Neurophobia among medical students

Objective:

To assess the attitude of medical students and junior physicians toward neurology.

Methods:

A self-administered, previously validated, questionnaire was distributed among 422 students and junior physicians at King Abdulaziz University, Jeddah, Saudi Arabia from September to December 2012. In this cross-sectional study, the questionnaire included demographic data and 12 statements to examine attitudes toward neurology using a Likert scale.

Results:

The response rate among participants was 70.3%. The mean age was 22.35 (SD+/-1.28) years. Males comprised 46.2%. While 31.3% of students had not decided regarding their future career, 11.8% selected neurology as their first possible choice. Whereas 29.6% of students were not satisfied with their neurology teaching experience, 84.4% found neurology difficult, and 42.7% of the whole group thought that their neuroscience knowledge was insufficient. Advanced clinical year students (namely, interns) were less likely to consider neurology as a career choice (p=0.001).

Conclusion:

Most of the students had an unfavorable attitude toward neurology on the Likert scale. New strategies are needed to change students’ attitude toward this demanding specialty.Neurological disorders comprise 6.4% of the global health burden, and contribute to 12% of global mortality.1 A large proportion of these disorders are chronic, outpatient based, and typically cared for in the community by general medical staff.2-6 Hence, it is important that medical students, and eventually medical doctors of different specialties, become more familiar and comfortable with dealing with these common diseases. Neurophobia, or the fear of neuroscience and clinical neurology, is well known among medical students and junior physicians.2 Neurology is considered, throughout the world, as the most difficult and the least understood medical specialty.2-5 Students, residents, and general practitioners display less confidence when dealing with neurological cases compared with other medical conditions.5,7 This has been attributed to limited patient exposure, difficult neuroanatomy, complex clinical examination, insufficient teaching, and diagnostic complexity.3,5,6,8 In Saudi Arabia, the attitude of medical students toward neurology and the extent of neurophobia is not well explored. Our study aimed to examine this issue and its extent among Saudi medical students.     

Appropriate training based on Balint groups can improve the empathic abilities of medical students: A preliminary study

Objective

Although empathy is critical in a doctor–patient relationship, empathic abilities seem to decline throughout medical school. This study aimed at examining changes in empathic abilities of fourth-year medical students who participated in an optional certificate based on Balint groups.

Methods

Thirty-four students were included in the “Balint group” certificate and compared with 129 participating in other certificates. Before the training sessions and 4 months later, they filled up the interpersonal reactivity index (IRI) and were asked to rate their emotional reactions in response to two case-reports: the first described a woman with diabetes, borderline- personality traits and a history of childhood trauma; the second, a woman with histrionic traits suffering from multiple sclerosis and hospitalized for functional symptoms. A principal component analysis extracted four factors from the 8 questions asked: empathic-approach (e.g. finding the patient touching), rejecting-attitude, intellectual-interest and fear of emotion contagion.

Results

At baseline, there were no socio-demographic or psychological differences between groups. At follow-up, an increase of IRI fantasy-scale (p = 0.02) and a decrease of IRI empathic-concern (p = 0.006) were observed, regardless of the group. Empathic-approach only increased in the “Balint group” and for the first case-report (p = 0.023), with a difference between the groups at follow-up (p = 0.003).

Conclusion

Results suggest that Balint groups may enable medical students to better handle difficult clinical situations such as those presented by borderline personalities. Our findings encourage assessing training initiatives designed at helping young medical students to take into account the emotional component of a doctor–patient relationship.     

Confidence and attitudes of pharmacy students towards suicidal crises: patient simulation using people with a lived experience

Purpose

Health care professionals, including pharmacists, have the potential to recognise and assist those at risk of suicide. The primary aim of this study was to assess the impact of utilising people with a lived experience of mental illness as simulated patients on final year pharmacy students’ attitudes toward and confidence in caring for people at risk of suicide after first receiving Mental Health First Aid (MHFA) training.

Methods

A parallel group repeated measures design was used. People with a lived experience of mental illness enacted patients experiencing a mental health crisis, including possible suicidal ideation. Following MHFA training, the first group directly participated in the simulation, the second group observed, and the final group had no exposure to the simulation. Validated surveys measuring student attitudes and confidence were conducted at three time points; pre and post MHFA, and then at 2–4 weeks follow-up.

