Mental health declines throughout medical school for many students with half of students reporting symptoms of burnout, which may negatively impact individual health and professional development. American College of Physicians in alignment with the PERMA well-being model suggest organisations provide programming to promote belonging and social support through opportunities to connect with peers. To overcome a medical culture that encourages perfectionism (while hiding vulnerability) and to achieve meaningful interaction, brave and safe student spaces need to be created. Medical student support groups facilitated by psychotherapists and faculty have promoted well-being yet are limited by facilitator availability and student concern for possible career implications. To create brave spaces for meaningful interaction, the authors created and implemented unstructured, participant-directed, near-peer facilitated medical student support groups. The authors recommend empowering student facilitators with (1) a brief training from a psychologist, (2) access to a faculty advisor, (3) a sample facilitator guide for 'how to' facilitate unstructured sessions and (4) opportunities for reflection and for receiving participant feedback. Participants and facilitators appreciated the opportunity to connect honestly with peers and have experiences normalised. Near-peer facilitated support groups have the potential to improve the training experience, promote well-being and mental health and shape the culture of medicine.

Michel Foucault was interested in two things: correcting what he was interested in and good puns. In the spirit of both, in this piece, I muse on medical education's fascination with its 'self'. More specifically, through a playful discourse analysis, I will examine medical education's use of the 'self' to critique the limits of its 'self' exploration.

Burnout is a pervasive issue among medical students, with implications for their mental health, academic performance, and future careers in healthcare. Medical students face unique stressors, including heavy academic workload, emotional demands and insufficient support, which may contribute to burnout. In Nigeria, where medical students also grapple with socioeconomic challenges, the prevalence and causes of burnout remain underexplored. This study aims to investigate the prevalence of burnout, its contributing factors, and the role of support systems among medical students at the University of Ibadan, Nigeria.

A mixed-methods approach was employed, combining both quantitative and qualitative data. The study involved 355 medical students from the University of Ibadan, spanning second to sixth years, who completed a self-administered online survey. The quantitative component assessed burnout using the Oldenburg Burnout Inventory for Students (OLBI-S) and social support using the Multidimensional Scale of Perceived Social Support (MSPSS). The qualitative component consisted of a focus group discussion (FGD) with 11 participants, exploring their perceptions of burnout, coping mechanisms, institutional support and factors contributing to burnout. Data from both components were triangulated for comprehensive analysis.

The survey found that 81.1% of participants were classified as experiencing burnout, with high academic workload and lack of breaks as the primary contributing factors. Female students (91.7%, p < 0.001) and those in advanced years (600 level, p = 0.004) reported significantly higher levels of burnout. While 59.2% of students reported strong social support, particularly from family, only 3.9% had ever utilised the College's counselling services, highlighting a gap in institutional support. The FGD revealed that students rely heavily on peer support, family, social events and religious gatherings to cope with burnout. However, dissatisfaction with the College's counselling services was prevalent, as they were seen as ineffective and underutilised.

The high prevalence of burnout among medical students at the University of Ibadan underscores the need for systemic reforms in medical education. Key recommendations include more frequent academic breaks, improved infrastructure and enhanced institutional support services. Efforts to address burnout should focus on fostering a more supportive academic environment. These findings are crucial for developing interventions aimed at improving the mental health and well-being of medical students in Nigeria and similar contexts.

Illness presenteeism (IP)-characterized by individuals working despite being sick-is a prevalent and complex phenomenon among physicians and trainees amidst competing priorities within medicine. The COVID-19 pandemic and growing attention to physician and trainee well-being have sparked renewed interest in IP. We conducted a scoping review to explore what is known about IP: more specifically, how IP is perceived, what approaches have been used to study the phenomenon and how it might have changed through the COVID-19 pandemic.

The Arksey and O'Malley scoping review framework was used to systematically select and summarize the literature. Searches were conducted across four databases: Medline, Embase, PsycInfo and Web of Science. Quantitative and thematic analyses were conducted.

Of 4277 articles screened, 45 were included. Of these, four were published after the onset of the COVID-19 pandemic. All studies framed IP as problematic for physicians, patients and health care systems. Dominant sociocultural drivers of IP included obligations towards patients and colleagues and avoiding the stigma of appearing vulnerable or even temporarily weak. Structural factors included heavy workload, poor access to health services and lack of sick leave policies for physicians. The pandemic does not appear to have affected IP-related causes or behaviours. Proposed solutions included both educational interventions and policy-driven changes.

