Figure - available from: Journal of Medical Education and Curricular Development
This content is subject to copyright.
Source publication
Introduction
Medical culture can make trainees feel like there is neither room for mistakes, nor space for personal shortcomings in the makeup of physicians. A dearth of role models who can exemplify that it is acceptable to need support compounds barriers to help-seeking once students struggle. We conducted a mixed-methods study to assess the impa...
Similar publications
Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCP...
Citations
... Another mechanism to reduce stigma is for senior doctors to openly disclose and share their experiences of mental ill-health. Medical students exposed to physicians who self-disclose a history of mental illhealth can lessen stigma towards mental illness and lead to more positive attitudes towards helpseeking [27,28]. ...
Background
High rates of burnout, anxiety, and depression in medical students are widespread, yet we have limited knowledge of the medical school experiences of students with mental health issues. The aim of the study is to understand the impact of mental health issues on students’ experience and training at medical school by adopting a qualitative approach.
Methods
Qualitative study using in-depth semi-structured interviews with 20 students with mental health issues from eight UK medical schools of varying size and location. Students were purposefully sampled to gain variety in the type of mental health issue experienced and demographic characteristics. Reflexive thematic analysis was employed using NVivo software.
Results
Three themes were identified. 1) Culture of medicine: medical culture contributed to causing mental ill-health through study demands, competitiveness with peers, a ‘suck it up’ mentality where the expectation is that medical school is tough and medical students must push through, and stigma towards mental ill-health. 2) Help-seeking: students feared others discovering their difficulties and thus initially tried to cope alone, hiding symptoms until they were severe. There were multiple barriers to help-seeking including stigma and fear of damage to their career. 3) Impact on academic life: mental health issues had a detrimental impact on academic commitments, with students’ unable to keep up with their studies and some needing to take time out from medical school.
Conclusion
This study provides insight into how medical culture contributes both to the cause of mental health difficulties and the reluctance of medical students to seek help. Mental health issues had a considerable negative impact on medical students’ ability to learn and progress through their degree. Addressing the medical culture factors that contribute to the cause of mental health issues and the barriers to help-seeking must be a priority to ensure a healthier medical workforce.
... However, consistent with Martin et al. (2020), sharing histories of personal vulnerability can lessen stigmatised views on mental health. This requires the psychiatrist to pass the "medical gatekeeper era", and start searching for a moral and normative professionality (van Os and Gü loksü z, 2022). ...
... Table 1 presents an overview of the included studies. Studies included in this review were conducted in Canada (42,43), New Zealand (44), Malaysia (45), and Israel (46). The date range was 2013 to 2021. ...
... Ages ranged from 20 to 69 across the four studies. For the four studies that reported gender information (42,43,45,46), more than half of the total participants were female (62.3%). ...
... One study was a comparative cohort study comparing cohorts across two campuses who undertook a standard psychiatric rotation and then either received or did not receive a stigma reduction intervention (44). Two studies were quasiexperimental design with no control (43,46), with Martin et al. (46) also incorporating a qualitative component. Three studies delivered the intervention in a single session (43,45,46), while the other two studies delivered the intervention over a series of weeks with several components (42,44). ...
Background
A growing body of literature has revealed that many medical students and doctors do not seek professional help for their mental health due to fear of stigma (both public- and self-stigma) and questioning of their clinical competency. The aim of this systematic review was to identify and evaluate direct and indirect interventions that address mental health stigma in medical students and/or doctors. We focused explicitly on studies that measured the impact on self-stigma outcomes.
Method
A systematic search of the following electronic databases was undertaken from inception to 13 July 2022: PubMed, Embase, PsycINFO, and CINAHL, together with manual searching of reference lists. Screening of titles, abstracts, and full texts of eligible studies, plus quality appraisal using the Mixed Methods Appraisal Tool, were independently conducted by multiple reviewers with disagreements resolved via discussion.
Results
From 4,018 citations, five publications met the inclusion criteria. None of the studies explicitly aimed to reduce self-stigmatisation, with the majority focusing on medical students. Most of the identified interventions focused on reducing professional stigma (i.e., stigma toward patients with mental illness) and measurement of self-stigma was incidentally collected via a subscale of the general stigma measure selected. Three studies found significant reductions in self-stigma following the delivered intervention. These studies were of moderate quality, had medical student samples, employed combined education and contact interventions, and used the same outcome measure.
