Medical Education最新文献

Introduction: Medical education is associated with considerable demands, often resulting in increased burnout risk and higher dropout intentions. However, longitudinal evidence on how these factors evolve and interact across different stages of training remains limited. This study examines the evolution of dropout intentions throughout medical education, identifies the learning stages most at risk, and investigates the roles of demands, resources, and burnout (i.e. emotional exhaustion and cynicism) in influencing these dropout intentions.

Methods: In a longitudinal cohort study, medical students and residents (n = 1.257) from five Flemish universities completed annual online surveys over three consecutive years (T0-T2). Dropout intentions were assessed as the outcome variable, with emotional exhaustion and cynicism integrated as mediators. Key demands and resources included workload, work-home conflict, meaningfulness, learning opportunities, and the learning environment. Linear Mixed-Effects Models examined changes in dropout intentions across stages, and Structural Equation Modelling tested direct and indirect pathways via emotional exhaustion and cynicism.

Results: The results showed a progressive increase in dropout intentions, with the highest levels during residency. Workload and work-home conflict were consistently associated with emotional exhaustion and cynicism, while meaningfulness showed protective effects. Cynicism was the strongest determinant of dropout intentions among students, whereas both cynicism and emotional exhaustion were related to intentions among residents. Indirect effects indicated that workload, work-home conflict, and meaningfulness influenced dropout intentions primarily through cynicism in students, and through both burnout complaints in residents.

Conclusion: Dropout intentions in medical education are influenced by distinct stage-specific pathways of demands, resources, and burnout complaints. Interventions should target reducing workload and work-home conflict and enhancing meaningful tasks with academic and clinical tasks.

Background: The high-pressure environment of medical education presents significant challenges to the long-term psychological well-being of medical students. Although anxiety and depression are well-documented among medical students, few studies have explored the developmental trajectories of these symptoms over time. This study aims to explore the two-year developmental trajectories of anxiety and depression symptoms in medical students and identify key predictors of these trajectories.

Methods: This longitudinal study involved 810 medical students from a Chinese medical school, with data collected over four waves spanning two years. A total of 730 students completed the baseline survey and were included in the analysis, yielding a valid response rate of 90.1%. Participants completed the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety. Latent Growth Mixture Modelling (LGMM) was used to identify the latent trajectories of depression and anxiety symptoms, with full information maximum likelihood estimation applied to handle missing follow-up data. Regression analysis was conducted to determine predictors of these trajectories.

Results: The four waves of data for both depression and anxiety symptoms fit the model well. Depression followed two trajectories: a slowly decreasing group (92.0%) and a significantly increasing group (8.0%). Anxiety exhibited three trajectories: a low level-slow decreasing group (72.7%), a high level-significantly decreasing group (21.2%) and a low level-significantly increasing group (6.1%). Significant predictors of these trajectories included family structure, quality of relationships with parents and roommates, social support, past suicidal ideation and self-harming behaviour. Higher levels of social support were associated with decreasing symptom trajectories, whereas poor family relationships and past suicidal ideation predicted increasing symptoms.

Conclusions: Depression and anxiety symptoms in medical students follow distinct developmental trajectories, providing a basis for targeted psychological interventions. Strengthening social support should be a priority for educational institutions and policymakers.

Introduction: Mistreatment toward peers, residents, and patients has been shown to trigger negative emotions among medical trainees. However, the impact of such experiences on trainees' learning needs to be further explored. This study reports on the impact of a situation of mistreatment experienced by a medical resident on novice medical students' learning of a scientific text.

Methods: Videos portraying a medical resident receiving feedback about his performance in caring for a patient who died were used. Participants were randomly assigned to watch either a video where the feedback is accusatory and disrespectful (emotionally negative group-ENG) or understanding and respectful (neutral group-NG). Subsequently, all participants studied a scientific text. Study time and cognitive engagement with the text were recorded. Finally, they did a recall test about the text.

