AIM: The study's aim was to determine whether medical doctors' expectancy that alcohol use reduces tension predicts the extent of their hazardous drinking and whether this effect is mediated by drinking to cope. METHODS: A group of Norwegian medical doctors' (n = 288) alcohol use was followed for 6 years. The expectancy that alcohol reduces tension and the use of alcohol to cope with tension were measured 3.5 years after graduation (T1), and hazardous drinking was evaluated at T1 and 9.5 years after graduation (T2). RESULTS: At T1, 15% of men and 3% of women reported hazardous drinking. At T2, these proportions were 16 and 2%, respectively. Men reported a higher expectancy than women that alcohol reduces tension (p = 0.03), whereas there was no sex difference in drinking to cope. Adjusted predictors of hazardous drinking at T2 were male sex (p
To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress.
Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models.
Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills.
The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress.
Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum.
Curricula should be evaluated for improvement implementations.
Completion of treatment is an important predictor of favourable outcome. We need more knowledge about predictors of completion in the inpatient psychosocial treatment modality. This prospective study from 13 such programmes follows a consecutive sample of clients (n = 307) from admission to completion/dropout. Instruments: EuropASI, MCMI II, SCL-25. The mean completion rate was 40% (20-71%), with no difference between clients with no ('debutants') or previous ('veterans') inpatient stays. Among 'debutants', the number of years of heroin use was negatively related to completion. Among 'veterans', age and amphetamine use were positively related, while the presence of a personality disorder and number of previous inpatient treatments were negatively related to completion. Specific strategies for involving clients with personality disorders are needed. After three inpatient stays, other types of treatment should be offered.
We have previously identified long-term individual predictors of hazardous drinking in doctors, but longitudinal studies on contextual factors (work and life stress) and mental distress being independently linked to hazardous drinking over the first 15 years of a medical career are lacking.
Two nationwide cohorts of Norwegian doctors (n = 1,052) from all 4 Norwegian universities were surveyed in their final year of medical school (1993/1994 and 1999) (T1), and 4 (T2), 10 (T3), and 15 (T4) years later. Hazardous drinking was measured using a validated 9-item version of the Alcohol Use Disorder Identification Test. Work-related and other predictors were analysed using generalized estimating equations.
Ninety percent (947/1,052) responded at least once, and 42% (450/1,052) responded at all 4 time points. Hazardous drinking was reported by 16% at T1, 14% at T2 and T3, and 15% at T4. Life events (p = 0.009) and mental distress (p = 0.002) were adjusted predictors of hazardous drinking, in addition to male gender, no religious activity, drinking to cope with tension, and low conscientiousness.
Doctors' work-related stress was not linked to hazardous drinking, but life events, mental distress, and drinking to cope were. Prevention should target mental distress and drinking to cope with tension.
Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students.
The study design was a cross-sectional survey performed in the four Norwegian medical schools with different curricula, spring 2003. A self-administered questionnaire regarding knowledge of communication skills (an abridged version of van Dalen's paper-and-pencil test) was sent to all students attending the four medical schools. A total of 1801 (59%) students responded with complete questionnaires.
At the end of the 1st year of study, the score on the knowledge test was higher in students at the two schools running communication courses and providing early patient contact (mean 81%) than in the other two medical schools (mean 69-75%, P
Cites: Med Educ. 2002 Feb;36(2):108-911869435
Cites: Med Educ. 2002 Feb;36(2):125-3411869439
Cites: Med Educ. 2002 Feb;36(2):148-5311869442
Cites: Can J Neurol Sci. 2002 Jun;29 Suppl 2:S23-912139082
The authors investigated whether a new type of medical school curriculum-with problem-based learning, integrated preclinical and clinical phases, and increased levels of contact between students, patients and teachers--is associated with lower levels of students' negative attitudes towards medical training than is a traditional medical school curriculum. This association was found, and was confirmed by a comparison between students in a university that had changed from a traditional curriculum to a new curriculum. Curriculum design may explain differences in students' attitudes towards medical school.
Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, POB 1111 - Blindern, Norway, N-0317, Oslo, Norway. firstname.lastname@example.org.
This prospective study from end of medical school through internship investigates the course and possible change of self- reported self-efficacy in communication skills compared with observers' ratings of such skills in consultations with simulated patients.
Sixty-two medical students (43 females) from four Norwegian universities performed a videotaped consultation with a simulated patient immediately before medical school graduation (T1) and after internship (internal medicine, surgery and family medicine, half a year each - T2). Before each consultation, the participants assessed their general self-efficacy in communication skills. Trained observers scored the videos and applied a well-validated instrument to rate the communication behaviour. Results from the two assessment methods were correlated at both time points and possible differences from T1 to T2 were explored.