Discussion
Intentional development and evaluation of interventions specifically designed to decrease self-stigma among doctors and medical students are needed, with further research required on the optimal components, format, length, and delivery of such interventions. Researchers delivering public/professional stigma reduction interventions should strongly consider measuring the impact of such interventions on self-stigma outcomes, using fit-for-purpose, psychometrically sound instruments.
... The only significant predictors of intent to receive mental health services were need and sex, which is different from intent to receive alcohol or drug treatment, for which additional predictors were significant. It is unclear whether this is due to stigma for mental health problems, the low treatment rate during incarceration, or because of the stigma associated with mental health treatment (Martin et al., 2020). ...
Knowledge and understanding of reentry challenges, reentry programming, and reentry evaluations is primarily limited to formerly incarcerated persons (FIPs) who return to urban areas despite the structural and contextual differences between urban and non-urban locales. These differences may be especially salient when it comes to access to services for behavioral health needs that, if left untreated, increase the likelihood of recidivism. Reentry planning prior to release has been found to be beneficial, as well as providing direct linkages to services post-release. However, barriers or competing priorities may keep FIPs from accessing needed behavioral health services after release. To increase the probability for more successful post-release transitions, studies need to determine and understand soon-to-be-released inmates’ likelihood of utilizing these services. Thus, the purpose of this research was to examine the importance of demographic characteristics, ecological factors, and utilization of treatment services for drugs, alcohol, mental health, and anger management prior to release to FIPs’ intent to receive these services after their release. Data was collected from 173 individuals incarcerated in either a prison or a community-based correctional facility (CBCF) and analyzed via logistic regressions. Results suggest that being female and utilization of services while incarcerated predicted intent to use drug and mental health services after release; not surprisingly, crime type and type of facility was predictive of intent to utilize anger management services post release; type of facility, and interaction of housing and concentrated disadvantage was predictive of intent to take advantage of alcohol treatment services. These findings have micro, mezzo, and macro implications and are especially relevant given the limitations of resource availability and accessibility in urban and non-urban areas. Streamlining these services to FIPs’ needs and building community capacity to meet specific needs identified by FIPs is more likely to engage them and increase their likelihood to improve reentry outcomes.
... Finalmente, el estudio de Martin et al. (2020) señala una tercera estrategia también relacionada con la normalización de los malestares, pero enfocada en los espacios educativos a través de compartir historias personales de malestar en los/as docentes. ...
... En relación con esto, el/la proveedor/a de servicios de salud ejerce un papel clave en desarrollar estrategias de normalización y afrontamiento del estigma que pueden aplicarse en diferentes contextos. Los estudios revisados muestran que compartir situaciones/condiciones de sufrimiento psíquco en espacios docentes constituye una estrategia formativa que permite comprender la salud mental sin la reducción que implica el estigma (Martin et al., 2020). Mientras que, en espacios de intervención, es posible desarrollar acompañamientos en la divulgación del diagnóstico e identificación de aquellos grupos/personas que pueden fungir como sostén tras la divulgación (Dobransky, 2018). ...
El estigma en profesionales de la salud es un objeto de estudio al que se le está prestando mayor atención. Esto debido al papel clave que desempeñan en el proceso de recuperación, así como en la implementación de intervenciones y difusión de las condiciones de salud mental que engloba el concepto Trastorno Mental Grave. El objetivo de este artículo es realizar una revisión sistemática de las investigaciones que abordan el estigma en profesionales de la salud para conocer el estado de conocimiento actual en este tema. Los resultados señalan relaciones complejas que forman parte del fenómeno del estigma. Por un lado, por la presencia de estigma (creencias, emociones y conductas discriminatorias) en los/as profesionales de la salud, así como relaciones entre este estigma y las prácticas de atención. Por otro lado, también muestran a los/as profesionales como objeto de estigmatización y las consecuencias estresoras del estigma en el ejercicio de su profesión. Finalmente, emerge una última categoría que muestra a los profesionales como agentes de desestigmatización.
... Additional key elements of effective contact-based learning include facilitators with first-person experiences, contradiction of stereotypes, and teaching communication and behavioral skills for future patient interactions [11]. In health professional students, contact with more senior providers sharing personal experiences of MI may be particularly salient for stigma reduction [13][14][15]. ...
