In this study, we investigated the impact of educational intervention on the mental health of senior medical students. In brief, we designed educational courses based on the positive experiences shared by clinicians and courses were subsequently carried out on the third and fourth-year medical students. Additionally, we required all enrolled participants to complete several self-assessment questionnaires regarding their physical wellbeing, mental health (depression, QoL), self-motivation (burn-out, SE) and doctor-patients communication (empathy) before and after the interventional courses. Our results demonstrated that the students who received the intervention course had significantly improved scores of depression and empathy after the course, compared with students who underwent random conversational sessions in similar settings.
Intense medical school schedule, unbalanced work-life load and heavy stress from doctor-patient communication can negatively impact the mental well-being of medical students. These mental health problems are more prevalent in the senior students because they have more specialized courses and more complex clinical work. Perera et al showed that the score of empathy was negatively correlated with the increasing load of clinical work in medical students at Boston University (R. Perera 2016). In China, the 3rd and 4th year of the medical course is an important transitional stage in the student’s academic calendar which is characterized by the heaviest study load and the full-time clinical exposure. The incidence of depression was proven to be higher in senior medical students by a national survey that has screened 33 universities in China . Hence, we selected the 3rd/4th grade medical students as the participants in this study.
In the pre-trial interview, we analyzed and extracted the main challenges facing students including anxiety about clinical practice, fear of uncertainties and medical errors as well as dealing with doctor-patient conflicts. These challenges have been served as associated risk factors accounting for the above-mentioned mental health problems. Based on the results from the interview in the pilot group study, we designed our interventional courses accordingly. We chose experienced clinicians to share real life experiences in participants with stress risk factors in a form of workshop. Interestingly, we found that the depression score was significantly reduced by 10.8%, and the QoL score increased significantly after the interventional courses. In Malaysia, the impact of a well-being workshop was examined in medical students . Medical students were taught specific strategies to deal with stress and the outcome was favorable . Similarly, Lee and Graham designed an elective course in improving medical students’ mental wellness. During this course, students learned about emotional relief and time management to help them cope with clinical workload pressure . Nevertheless, the above-mentioned studies were not randomized controlled studies and they examined junior medical students (1st /2nd) grade. Therefore, their interventional courses might not be suitable for senior Chinese medical students. In addition, the above-mentioned studies using psychologists as the docents, who lacked clinical experience, potentially hindering the clinically effective communication with medical students. In our study, we selected senior medical students who are most reliable candidates. We designed a randomized controlled study to strengthen the validity of our intervention. Furthermore, we selected senior and experienced clinicians to share their own clinical experiences, empathy education and communication skills during the study. We have indeed observed that the well-designed interventional courses for Chinese medical students were effective when combining clinical and technical skills teaching with doctor-patient communication skills teaching. Students who received our interventional courses could comfortably handle their clinical workload pressure and work-related anxiety and stress with improvement in their QoL.
Our results demonstrated that empathy in the interventional group improved significantly. Empathy can be of great help in the better doctor-patient communication to achieve the best mutual understanding . Empathy is also important to patient care by enhancing patients’ satisfaction, comfort, self-efficacy and trust leading to accurate diagnosis, shared decision making and therapy adherence. (Quince et al. 2016) Hence, improving empathy of medical students is a primary focus of medical educators. Hospital-related violent incidents have been shown to be closely related to poor doctor-patient communication . Poor doctor-patient relationship may lower the students’ clinical empathy which could further exacerbate the doctor-patient communication ultimately affecting the patients’ prognosis [26, 27]. In this study, we used experienced clinicians as role models to teach students about the value of empathy. Our clinicians shared real life cases for efficient doctor-patient communications and requested students to reflect on their own experiences. As described in the follow up emails, students stated that they were impressed by the stories shared by the experienced clinicians. The students have been using those stories in guiding their real-life doctor-patient communications and clinical practice.
In this study, 50 (34.2%) of our senior medical students had the symptoms of burnout. In another study, Chunming et al previously reported that the burnout rate in Chinese medical students was 40% which was thought to be related with gender, grade and previous history of psychological diseases . In contrast, our study did not observe a correlation between gender and burnout. Additionally, the interventional course did not show a significantly improvement of burnout or self-efficacy. This could be attributed to either the heavy workload of the 3rd and 4th medical years or the relatively short duration of the interventional course. Future studies with longer interventional courses and longer follow-up periods will be required to validate our hypothesis.
This study has several limitations with firstly being a single-center study. Secondly, we could not prevent the student participants’ communication regarding the research contents after classes which might lead to bias on follow-up data collection. In summary, our results need to be confirmed in a large multicenter double-blind randomized study to prove its applicability.