Results

Full datasets of survey responses were received from 34/40 direct participants (85%), 104/146 observers (71%) and 50/66 comparison students (76%). Mean confidence scores significantly improved for all groups post MHFA training (p?<?0.05). At follow-up, all 8 confidence items for the direct participant and observer group maintained significance from baseline to post intervention (p?<?0.05). Mixed results in relation to attitudes towards suicide were evident at each time point and among each participant group.

Conclusions

Utilising people with a lived experience of mental illness as simulated patients has a positive effect on sustaining pharmacy student confidence in discussing suicidal behaviour post MHFA training. The inconsistency in attitudes towards suicide suggests that attitudes are complex in nature, involving multiple dynamic influences.

     

Neurology as career option among postgraduate medical students

Background:

In the context of inadequacy of neurology workforce in India, it is important to understand factors that post-graduate medical students consider for and against choosing neurology as their career option. Understanding these factors will help in planning strategies to encourage students to pursue a career in neurology. At present, there is a paucity of studies addressing this issue in India.

Aims and Objectives:

(1) To analyze factors, which post-graduate students consider for and against choosing neurology as a career specialty. (2) To access the level and quality of neurology exposure in the current MBBS and MD curricula.

Materials and Methods:

Statewide questionnaire based study was conducted in the state of Maharashtra for students eligible to take DM neurology entrance examination (MD Medicine and MD Pediatrics).

Results:

In this survey, 243 students were enrolled. Factors bringing students to neurology were - intellectual challenge and logical reasoning (72%), inspired by role model teachers (63%), better quality-of-life (51%) and scope for independent practice without expensive infrastructure (48%). Factors preventing students from taking neurology were - perception that most neurological diseases are degenerative (78%), neurology is mainly an academic specialty (40%), neurophobia (43%) and lack of procedures (57%). Inadequate exposure and resultant lack of self-confidence were common (31%, 70-80%). 84% of the students felt the need for a short term certification course in neurology after MD.

Conclusions:

To attract more students to neurology, “role model” teachers of neurology could interact and teach students extensively. Neurologists’ efforts to shed their diagnostician''s image and to shift their focus to therapeutics will help change the image of neurology. Out-patient neurology clinics should be incorporated early in the student''s career. Procedures attract students; hence, they should be made conversant with procedures and interventions. Increasing the level of neurological exposure in our current MBBS and MD curriculum is necessary. A case could be made for consideration of short certification course in neurology for physicians.Key Words: Career, neurology, postgraduate, students     

Impact of medical audit on electrodiagnostic medicine in polyneuropathy

Objective

The aim of the study was to investigate whether experienced physicians’ electrodiagnostic practice and criteria can be influenced by international collaboration involving peer review medical audit.

Methods

Data was obtained from the ESTEEM project, an ongoing collaboration since 1991 among European neurophysiologists concerned with quality improvement in electrodiagnostic medicine. Three sets of the physicians’ polyneuropathy examinations performed with intervals of 2–4 years were analysed.

Results

Changes towards increased homogeneity among the physicians were found in (1) the average number of studies performed per patient and the number of abnormal studies required for accepting the diagnosis of polyneuropathy, with the most pronounced changes seen for abnormal motor nerve segments, abnormal F-wave studies, and electromyographic studies, and (2) the agreement on pathophysiological interpretation of nerve conduction studies and classification of polyneuropathy.

Conclusions

Changes towards increased homogeneity contributed to years of participation in peer review medical audit, were seen among a group of experienced physicians. Peer review medical audit as carried out here is however difficult to scale up. Therefore guidelines or minimal criteria should ideally supplement a medical audit process to disseminate the results obtained to a larger audience.

Significance

These results support the role of international peer review medical audit in quality improvement of electrodiagnostic medicine.     

Sleeping over a sleep disorder - Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students

Background:

Obstructive sleep apnoea (OSA) syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension.

Objective:

To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension.

Methods:

Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19.

Results:

180 participants completed the survey questionnaire. Only 24 (13.3%) identified OSA as a reversible risk factor for ischemic stroke. 11 (6%) participants only could answer OSA as an identified risk factor for hypertension as per Seventh Joint National Committee report.