... Changing the nature of the interpersonal context from a shared physical space to a shared virtual space may alter its impact in meaningful ways that could facilitate or inhibit influential factors such as engagement and psychological safety [20,21]. There is initial evidence that stigma reduction benefits are maintained when changing an in-person contactbased program to a virtual format [13,14]. However, studies that explicitly compare the exact same set of multidimensional outcome measures across inperson and virtual formats and include longitudinal analyses of effects are lacking [18]. ...
... Live virtual contact in lieu of in-person contact increases dissemination potential of such programs and may be more feasible for institutions with a distributed clerkship model, students who are geographically isolated from institutions during clerkships, or implementation with specific stigmatized patient populations. Additionally, videoconferencing features may increase the diversity of interaction opportunities to better engage certain learners (e.g., chat, polling, and whiteboard features) and provide some with enhanced psychological safety (e.g., anonymous submission of questions or feedback; virtual breakout room discussions) [14,21]. ...
Purpose
Contact-based education, offering meaningful contact with individuals living in recovery with mental illness, reduces stigma. This study evaluated the effectiveness of the National Alliance on Mental Illness Provider Education Program (NAMI PEP) when implemented as a curricular requirement across two cohorts of third-year osteopathic medical students, comparing traditional, passive learning and active, online delivery formats.
Materials and Methods
Participants were two cohorts of third-year medical students (Cohort 1 n = 186; Cohort 2 n = 139; overall N = 325) who completed questionnaires measuring affect, beliefs, and behaviors toward patients with mental illness at pre-program, 1-week follow-up, and 6-month follow-up. For Cohort 1, the existing community-based NAMI PEP was implemented. For Cohort 2, the program was adapted to an online, active learning format tailored to medical students, and an additional 3-month follow-up assessment was added to better identify intermediate-term effects.
Results
The NAMI PEP was associated with longitudinal improvements in target outcomes, with enhanced effects with the adapted curriculum in Cohort 2. At 6-month follow-up, students reported less stigma, fewer stereotyping negative attitudes, and lower anxiety treating patients with mental illness. They also reported increased confidence integrating psychiatry into routine care and increased competence in principles of collaborative mental health treatment.
Conclusions
This study demonstrates the longitudinal effectiveness of the NAMI PEP across two cohorts of medical students, with strengthened effects observed when the program is tailored to contemporary medical education.
... However, consistent with Martin et al. (2020), sharing histories of personal vulnerability can lessen stigmatised views on mental health. This requires the psychiatrist to pass the "medical gatekeeper era", and start searching for a moral and normative professionality (van Os and Gü loksü z, 2022). ...
Purpose
This study aims to explore the perspectives of psychiatrists with lived experiences and what their considerations are upon integrating the personal into the professional realm.
Design/methodology/approach
As part of a qualitative participatory research approach, participant observations during two years in peer supervision sessions (15 sessions with 8 psychiatrists with lived experiences), additional interviews as part of member feedback and a focus group were thematically analysed.
Findings
Although the decision to become a psychiatrist was often related to personal experiences with mental distress and some feel the need to integrate the personal into the professional, the actual use of lived experiences appears still in its early stages of development. Findings reveal three main considerations related to the personal (3.1), professionality (3.2) and clinical relevance (3.3) comprising 11 facilitators and 9 barriers to harness lived experiences.
Research limitations/implications
This study was conducted locally and there are no similar comparable studies known. It was small in its size due to its qualitative nature and with a homogeneous group and therefore may lack generalisability.
Practical implications
Future directions to further overcome shame and stigma and discover the potential of lived experiences are directed to practice, education and research.
Originality/value
Psychiatrists with lived experiences valued the integration of experiential knowledge into the professional realm, even though being still under development. The peer supervision setting in this study was experienced as a safe space to share personal experiences with vulnerability and suffering rather than a technical disclosure. It re-sensitised participants to their personal narratives, unleashing its demystifying, destigmatising and humanising potential.
... It has been suggested that due to "self-stigma" (Henderson et al., 2012), medical students might fear being perceived by their peers and faculty members as less able to handle their responsibilities (Schwenk et al., 2010). Growing evidence suggests that senior physicians disclosing histories of personal vulnerability could support destigmatizing mental illness and normalizing help-seeking among medical students (Martin et al., 2020). However, self-stigma was not assessed in our survey. ...
Background
This study aimed to determine the prevalence of substance consumption and mental health problems among Spanish medical students, and their association with sociodemographic factors.
Methods
A multicentre cross-sectional study was conducted. Self-reported data on sociodemographic and clinical characteristics were collected, including BDI-II, PHQ-9, brief STAI, and single-item academic burnout (IUBA).