Despite being viewed in the literature as largely negative, IP remains highly prevalent among physicians and trainees. Our review highlights that IP among physicians is fraught with tensions: while IP seemingly contradicts certain priorities such as physician wellbeing, IP may be justified by fulfilling obligations to patients and colleagues. Future work should examine IP through diverse theoretical lenses to further elucidate its complexities and inform nuanced individual and systems-level interventions to minimize the negative consequences of IP.

The characteristics of good clinical teachers, as considered by clinical trainee dental residents, remain uncertain not only in Japan but also globally. This study aimed to ascertain the characteristics associated with a good clinical teacher as perceived by clinical trainee dental residents in Japan; additionally, it determined how these characteristics differ from those identified in previous studies at various learning stages and in other professions, particularly among physicians.

Employing a qualitative approach, data were gathered through semi-structured focus groups and in-depth interviews. The focus group transcripts were analysed meticulously and independently, with anonymisation and coding conducted by the three authors. Clinical trainee dental residents or dentists within a year of completing clinical training were recruited using maximum variation sampling until thematic saturation was achieved.

A total of 38 participants took part in eight focus group interviews and one in-depth interview. The 376 identified descriptors were categorised into 44 distinct themes. 'Provides advice at the level of resident' emerged as the most prevalent theme, followed by 'Provides feedback and formative assessment', 'Provides practical guidance', and 'Models a close dentist-patient relationship'. Using Sutkin's primary categories (teacher, physician and human characteristics), 25 of the 44 themes were classified as teacher characteristics, 10 as physician characteristics, and 9 as human characteristics. Twenty-two themes corresponded directly to Sutkin's framework, and 22 were novel contributions of this study.

While the identified common themes resonate with those recognised in the medical field as attributes of good clinical teachers, half of the themes were specific to the dental domain and were independently established. These findings underscore the successful elucidation of the unique attributes specific to good clinical teachers among clinical trainee dental residents.

Medical trainees experience occupational stress, prompting increasing research to explore wellbeing interventions. To date, few meta-analyses have evaluated intervention effects, and none have focused on trainees in family medicine or general practice (FM/GP), specifically. Aim: To synthesise available literature on psychosocial interventions to promote wellbeing, and subsequently reduce ill-being or burnout, among FM/GP specialty trainees.

Preferred Reporting Items for Systematic Review and Meta-Analysis were followed and online databases (Embase, Medline, PsycINFO, ProQuest, Scopus) systematically searched (no date limits) for published studies and dissertations. The methodological quality of included studies was reviewed (Mixed Methods Appraisal tool, GRADE assessment), and pre-post changes (Hedges' g) pooled using random effects modelling.

Eleven independent studies, involving 182 FM/GP trainees, were included in this review. Evaluated studies varied in their design and the results were characterised by imprecision. Interventions differed in their content, delivery, and length. The data did not favour a single type of intervention, although supporting individuals to monitor their wellbeing did produce significant, positive effects.

There is a lack of evidence about the best ways to promote wellbeing in FM/GP trainees. Both the methodology and design of training and educational initiatives for FM/GP need careful consideration in order to progress this research.

Despite the benefits of clinical training, stressors naturally arise during students' training. These stressors may negatively impact the emotional and psychological wellbeing of the students. There is paucity of literature on the clinical stressors and the challenges faced by medical imaging students in Ghana. This study explored undergraduate medical imaging students' perceptions of stressors during clinical training and suggested measures that may lessen burn out.

Cross-sectional study design was employed. The study population consisted of 293 medical Imaging students from College of Health and Wellbeing Kintampo (CoH-K), Kwame Nkrumah University of Science and Technology (KNUST), University of Cape Coast (UCC), University for Development Studies (UDS), University of Ghana (UG), and University of Health and Allied Sciences (UHAS). A self-administered questionnaire with closed-ended questions and a section for open remarks was used for data collection and subsequently analysed using IBM SPSS version 26.

63.50% were males and final year students were the majority (48.80%). The highest ranked stressor was, ''theory to practical" (89.42%) while "sexual harassment from superiors" ranked lowest (0.12%). UCC recorded the highest responses (35.8%). The coping mechanism, "Reflecting on situations and making better plans for future experiences" ranked highest (89.08%) while "taking alcohol or hard drugs" ranked lowest (2.39%).

