Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction.

PURPOSE: Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled 'Responding to Experienced and Anticipated Discrimination' (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety. METHODS: This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis. RESULTS: READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference - 2.50; 95% CI - 3.54 to - 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety. CONCLUSION: This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions.

Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness - study protocol for an international multisite non-randomised controlled study.

BACKGROUND: Stigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students' ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding. METHODS/DESIGN: READ training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students' knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention. DISCUSSION: This is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients' experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed.

Evaluation of outcomes of a formative objective structured clinical examination for second-year UK medical students.

OBJECTIVE: To explore how formative OSCEs influence student performance and perception when undertaking summative OSCEs. METHODS: We introduced formative OSCEs for second-year medical students at a large London medical school. Examination data from both formative and subsequent summative OSCEs were analysed to determine the effect on summative OSCE performance. We gathered student perceptions using an anonymous online survey tool. The data was investigated using a standard scale of 1 to 5 and qualitative analysis of free text. RESULTS: Overall, 46.6% and 85.0% of students passed the formative and summative OSCEs respectively. Formative OSCEs did not improve overall pass rates in summative OSCEs. Inclusion of an individual formative station was associated with improved performance in that station in summative OSCEs, with one exception. Formative OSCEs had a positive predictive value of 92.5% for passing the summative OSCE but limited negative predictive value. Students who passed fewer than two out of three formative OSCE stations were significantly more likely to fail the summative OSCE (78.2% vs 89.7%, p <0.001). Students felt formative OSCEs were good exam preparation and suggested logistical changes. CONCLUSIONS: Formative OSCEs were associated with improved performance in subsequent summative OSCEs only for identical stations. They did not improve overall pass rates in summative OSCEs, and did not predict performance well. Students viewed the formative OSCE as a positive and useful activity. However, to maximise its benefit as a tool for learning, students need better communication about the role and purpose of formative OSCEs.