Results: Data from 68 third-year medical students were analysed. Test scores were lower for the students in the ENG compared with the NG [10.82 (5.37) and 14.44 (7.02), respectively, p = 0.020, d = 0.58]. No differences in cognitive engagement [3.98 (0.60) and 4.10 (0.73) for ENG and NG, respectively, p = 0.45] or time spent studying the scientific text [5:05 (1:36) and 4:56 (1:37) for ENG and NG, respectively, p = 0.71] were observed.

Discussion: A simulated situation of mistreatment experienced by a resident negatively impacted the learning of a scientific text by novice medical students. These results extend the evidence on the negative impact of mistreatment on learning. It supports the relevance of mitigating mistreatment and adjusting training activities in situations of emotional distress.

Introduction: Impaired wellness among residents has become a global concern, with burnout, stress and fatigue linked to negative outcomes for both residents and patients. To date, most of the existing research has come from Western contexts, where cultural norms and training structures may significantly differ from those in other regions. However, there remains limited understanding of how residents in non-Western settings experience and interpret impaired wellness. This study aims to explore the perceptions and experiences of residents' impaired wellness within the context of residency training in China.

Methods: We conducted a constructivist qualitative study. Participants were recruited through purposive and snowball sampling from a teaching hospital in Shanghai. Semi-structured interviews were conducted in Chinese between March 2024 and February 2025, guided by a six-dimensional wellness framework developed from existing literature. We used reflexive thematic analysis to analyse the data both deductively and inductively.

Results: Chinese residents perceived some degree of wellness impairment across physical, psychological and social dimension as acceptable, often framing such impairments as contributing to professional and personal growth, reflecting cultural values emphasising acceptance of and growth through hardship. In contrast, impairments in the intellectual and financial dimensions, exacerbated by unfair compensation, limited supervision and research pressure, were seen as unreasonable yet preventable. Residents' recognition of these challenges as rooted in systemic and structural conditions of residency training, largely beyond their control, often led to resignation, passive endurance, and in some cases, consideration of leaving the profession. Harmonious work relationships were described as central to navigating impaired wellness, serving as vital buffers when present but vulnerabilities when absent, largely echoing cultural ideals of harmony.

Discussion: This study sheds light on how the inherently demanding nature of clinical practice, cultural values and local systemic and structural conditions of residency training intersect to shape residents' perceptions and experiences of impaired wellness.

Introduction: Speaking up about medical errors is a critical behaviour for medical students, as it plays a vital role in enhancing patient safety. Few studies have explored the drivers and barriers affecting their willingness to speak up in clinical training, particularly within hierarchical Asian cultures. The purpose of this study was to explore drivers and barriers shaping medical students' speaking up behaviours about medical errors to inform education, mentorship and patient safety practices.

Methods: This qualitative study using a descriptive phenomenological approach was conducted at a teaching hospital in Northern Taiwan between October 2023 and April 2024. Sixth-year medical students, with 20 months of clinical rotations and simulated speaking-up training, were invited to participate in semi-structured interviews. The interview process was concluded after the 10th participant, as data saturation had been achieved. Data were analysed using thematic analysis to explore factors influencing students' willingness and behaviour to speak up in clinical settings.

Results: Three main themes were observed: (1) predisposing features, such as personal traits and prior experiences, which may influence students' speaking up behaviour; (2) psychological processes, highlighting the role of professional knowledge, attitudes towards clinical work and ethical and legal considerations; and (3) contextual interaction, emphasising the influence of patient urgency, supervisor characteristics and team atmosphere. The research team also found that the themes are interconnected and collectively influence novices' speaking-up behaviours when faced with a medical error.

Conclusion: Confidence and responsibility promote speaking up, but barriers such as hierarchy and fear of criticism hinder it. Although ethical and legal training is designed to promote patient advocacy, it may unintentionally prioritise self-preservation, thereby discouraging speaking-up behaviour in medical error events. These findings may prompt medical educators to re-evaluate the hidden curriculum within ethical and legal training as well as clinical rotations.