The data highlighted various clinical stressors experienced by students identifying theory to practical gap as the most prominent. It also provided valuable insights into the coping mechanisms adopted by the students to manage clinical stressors, with reflection, support-seeking, and relaxation techniques being prominent strategies.

Institutions of higher education in Ghana should institute measures to improve students' wellbeing in the clinical areas.

For more than a decade, the literature has been dominated by the notion that medical students may paradoxically lose their empathy during medical school. However, medical curricula have significantly evolved, and the question is whether this is still the case. The present study aimed to describe the trajectories of different dimensions of empathy from the beginning to the end of a six-year medical curriculum and explore the influence of different psychosocial and health-related factors.

In an open cohort design, all medical students at the University of Lausanne (Switzerland) were invited to complete four waves of yearly online questionnaires. Cognitive, affective, and behavioral empathy were measured with three validated instruments, and emotion recognition was assessed with a performance test. For each measure, linear mixed models including an array of psychosocial and health-related potential covariates were modelled. Different temporal variance-covariance structures and nonlinear trajectories were tested.

The final sample included 3224 questionnaires completed by 1667 medical students. The cognitive and affective dimensions of empathy significantly increased in the first half of medical school, followed by a plateau, whereas behavioral empathy remained stable. For emotion recognition, a significant linear increase was observed. The only covariate with substantial influence was gender: students identifying as male presented similar trajectories of empathy and emotion recognition but with overall lower scores than students identifying as female or nonbinary.

This study revealed significant increases in cognitive empathy, affective empathy, and emotion recognition. Developments in today's medical curricula may have contributed to the observed increase in empathy. Future multisite studies are warranted to identify the features of the educational environment that impact the trajectories of empathy during medical school.

Burnout remains a vexing issue for healthcare workers, educators and policy makers. Continuing high prevalence rates have focused the need for new and innovative approaches. The deleterious personal and professional consequences of burnout when it does develop place this focus on primary prevention. Yet despite its benefits, primary prevention initiatives have several barriers to engagement which impact their effectiveness. In this article, the authors explore potential barriers to engagement with primary level prevention of burnout amongst physicians-in-training, many of which are rooted in the social and professional contexts of training. Understanding the motivations of physicians-in-training should be used to guide the development of initiatives which combine protection against burnout with relevant goal-directed, instrumental outcomes. Three principles which can guide initiatives combining these features are explored. Promoting curiosity and curiosity-led enquiry combines a well-established protective attribute with educational and professional benefits. Curiosity-led endeavours can be developed into areas of special interest and competence, harnessing the protective benefits of self-efficacy and peer acknowledgement. Finally, special interests and the professional roles to which they lead foster the development of professional social networks and mentorship relationships. These are protective, particularly for physicians-in-training navigating role and organisational transitions. Supporting interventions with instrumental outcomes is both beneficial in engaging investment and also sustainable across the career-span. Burnout remains a challenging issue, and while programmatic interventions continue to have a role, the benefits of broader primary preventative approaches should be considered in terms of the potential engagement and sustainability advantages they confer.

The online version contains supplementary material available at 10.1007/s40670-024-02276-6.

Objective: To assess and examine how the COVID-19 pandemic may have impacted the mental health of a sample of health professions students (HPS) using an explanatory sequential mixed-methods design. Participants: Participants included 41 HPS enrolled in a co-curricular interprofessional education (IPE) program. Measurements: Measures included the CES-D scale, PSS scale, and the GAD scale. Qualitative description was used to explore the experiences of these HPS. Results: The HPS explained that fear of acquiring COVID-19, transmitting the virus to loved ones, and dying as a result of the disease negatively influenced their mental health. The HPS revealed that there were some beneficial outcomes resulting from the pandemic, including the strengthening of family bonds and the cultivation of resiliency. Conclusions: The pandemic has had a negative impact on the mental health of these HPS. It is essential that these students receive support for their mental health in order to provide optimal care to the population they serve.

In recent years, studies have highlighted that stress levels among medical students are alarmingly high. The study aim was to examine how academic stress and depressive symptoms in medical students are affected by individual moderators (self-efficacy/optimism) and structural influencing factors (health promotion offers).

