PurposeTo systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.MethodMedline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxie

http://www.medical-mastermind-community.com/uploads/63-Systematic_Review_of_Depression_Anxiety_and.9.pdf

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.

Medical Student Distress: Causes, Consequences, and Proposed Solutions

Purpose Burnout, a marker of professional distress prevalent among residents and physicians, has been speculated to originate in medical school. Little is known about burnout in medical students. The authors sought to identify the prevalence of burnout, variation of its prevalence during medical school, and the impact of personal life events on burnout and other types of student distress. Method All medical students (n 1,098) attending the three medical schools in Minnesota were surveyed in spring 2004 using validated instruments to assess burnout, quality of life, depression, and alcohol use. Students were also asked about the prevalence of positive and negative personal life events in the previous 12 months. Results A total of 545 medical students (response rate 50%) completed the survey. Burnout was present in 239 (45%) of medical students. While the frequency of a positive depression screen and at-risk alcohol use decreased among more senior students, the frequency of burnout increased (all p .03). The number of negative personal life events in the last 12 months also correlated with the risk of burnout (p .0160). Personal life events demonstrated a stronger relationship to burnout than did year in training on multivariate analysis. Conclusions

Personal life events and medical student burnout: a multicenter study.

Feedback and reflection are two basic teaching methods used in clinical settings. In this article, the authors explore the distinctions between, and the potential impact of, feedback and reflection in clinical teaching. Feedback is the heart of medical education; different teaching encounters call for different types of feedback. Although most clinicians are familiar with the principles of giving feedback, many clinicians probably do not recognize the many opportunities presented to them for using feedback as a teaching tool. Reflection in medicine—the consideration of the larger context, the meaning, and the implications of an experience and action—allows the assimilation and reordering of concepts, skills, knowledge, and values into pre-existing knowledge structures. When used well, reflection will promote the growth of the individual. While feedback is not used often enough, reflection is probably used even less. Acad. Med. 2002;77:1185‐1188.

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Feedback and reflection: teaching methods for clinical settings.

PurposeThe author interprets the state of the art of assessing professional behavior. She defines the concept of professionalism, reviews the psychometric properties of key approaches to assessing professionalism, conveys major findings that these approaches produced, and discusses recommend

Assessing professional behavior: yesterday, today, and tomorrow.

Many existing ethics curricula fail to address the subtle yet critical ethical issues that medical students confront daily. The authors report on the kinds of dilemmas students face as clinical clerks, using cases that students submitted in 1991-92 during an innovative and well-received ethics class given at a tertiary care hospital as part of the internal medicine clerkship. Analysis of these cases reveals that many dilemmas are intimately tied to the student's unique role on the medical health care team. Recurring themes included the student's pursuit of experience, differing degrees of knowledge and ignorance among team members, and dealing with disagreement within the hierarchical authority structure of the medical team. The authors conclude that some components of ethical education must be participant-driven and developmentally stage-specific, focusing more attention on the kinds of ethical decisions made by medical students as opposed to those made by residents or practicing physicians.

D A Christakis

Papers

Ethics in a short white coat: the ethical dilemmas that medical students confront