Results
Overall, 1265 students (74.2% female) completed the survey. Of them, 37.4% scored positive for depressive symptoms, as measured by the BDI-II, and more than half (53%) by the PHQ-9. Suicidal ideation was reported by about 12% whilst high levels of state and trait anxiety were informed by 28.8% and 29.4% of the students. The prevalence of burnout was 40.2%. Female and pre-clinical students reported significantly (p < 0.01) higher rates of depressive, anxiety, and burnout symptoms. Alcohol, energy drinks, and tobacco were the most frequently used substances. Total scores of self-reported mental health problems negatively correlated (p < 0.001) with objective academic results and positively correlated (p < 0.02) with the number of substances consumed in the last 30 days.
Limitations
Research-based on self-reported data could favour information bias due to the social desirability effect and memory error.
Conclusions
A high prevalence of substance consumption and several mental health problems was found among medical students, especially females. The relevant influence of academic-related factors on students' well-being may be a call for medical schools to implement initiatives aimed to improve students' ability to detect, address, and seek help for their mental health issues.
... The investigations were conducted in seven countries: three in Spain (Díaz-Iso et al., 2020;Fernández et al., 2020;Luque-Suárez et al., 2021), two in the United Kingdom (Mayew et al., 2020;Defeyter et al., 2021), and one in Germany (Paulus et al., 2021), Taiwan (Dutta et al., 2021), Israel (Martin et al., 2020), the United States of America (Vatovec and Ferrer, 2019), and Sweden (Bälter et al., 2018). Most studies included students in higher education (as it was an inclusion criterion), however, Bälter et al.'s (2018) investigation included also nine teachers. ...
... Most studies included students in higher education (as it was an inclusion criterion), however, Bälter et al.'s (2018) investigation included also nine teachers. Those students' (and teachers') scientific fields are distinct such as medicine (Martin et al., 2020), engineering (Bälter et al., 2018;Paulus et al., 2021), education (Luque-Suárez et al., 2021), human health and the environment (Vatovec and Ferrer, 2019). The remainder studies did not specify the scientific areas of the participants but stated that they belong to various areas, colleges, or universities. ...
... Six of the authors' approaches were fundamentally quantitative, with questionnaire searching as data collecting instrument (Fernández et al., 2020;Mayew et al., 2020;Defeyter et al., 2021;Dutta et al., 2021;Luque-Suárez et al., 2021;Paulus et al., 2021), and four employed a mixed methods approach, where other instruments were used alongside the questionnaires, such as interviews (Bälter et al., 2018;Díaz-Iso et al., 2020), life experiences (Martin et al., 2020), and intervention reports (Vatovec and Ferrer, 2019). Table 1 displays the results and provides an overview of the research found. ...
This literature Review had the purpose of inspecting how the use of active learning methodologies in higher education can impact students’ Well-being. Considering the Heads of State meeting at United Nations Headquarters on September 2015, in which the 2030 Agenda for Sustainable Development was adopted by all United Nations Member states, this literature review is limbered to the time period between September 2015 and September 2021. A Previous research focused on reviews was made to support the conceptual framework. The search was done in two databases - Web of Science main collection and Scopus - by two researchers autonomously, using the following search criteria: “higher education AND active learning AND student AND wellness OR well-being OR wellbeing.” The studies section attended the following inclusion criteria: (i) published in peer-reviewed journals; (ii) empirical studies; (iii) written in English, French, Portuguese or Spanish; (iv) open access full text; (v) Higher education context; and (vi) focused on the topic under study. The search provided 10 articles which were submitted to an inductive thematic analysis attending to the purpose of this review, resulting in two themes: (i) students’ well-being during confinement; (ii) methodological solutions for students’ well-being. Data show that the use of active methodologies, as digital technologies, and the incorporation of some practice as physical activity and volunteering seems to benefit students’ well-being, namely in their academic achievement, physical, emotional, and social life, and empower them to the professional future with multi-competencies. Higher education institutions need to understand the value of active learning methodologies in sustained education and promote them in their practices.
... I have taught and written about mood disorders for most of my professional life [4][5][6][7][8][9]. I have shared my experiences in public in an effort to help others [10][11][12][13][14][15]. I literally wrote the book on it (edited it, at least) [16][17][18]. ...
As part of a series of autobiographical case reports about physicians reporting on their own medical afflictions, a psychiatrist reflects on his lifelong experience with an illness under his discipline's purview.