Data collection occurred at three measurement points during the first 1.5 years at a medical school in Germany [baseline measurement (BM; Winter 2019, 226 participants), follow-up measurement 1 (FUM1; Summer 2020, 106 participants) and follow-up measurement 2 (FUM2; Winter 2020, 107 participants)]. Cross-sectional and longitudinal analyses were conducted with the data of FUM1 and FUM2, BM being only cross-sectionally analyzed as a baseline measurement. Interactions were calculated cross-sectionally with multiple linear regressions, and longitudinally with mixed effects models.

Academic stress was positively correlated with depressive symptoms cross-sectionally. In the longitudinal sample, optimism was found to moderate the association between academic stress and depressive symptoms, while the moderating effect of self-efficacy was found cross-sectionally for FUM2. "University sports offers" was the most-used health promotion offer for both FUM1 and FUM2. The other services, especially "psychological counseling", were rarely used by the students. The prevalence of depressive symptoms increased during the study course (BM: 4.9%; FUM1: 25.5%; FUM2: 23.4%).

The increase of depressive symptoms linked to rising academic stress within the study course is alarming. Individual attributes such as optimism and self-efficacy have a moderating role on the relationship between academic stress and depressive symptoms and prevention offers may affect those individual attributes..

The online version contains supplementary material available at 10.1007/s40670-024-02240-4.

It is widely acknowledged that healthcare practitioner well-being is under threat, as many factors like excessive workloads, perceived lack of organizational support, the rapid introduction of new technologies, repercussions of the COVID-19 pandemic, and other factors have transformed the health care workplace. Distress, anxiety and burnout are on the rise, and are particularly concerning for health professions' students who must navigate challenging academic and clinical demands, in addition to personal responsibilities. While not a panacea for the systemic issues at play, 'mindfulness practices' have shown some promise in supporting students to navigate stressful environments. Yet despite calls for more phenomenological studies, little is known about health professions students' lived experiences of learning about and using mindfulness in higher education contexts. The objective of this hermeneutic phenomenological study was to inquire into the first-hand lived experiences of health professions students by examining their written reflections on learning about and using mindfulness in a higher education context. The study reports on themes identified in an analysis of students' phenomenological reflections written during and following a mindfulness elective course offered at a Canadian University. The analysis revealed four predominant themes: (a) reframing perceptions, (b)'being' while 'doing', (c) witnessing the struggle, and (d) compassion for self and others. In a time when health professionals are increasingly under strain, and systemic reform is needed but slow to take shape, the findings of this study reveal potential affordances of mindfulness for helping students to navigate the myriad of challenges they face. The findings are unique in their in-depth exploration of students' reflections on the experience of learning about and engaging in 'mindfulness practices' in a higher education context. The findings contribute first-hand perspectives to the evolving field of mindfulness education research and generate new conversations about mindfulness education in the health professions curriculum.

BackgroundBurnout, marked by emotional exhaustion, depersonalization and depletion of professional efficacy, is rampant among residents. With deleterious effects on productivity, conduct and patient care, resident programs have increasingly emphasized resilience training to combat burnout. However, the personalized nature of burnout complicates the effective design of such programs. Premised on recent works that identify burnout as a result of shifting personhood, this study utilizes the Ring Theory of Personhood to guide the conceptualization of resilience training programs that address changes in the belief systems shaping one's self-concept.MethodsA systematic scoping review to explore how resilience is addressed and assessed amongst medical residents was conducted. Guided by the PRISMA-compliant Systematic Evidence-Based Approach (SEBA), searches for relevant articles published between 1st January 2000 and 4th November 2024 on PubMed, Embase, Scopus, ERIC and PsycINFO were performed. The SEBA methodology facilitated the integration of the themes and categories identified using thematic and content analyses.ResultsOf 15 953 abstracts screened, 666 articles were reviewed and 69 full-text articles were included. Three domains were identified: guiding theories; methods of teaching resilience; and assessment.ConclusionThe reliance on individual or societal theories has constrained the understanding, design and assessment of resilience programs. Current approaches, including mindfulness workshops, self-care initiatives and organization-led resilience training, are neither timely nor focused on the needs of each resident. To mitigate burnout, personalized, longitudinal and timely support is essential. Mentoring offers a more suitable alternative, providing culturally sensitive, resource-appropriate, sustainable and clinically relevant support to build resilience effectively.

