medical students' mental health and thereby preventing mental disorders. Online programs are an opportunity to provide appropriate options that have the advantage of being accessible from anywhere, at any time, and with a low entry threshold. This review provides a literature overview of current online programs for medical students. The findings can serve as a point of reference for designing effective online programs for mental health-promotion and mental disorder-prevention in medical curricula. We applied a systematic literature search in PubMed, ERIC, Cochrane, and Web of Science. Programs offered had to be web-based, and the addressed group had to be medical students. Protective individual characteristics for mental health and information on the programs' effectiveness were included in the search. As outcomes, we included mental health, burnout, symptoms of depression, anxiety, and well-being. The search yielded 723 articles; of them, 11 met the inclusion criteria. Programs found were grouped according to their focus: mental health literacy, mindfulness, based on Cognitive Behavioral Therapy, or peer support. Two studies showed significant reductions in perceived stress; one study indicated reduced burnout levels. One program had significant immediate effects on mindfulness, empathy, and resilience; two studies indicated strengthening coping strategies. Two programs were qualitatively assessed as helpful; two studies are ongoing. Nine studies lacked control groups; two randomized controlled trials were ongoing. Only a few online programs with limited evidence of effectiveness were found. They addressed protective individual characteristics, highlighting their importance for mental health. Thus, more health-promoting and mental disorder-preventing programs with high-quality effectiveness studies are necessary. An integration of such programs into curricula would allow for greater utilization and could give greater emphasis to and prioritize mental health in medical education.

A longitudinal investigation of mental health, perceived learning environment and burdens in a cohort of first-year German medical students' before and during the COVID-19 'new normal'.

BACKGROUND: Medical students' propensity to develop mental morbidity has been described for decades but remains unresolved. To assess student mental health person-centred and longitudinally, we have been investigating a cohort of German students since October 2019. After their first semester under 'normal' conditions, rapid changes became necessary due to the COVID-19 situation. In line with the initial aim, we investigated students' change of mental health, perceived learning environment and burdens in the 'new normal'. METHODS: Students in a newly founded German medical study programme (n = 63) answered a questionnaire each semester (October 2019 = entering medical school; December 2019 = 'old normal'; June 2020 = 'new normal'; December 2020 = 'new normal') on their well-being (FAHW-12), burnout (Maslach Inventory), depression (PHQ-9), perception of the learning environment (DREEM), burdens and protective attitudes in the 'new normal' (items designed for the study). RESULTS: Friedman tests reveal overall significant differences (all p < .001) in depression and burnout (emotional exhaustion, depersonalisation, personal accomplishment); changes in well-being were identified as just non-significant (p = .05). The effects were explained by a significant increase in burnout and depression identified post-hoc from October 2019 to December 2019. No increase in severity was identified in the 'new normal' semesters. The learning environment was perceived positively even with a significant improvement for June 2020 (repeated measures ANOVA p < .001). Study-related burdens (e.g. procrastination of online-learning material) took on greater relevance than burdens related to physicians' occupation (e.g. potential for students' recruitment to the healthcare system during their studies). CONCLUSIONS: The 'new' when entering medical school had a greater impact on our students' mental health than the 'new normal'. The readiness for change in the context of a newly designed study programme may have been beneficial with regard to students' positively perceived learning environment during the virtual semesters. Monitoring medical students' mental health longitudinally should be a concern regardless of a pandemic.

Academic-associated emotions before and during the COVID-19-related online semester - a longitudinal investigation of first-year medical students.

Background: Due to the COVID-19 pandemic, students have been confronted with an online semester. Because of the special requirements, online teaching can trigger negative emotions, which can have an unfavourable impact on the learning process and which therefore need to be regulated. This study investigates academic-associated emotions and the regulation of those emotions both before (December 2019) and during (June 2020) the online semester for first-year medical students. Methods: Questionnaire data (t1=Dec 2019; t2=Jun 2020) regarding academic-associated emotions and emotion regulation, taken from a longitudinal research project (Experienced Learning Medicine Augsburg; ELMA) at the University of Augsburg, was used. At t2, the students were also asked, as future physicians, to name their three most significant emotions regarding their studies, taking into account the COVID-19 situation. Results: Longitudinal analyses (Wilcoxon tests) showed few changes in academic-associated emotions. The emotions happy (r=.32) and proud (r=.33) increased significantly with moderate effects at the online semester. There also was an increased, but still low suppression of emotions (r=.22) at t2. The future physicians were most often curious, grateful and afraid about their medical studies with regard to the COVID-19 situation. Overall, medical studies were more often associated with positive than negative emotions during the online semester. Conclusions: The results show that the online semester did not have any worrying impacts on academic-associated emotions and emotion regulation. There was even some indication that students might benefit from online teaching formats.