Dataset Information

"A lot of medical students, their biggest fear is failing at being seen to be a functional human": disclosure and help-seeking decisions by medical students with health problems.

ABSTRACT:

Background

Although medical students have a duty to seek advice for their health conditions, they tend to avoid disclosure and help-seeking behaviours, therefore potentially posing a risk to themselves and their patients. The literature regarding their decisions to seek help or disclose health conditions is limited. The study's purpose was to explore the factors that determine disclosure and help-seeking decision processes by medical students who have health conditions with or without disability.

Methods

We recruited by purposive sampling and conducted in-depth semi-structured interviews with 11 male and female medical students from a UK medical school, who had physical or mental health disorders. Thematic analysis was used to identify themes. A mix of inductive and deductive techniques was used while using an organising framework proposed by Llewellyn-Thomas (1995).

Results

The impact of individuals' features, such as personality traits on medical students' disclosure and help-seeking decisions were identified. Different aspects of the condition, such as its type and severity were found to influence these decisions. Participants made an evaluation of the potential receiver of a disclosure, consisting of factors such as the receiver's characteristics and attitudes. The culture of the medical environment, such as role models, had a major impact on their decisions. Finally, systemic factors, such as the lack of clarity of policies influenced students' decisions.

Conclusion

Medical students' disclosure and help-seeking decision processes are influenced by risk-benefit evaluations and factors in interlinked spheres of their lives. They tend to avoid or postpone disclosure and seeking help, especially when the university is involved, due to a perceived risk to their future. Future research should examine the role of personality traits and the medical culture. Medical schools should encourage earlier help-seeking and disclosure behaviours by clarifying procedures and building trust via online and confidential platforms; interpersonal channels and normalisation processes within the medical education and the profession as a whole.

SUBMITTER: Shahaf-Oren B

PROVIDER: S-EPMC8645095 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:IntroductionUncertainty tolerance (UT) describes how individuals respond to stimuli of uncertainty, with low UT among medical doctors and students linked to negative outcomes such as burnout. UT research in medical education has focused on measuring the construct, with little research seeking to understand how medical students experience uncertainty. Hence, knowledge on how education may shape students' UT development is lacking. As a first step to understanding students' UT, we asked 'How do medical students, in their clinical years, experience uncertainty stimuli?'MethodsUtilising a social constructionist approach, we undertook a qualitative study with 41 clinical years medical students. Data were collected during the 2020 academic year employing in-semester reflective diary entries (n = 230 entries), and semi-structured interviews at the end of semesters (n = 40 interviews). Data were analysed by framework analysis.ResultsStudents described three major themes of uncertainty stimuli: (i) educational uncertainty, (ii) professional uncertainty and (iii) clinical uncertainty. Educational uncertainty was the dominant stimulus described by students and represents unknowns related to what students needed to learn and how to learn within the context of clinical placements. Professional uncertainty encompassed questions about who students are as developing professionals and who they would be as doctors. Clinical uncertainty was the least represented stimulus and concerned aspects of patient care where the body of medical knowledge is unable to provide clear answers.ConclusionsOur findings indicate that clinical learners experience wide reaching uncertainties and suggest that students' stimuli may differ from those of clinicians with more established knowledge and careers. This work now paves the way forward in developing educational interventions to foster UT, such as modifying uncertainties not integral to learning, and purposefully introducing clinical uncertainties relevant to students' learning stage.

Project description:ObjectiveMedical students in China are currently facing a dilemma of whether to clarify their identity as students to patients. Further investigation is needed to support policy-making. The aim was to identify factors influencing medical students' decision on whether or not to clarify their identity to patients and to examine the effects of their decision.MethodsThe study was a cross-sectional nationwide multicenter survey consisting of 947 medical students. A self-designed questionnaire was composed of 19 structured questions investigating the present situation and participants' perception of the ethical dilemma surrounding medical student identity. The questionnaires were distributed randomly in teaching hospitals affiliated with 13 medical schools across China from June 2015 to January 2016.ResultsA total of 947 valid questionnaires were retrieved with a valid response rate of 83.7%. Most medical students (71.4%) tended to be ambiguous about their student identity in front of patients. The frequency of encountering distrust and patients' or patient relatives' refusal to allow students to perform procedures was significantly lower for students who explicitly stated their identity than for those who were ambiguous about their identity (p<0.001). Less experience in clinical rotations (<0.5 y/0.5-1 y, OR 2.7, 95% CI 1.7-4.3; <0.5 y/>1 y, OR 3.6, 95% CI 2.0-6.5), preceptors' straightforward introduction of the students (OR 8.7, 95% CI 5.4-13.8) and students' acknowledgment of patients' right to know (OR 2.3, 95% CI 1.2-4.5) were related to students' clear self-introduction to patients.ConclusionIt is beneficial for medical students to clearly explain their identity to patients in order to decrease patient distrust and prevent the refusal to have certain appropriate procedures performed. Several methods, including emphasizing the role of mentors, developing curriculum for medical students, and creating clear regulations and guidelines for revealing the identity of medical students on the healthcare team can help address and ideally resolve this ethical dilemma of identity disclosure.

Project description:BackgroundEarly in medical education, physicians must develop competencies needed for tobacco dependence treatment.ObjectiveTo assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills.DesignA group-randomized controlled trial (2010-2014) included ten U.S. medical schools that were randomized to receive either multi-modal tobacco treatment education (MME) or traditional tobacco treatment education (TE).Setting/participantsStudents from the classes of 2012 and 2014 at ten medical schools participated. Students from the class of 2012 (N = 1345) completed objective structured clinical examinations (OSCEs), and 50 % (N = 660) were randomly selected for pre-intervention evaluation. A total of 72.9 % of eligible students (N = 1096) from the class of 2014 completed an OSCE and 69.7 % (N = 1047) completed pre and post surveys.InterventionsThe MME included a Web-based course, a role-play classroom demonstration, and a clerkship booster session. Clerkship preceptors in MME schools participated in an academic detailing module and were encouraged to be role models for third-year students.MeasurementsThe primary outcome was student tobacco treatment skills using the 5As measured by an objective structured clinical examination (OSCE) scored on a 33-item behavior checklist. Secondary outcomes were student self-reported skills for performing 5As and pharmacotherapy counseling.ResultsAlthough the difference was not statistically significant, MME students completed more tobacco counseling behaviors on the OSCE checklist (mean 8.7 [SE 0.6] vs. mean 8.0 [SE 0.6], p = 0.52) than TE students. Several of the individual Assist and Arrange items were significantly more likely to have been completed by MME students, including suggesting behavioral strategies (11.8 % vs. 4.5 %, p < 0.001) and providing information regarding quitline (21.0 % vs. 3.8 %, p < 0.001). MME students reported higher self-efficacy for Assist, Arrange, and Pharmacotherapy counseling items (ps ≤0.05).LimitationsInclusion of only ten schools limits generalizability.ConclusionsSubsequent interventions should incorporate lessons learned from this first randomized controlled trial of a multi-modal longitudinal tobacco treatment curriculum in multiple U.S. medical schools. NIH Trial Registry Number: NCT01905618.