A close to zero correlation between self-efficacy and observed communication skills were found at T1. At T2, participants' self-efficacy scores were inversely correlated with levels of observed skills, demonstrating a lack of concordance between young physicians' own assessment of self-efficacy and observers' assessment. When dividing the sample in three groups based on the observers' scores (low 2/3), the group of male physicians showed higher levels of self-efficacy than females in all the three performance groups at T1. At T2, those having a high performance score yielded a low self-efficacy, regardless of gender.
The lack of positive correlations between self-efficacy assessment and expert ratings points to limitations in the applicability of self-assessment measures of communication skills. Due to gender differences, groups of female and male physicians should be investigated separately. Those obtaining high-performance ratings from observers, through the period of internship, may become more conscious of how demanding clinical communication with patients may be. This insight may represent a potential for growth, but could in some physicians represent too much of a self-critical attitude. Active supervision of young physicians throughout internship is important in order to help physicians to be more aware of their strengths and weaknesses, in order to gain increased mastery in the art of doctoring.
Cites: Med Teach. 2007 Nov;29(9):921-6 PMID 18158666
Cites: J Med Pract Manage. 2001 Jan-Feb;16(4):184-91 PMID 11317576
To test whether young physicians improve their communication skills between graduating from medical school and completing clinical internship, and to explore contributing background and/or internship factors.
Norwegian medical students graduating June 2004 were invited to take part in a videotaped standardized patient interview February 2004. Of the 111 students who originally participated, 62 completed a second interview February 2006. Observed communication skills were assessed with the Arizona Communication Interview Rating Scale (ACIR).
The level of communication skills increased significantly during the period for participants overall; and for females but not males. General social skills reached significantly higher levels than specific professional skills, both types of skill improving during the study. Independent predictors were working in local hospitals, learning atmosphere and low stress. At school completion, 50% reached a level defined as 'advanced beginner'. Towards the end of the internship, 58% reached 'capable' and 27% 'competent' levels of communication skills.
Female physicians improved most in communication skills, the gender difference being multivariate mediated through low stress levels and learning atmosphere. The findings support the division of communication skills into general social and specific professional skills.
The relatively low proportion of young physicians, especially males, developing the capability to practise independently at internship completion indicates a need for more effective training in communication skills, during both medical school and internship.
To investigate the relationship between the length of a medical consultation in a general practice setting and the biopsychosocial information obtained by the physician, and to explore the characteristics of young physicians obtaining comprehensive, especially psychosocial information.
A prospective, longitudinal follow-up study.
Videotaped consultations with standardized patients on two occasions were scored for the amount of biopsychosocial information obtained. Consultation length was recorded in minutes. Subjects. Final-year (T-1) medical school students (n = 111) participated in the project. On completion of their internship one and a half years later (T-2), 62 attended a second time, as young physicians.
Pearson's r correlations between content and length at T-1 and T-2 were 0.27 and 0.66, respectively (non-overlapping confidence intervals). Psychosocial content increased significantly when consultations exceeded 13 minutes (15 minutes scheduled). Physicians using more than 13 minutes had previously, as hospital interns, perceived more stress in the emergency room and had worked in local hospitals.
A strong association was found between consultation length and information, especially psychosocial information, obtained by the physicians at internship completion. This finding should be considered by faculty members and organizers of the internship period. Further research is needed to detect when, during the educational process, increased emphasis on communication skills training would be most beneficial for students/residents, and how the medical curriculum and internship period should be designed to optimize young physicians' use of time in consultations.
Cites: Br J Gen Pract. 2001 Jun;51(467):456-6011407050
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Cites: Med J Aust. 2004 Jul 19;181(2):100-415257650
OBJECTIVES: The aims of this study were to assess the prevalence of self-reported mental health problems and help-seeking among young physicians, and identify predictors of seeking help. METHODS: A prospective cohort sample of Norwegian medical students (N = 631) were assessed in their final semester (T1), and in the first (T2) and fourth (T3) postgraduate year. The average observation period was 3.6 years. RESULTS: The prevalence of mental health problems that needed treatment over the preceding year was observed to have increased from 11% at T2 to 17% at T3. There was no increase in help-seeking. Longitudinally, 34% reported that they needed treatment on one or several occasions. Adjusted predictors of help-seeking were perceived level of mental health problems and a reality weakness personality trait. CONCLUSION: Those who sought help had higher levels of emotional distress than those who did not. However, higher reality weakness scores predicted lower help-seeking and, therefore, may be a risk factor for avoiding necessary care.