Previous studies had identified the significant issue of burnout and sleep quality in medical students. However, no studies have explored the interactions between learning burnout and sleep quality on a symptom level. This study used network analysis to explore the interaction and construct the network structure of learning burnout and sleep quality among medical students in China. We recruited 553 medical students to participate in our study. Learning Burnout of Undergraduates and Scale (LBUS) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure learning burnout and sleep quality. Expected influence and bridge expected influence were used to identify the central and bridge symptoms. Results showed 'B9' (Tired of learning) and 'B17' (I want to learn but feel bored with it) had the highest expected influence. 'B12' (I often fall asleep while studying) and 'P_DD' (Daytime dysfunction) had the highest bridge expected influence. Our findings revealed the characteristics of learning burnout and sleep quality in online learning and provided information to further understand the difference in the influence of mental health between online and offline learning.

Burnout is highly prevalent among residents, and although many studied interventions have targeted burnout by trying to promote well-being, it remains a substantial problem. This study utilized data from the Pediatric Resident Burnout-Resilience Study Consortium (PRB-RSC) Annual Burnout Survey to determine which program interventions categorical and noncategorical (medicine-pediatrics and combined programs) pediatric residents found most helpful to promote well-being.

We conducted a secondary analysis of an open-ended question on the PRB-RSC Annual Burnout Survey in 2019 and 2020: "What is the most helpful thing that your program provides you for wellness?" We performed thematic and content analysis on open-ended responses and compared distribution of themes and subthemes between years using a Chi-square test.

In 2019, 1401 (44%) of 3159 residents from 44 programs responded to the open-ended question, with 771 (49%) of 1563 residents from 21 programs responding in 2020. Residents found wellness interventions within 5 themes to be the most helpful. Promotes positive work environment and Optimizes scheduling were mentioned most frequently, but residents also valued when a program Facilitates traditional wellness interventions, Offers financial benefits, and Prioritizes education. Themes and subthemes were mentioned with the same frequency in both 2019 and 2020.

The results of this study show which institutional interventions residents have found to be most helpful to their well-being. Program leaders can use these data as a framework to discuss interventions with their residents, allowing them to tailor wellness programs and use limited available resources for what residents believe is most impactful.

To explore associations of bias frequency, sources, and types with burnout in a large, multispecialty sample of residents and fellows and to determine whether and how odds of burnout change after adjustment for bias experiences in multiple demographic subgroups.

Trainees in graduate medical education programs at Mayo Clinic sites were surveyed between October 12, 2020, and November 22, 2020. Survey items measured personal experiences with bias (frequency, sources, types), burnout (2 Maslach Burnout Inventory items), and demographic characteristics (age, gender, race/ethnicity, lesbian-gay-bisexual-transgender-queer-nonbinary-other identification, disability, socioeconomic background, year in school, specialty). The χ2 test and logistic regression analyses examined relationships between variables.

Of 1825 trainees surveyed, 942 (52%) from 77 programs responded. Overall, 16% (137/881) of respondents reported 1 or more personal bias experiences. Trainees reporting bias experiences weekly or more often had markedly higher odds of burnout in adjusted analyses (odds ratio [OR], 8.00; 95% CI, 2.68 to 23.89; P<.001). Bias from education leaders/staff, fellow learners, and faculty was independently associated with burnout, whereas bias from patients/companions and other staff/employees was not. Trainees with a disability (OR, 3.16; 95% CI, 1.05 to 9.53; P=.04) and trainees from a low-income background (OR, 1.53; 95% CI, 1.03 to 2.26; P=.03) had higher odds of burnout in unadjusted analyses, but these associations were no longer statistically significant after adjustment for bias frequency.

Self-reported bias experiences relate strongly to trainee burnout. Some bias sources may be more strongly associated with burnout than others. More frequent bias experiences could account, at least in part, for higher odds of burnout in some demographic subgroups.