Conclusion:

This study reveals dismal level of awareness, among health professionals and medical students, about OSA being an established and modifiable risk factor for hypertension and ischemic stroke.     

The utility of outpatient commitment: acute medical care access and protecting health

Objectives

This study considers whether, in an easy access single-payer health care system, patients placed on outpatient commitment—community treatment orders (CTOs) in Victoria Australia—are more likely to access acute medical care addressing physical illness than voluntary patients with and without severe mental illness.

Method

For years 2000 to 2010, the study compared acute medical care access of 27,585  severely mentally ill psychiatrically hospitalized patients (11,424 with and 16,161 without CTO exposure) and 12,229 never psychiatrically hospitalized outpatients (individuals with less morbidity risk as they were not considered to have severe mental illness). Logistic regression was used to determine the influence of the CTO on the likelihood of receiving a diagnosis of physical illness requiring acute care.

Results

Validating their shared and elevated morbidity risk, 53% of each hospitalized cohort accessed acute care compared to 32% of outpatients during the decade. While not under mental health system supervision, however, the likelihood that a CTO patient would receive a physical illness diagnosis was 31% lower than for non-CTO patients, and no different from lower morbidity-risk outpatients without severe mental illness. While, under mental health system supervision, the likelihood that CTO patients would receive a physical illness diagnosis was 40% greater than non-CTO patients and 5.02 times more likely than outpatients were. Each CTO episode was associated with a 4.6% increase in the likelihood of a member of the CTO group receiving a diagnosis.

Conclusion

Mental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.

     

Evaluation by undergraduate medical students of a role-playing training program on the management of acute states of agitation

Objectives

Acute states of agitation (ASAs) are frequent in daily medical practice. However, training on real ASAs raises technical and ethical issues, whereas lecture-based teaching hardly addresses some educational objectives, e.g., improving relational skills and team-based coordination. Simulation-based medical education (SBME) is a promising medium to train students on managing ASAs. We have recently implemented a role-playing training module on ASAs. In this scenario, four to five students play the role of the staff, while a trained professional actor plays the agitated patient. A subsequent standardized debriefing is conducted by a senior psychiatrist. A first wave of 219 students participated in a one-session training of this ASA module in June 2015. They completed pre-session and post-session questionnaires aiming to collect “proof-of-concept” data.

Prevalence of health anxiety problems in medical clinics

Objectives

To determine the prevalence of significant health anxiety (hypochondriasis) in patients aged 16–75 in cardiology, respiratory medicine, neurological, endocrine and gastrointestinal clinics in general hospitals in London, Middlesex and North Nottinghamshire.

Method

The Health Anxiety Inventory (HAI) (short form) was administered to patients attending the five clinics over a 21 month period and all those who scored 20 or more invited to take part in a further assessment for a randomised controlled trial.

Results

Of 43,205 patients attending the clinics 28,991 (67.1%) were assessed and of these, after exclusion of ineligible patients 5747 (19.8%) had significant health anxiety. 444 subsequently agreed to take part in a randomised controlled trial of treatment. The prevalence levels varied by clinic with neurology (24.7%) having the highest prevalence followed by respiratory medicine (20.9%), gastroenterology (19.5%), cardiology (19.1%), and endocrinology (17.5%).

Conclusion

Abnormal health anxiety is common and a significant problem in those attending medical clinics and deserves greater awareness.     

Risk factors for mental disorder among university students in Australia: findings from a web-based cross-sectional survey

Purpose

To identify variables associated with common mental disorders in an Australian university population.

Methods

We invited all Australia-based students from a large public university (N = 24,209) to participate in a web-based student mental health survey. Outcome measures included the patient health questionnaire depression, anxiety, and eating disorders modules, and the alcohol use disorders identification test. Explanatory variables of interest included gender, age, year of study, degree type, financial means, parental education, domestic/international status, and sexual orientation. Multiple logistic regression analysis was used to estimate independent associations with the four outcomes.

Results

Complete responses were received from 6,044 students (25 %). Proportions reporting depression, anxiety, eating disorders, and harmful drinking were 8, 13, 14, and 8 %, respectively, while 30 % had at least one of these disorders. The groups with the highest rates of disorder were women, 25–34-year-olds, students on low income, and homosexual or bisexual students. Parental education was not associated with disorder, nor was international/domestic status.

Conclusion

This is the first study examining mental disorders in a population-based sample of university students in Australia. Given increasing student numbers and participation of students from lower socio-economic backgrounds, policy is urgently needed to promote better mental health in this population, to routinely identify vulnerable students, and to intervene early. Groups in particular need are women, students on low incomes, and homosexual or bisexual students.     

Recent medical service utilization and health conditions associated with a history of suicide attempts

Objectives

Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention.

Methods

The study sample (n= 1422, 58% female, 72% African-American) is from a prospective cohort of adults (27–31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment.

Results

A suicide attempt history was associated with past year emergency department medical visits [aOR 1.51, 95% CI 1.04–2.18, P= .03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt [aOR 1.50, 95% CI 1.03–2.17 and aOR 1.67, 95% CI 1.06–2.63, respectively].

Conclusions

Suicide prevention, including universal screening and brief intervention, is indicated in emergency department settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.     

Be True to Our Schools—Models of Care in College Mental Health

Purpose of Review

To review and synthesize the previous, current, and proposed models of care in college mental health in order to identify best practices that will address the mental health needs of today’s students. To highlight data that supports existing or proposed models and describe areas where more data is needed.

Recent Findings

Despite the potentially appealing attributes of integrated care, empirical evidence supporting these systems and structures in campus settings is mixed. Recent surveys show less than half of campuses have an integrated mental health care model. Overall, there is only partial consensus on optimal models of campus mental health care.

Summary

Mental health needs in college student populations are greater and more complex than ever. While the resources available are vast and varied, there is limited evidence to support which models and programs can best meet students’ needs.

     

A mental health training program for community health workers in India: impact on knowledge and attitudes

Background

Unmet needs for mental health treatment in low income countries are pervasive. If mental health is to be effectively integrated into primary health care in low income countries like India then grass-roots workers need to acquire relevant knowledge and skills to be able to recognise, refer and support people experiencing mental disorders in their own communities. This study aims to provide a mental health training intervention to community health workers in Bangalore Rural District, Karnataka, India, and to evaluate the impact of this training on mental health literacy.

Methods

A pre-test post-test study design was undertaken with assessment of mental health literacy at three time points; baseline, completion of the training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a four day course based on a facilitator's manual developed specifically for community health workers in India.

Results

70 community health workers from Doddaballapur, Bangalore Rural District were recuited for the study. The training course improved participants' ability to recognize a mental disorder in a vignette, and reduced participants' faith in unhelpful and potentially harmful pharmacological interventions. There was evidence of a minor reduction in stigmatizing attitudes, and it was unclear if the training resulted in a change in participants' faith in recovery following treatment.

Conclusion

The findings from this study indicate that the training course demonstrated potential to be an effective way to improve some aspects of mental health literacy, and highlights strategies for strengthening the training course.     

Does colocated care improve access to cardiometabolic screening for patients with serious mental illness?

Objective

Individuals with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder) experience disparities in mortality relative to the general population, mainly because of medical conditions (i.e., cardiometabolic disease).We assessed whether VA patients with SMI and receiving care from VA mental health facilities with colocated medical care were more likely to receive cardiometabolic risk assessments in accordance with clinical practice guidelines than patients from noncolocated facilities.

Methods

Patients with SMI identified prescribed second-generation antipsychotic medications in fiscal year (FY) 2007 receiving care from VA mental health facilities completing the VA Mental Health Program Survey were included. VA administrative data were ascertained to assess receipt of the following tests every 6 months in FY 2007: body mass index (BMI), blood pressure, lipid profile and fasting glucose.

Results

Out of 40,600 patients with SMI prescribed second-generation antipsychotics, 29% received all cardiometabolic tests (lipid, glucose, BMI and blood pressure). While 79% and 76% received blood pressure and BMI assessments, respectively, only 37% received a lipid test. Patients from colocated sites were more likely to receive all cardiometabolic tests (odds ratio=1.26, 95% confidence interval: 1.18–1.35, P<.001).

Conclusions

Colocated general medical providers in mental health clinics are more likely to provide cardiometabolic assessments for patients with SMI prescribed second-generation antipsychotics.     

Lifelong Learning for Clinical Practice: How to Leverage Technology for Telebehavioral Health Care and Digital Continuing Medical Education

Purpose of Review

Psychiatric practice continues to evolve and play an important role in patients’ lives, the field of medicine, and health care delivery. Clinicians must learn a variety of clinical care systems and lifelong learning (LLL) is crucial to apply knowledge, develop skills, and adjust attitudes. Technology is rapidly becoming a key player—in delivery, lifelong learning, and education/training.

Recent Findings

The evidence base for telepsychiatry/telemental health via videoconferencing has been growing for three decades, but a greater array of technologies have emerged in the last decade (e.g., social media/networking, text, apps). Clinicians are combining telepsychiatry and these technologies frequently and they need to reflect on, learn more about, and develop skills for these technologies. The digital age has solidified the role of technology in continuing medical education and day-to-day practice.

Summary

Other fields of medicine are also adapting to the digital age, as are graduate and undergraduate medical education and many allied mental health organizations. In the future, there will be more online training, simulation, and/or interactive electronic examinations, perhaps on a monthly cycle rather than a quasi-annual or 10-year cycle of recertification.

     

The psychometric properties of the Cognitive-Somatic Anxiety Questionnaire in Chinese undergraduate students and clinical patients

Background

The present study was conducted to develop a Chinese version of the 14-item Cognitive-Somatic Anxiety Questionnaire (CSAQ) and examine its psychometric properties.

Methods

The original English version of the CSAQ was first translated into Chinese and then backtranslated and modified until cross-language equivalence was established. This version was then completed by 2168 undergraduate students and 289 clinical patients with mental disorder in China. The Mood and Anxiety Symptoms Questionnaire (MASQ) was also administered to students. Confirmatory factor analysis was performed to examine the two-factor construct, and the CSAQ's internal consistency, test–retest reliability, and concurrent and discriminant validity were also evaluated.

Results

The two-factor model (cognitive and somatic) of the CSAQ was confirmed, and the scale showed an adequate model fit in the student and clinical samples. The CSAQ showed adequate internal consistency (student sample: Cronbach's α = 0.82, mean inter-item correlation coefficient = 0.25; clinical sample: Cronbach's α = 0.81, mean inter-item correlation coefficient = 0.23) and good stability (2-week test–retest reliability in student sample, 0.84). The coefficient of correlation between CSAQ and overall anxious symptoms MASQ scores among students was 0.64.

Conclusions

The Chinese version of the CSAQ is a promising instrument for reliable and valid measurement of anxiety in Chinese populations.     

Social distance in Lithuanian psychology and social work students and professionals

Purpose

This cross-sectional study aimed to compare desire for social distance from people with mental illness in the disciplines of social work and psychology, and among students and professionals having different professional experience.

Methods

948 respondents (715 students and 233 professionals) from Lithuanian educational and mental health-care institutions participated in an anonymous survey. Social distance was measured using Lithuanian Social Distance Scale which was created for this study. Participants also answered questions about familiarity with mental illness. Bias of social desirability was measured using the balanced inventory of desirable responding.

Results

Series of ANCOVA analysis revealed that psychology and social work master’s and PhD students reported less social distance from people with mental illness when compared with bachelor’s students. Familiarity with mental illness was significantly related to less social distance in the student sample, but not in professionals’ sample. The strongest desire for social distance in the professionals’ sample was observed in social workers having less than 5 years of professional practice and most experienced psychologists with more than 10 years of professional practice.

Conclusions

Social distance from people with mental illness decreases through the study years; however, results of professional psychologists and social workers illustrate different trajectories in social distance through the professional career. The results of this study support the need for anti-stigma programmes and initiatives orientated towards mental health professionals.

     

Exploration of mental health of health students: Dental and medical formations promote anhedonia

Objectives

Health students usually report to experience stress during their formation. This is due to their exposure to patient's disease or death, to their learning of interpersonal relationships, and to the discovery of health practitioner's responsibility. Anhedonia represents a deficit in experiencing pleasure that is promoted by stressful living conditions. We hypothesized that health formations promote anhedonia. Our objectives have consisted in measuring anhedonia and analyzing its variation and heterogeneity among health students.