Little is known about the impact of the COVID-19 pandemic on medical students. We examined medical students' burnout, career regret, and medical school experiences from before to during the pandemic, and differences between students from marginalized and nonmarginalized groups. We analyzed data from 2019 to 2022 Association of American Medical Colleges Year Two Questionnaires (N = 52,152) and Graduation Questionnaires (N = 66,795). Given large samples, we focused on effect sizes versus statistical significance. All effects of study year were less than small (η2 < .01) indicating minimal differences in medical students' burnout, career regret, and school experiences from before (2019) to during (2020-2022) the pandemic. Interactions between study year and demographic characteristics (gender, race-ethnicity, sexual orientation) were less than small; thus, students from marginalized groups were not affected more by the pandemic than others. Across study years, women reported more exhaustion and discrimination than men. Black students reported more discrimination than students from other racial-ethnic groups; bisexual students reported more discrimination than heterosexual students (all ds > 0.20). Differences between students from marginalized and nonmarginalized groups were bigger than the effects of the pandemic, suggesting a need for system-level interventions to foster inclusion in medical education.

The quality of the educational environment (EE) influences residents' achievement of learning outcomes and their professional development. The purpose of this study was to evaluate the EE using the short-version Postgraduate Hospital Educational Environment Measure (PHEEM) and compare residents' perceptions in total and subscale PHEEM according to their age, sex, residency year, and specialty.

This multicenter cross-sectional study was conducted at 12 teaching hospitals affiliated with the Tehran University of Medical Sciences. We recruited residents from 24 specialties and from the first to third/fourth residency years. Data were collected using the short-version PHEEM, which consists of 12 items with three subscales: senior doctor support and teaching skills (4), conditions of working and time to learn (4), and lack of harassment (4). The association between scores in total and each subscale with sex, residency year, and specialty was assessed.

In total, 538 residents from 24 specialties completed the questionnaire. Most participants were from internal medicine (n = 72, 13.4%). A total of 347 (64.5%) participants were females. The total PHEEM score was 20.60 (standard deviation (SD) 5.44) out of 48, with occupational medicine residents giving the highest scores and forensic medicine residents the lowest. The mean scores for the dimensions of senior doctor support and teaching skills were 7.55 (SD 2.87), for conditions of working and time to learn 6.08 (SD 3.94), and 6.95 (SD 3.22) for lack of harassment. There was no significant difference in total PHEEM scores for males and females. However, significant differences were found in subscales by sex. There were no statistically significant differences in residents' perceptions of the EE (total and subscales) according to their residency years, but there were significant differences between the specialties (P < 0.001).

The EE of the residency training program during COVID-19 was perceived to have plenty of problems that need immediate attention and follow-up.

Occupational well-being is inherent to physicians' professional performance and is indispensable for a cost-effective, robust healthcare system and excellent patient outcomes. Increasing numbers of physicians with symptoms of burnout, depression, and other health issues are demonstrating the need to foster and maintain physicians' well-being. Assessing physicians' well-being, occupational demands, and resources can help create more supportive and health-promoting working environments. The WellNext Scan (WNS) is a 46-item questionnaire developed to assess (i) physicians' well-being and (ii) relevant factors related to physicians' clinical working environment. We collected data to investigate the validity and reliability of the WNS using a non-randomized, multicenter, cross-sectional survey of 467 physicians (staff, residents, doctors not in training, and fellows) from 17 departments in academic and non-academic teaching medical centers in the Netherlands. Exploratory factor analysis detected three composite scales of well-being (energy and work enjoyment, meaning, and patient-related disengagement) and five explanatory factors (supportive team culture, efficiency of practice, job control and team-based well-being practices, resilience, and self-kindness). Pearson's correlations, item-total and inter-scale correlations, and Cronbach's alphas demonstrated good construct validity and internal consistency reliability of the scales (α: 0.67-0.90; item-total correlations: 0.33-0.84; inter-scale correlations: 0.19-0.62). Overall, the WNS appears to yield reliable and valid data and is now available as a supportive tool for meaningful team-based conversations aimed at improving physician well-being.

The significance of issues in medical humanities, such as empathy, professionalism, patient-orientation, disclosure of harms, and communication skills, has been widely acknowledged in previous studies. While these studies have showcased the impact of individual facets of medical humanities on clinical practice, there exists a dearth of comprehensive assessments that encompass these constructs and their relationship with burnout and distress among medical students. This study aims to fill these gaps by exploring Chinese medical students' overall perceptions of medical humanities across different educational phases and shedding light on the intricate associations between perceptions of humanities, burnout, and stress.

We conducted a nationwide survey using a web-based questionnaire across 38 Chinese universities. The questionnaire includes Medical Humanities constructs, the Maslach Burnout Inventory constructs and the Perceived Stress constructs. The survey was administered using the snowball sampling method, with the data collection period running from September 8, 2022, to September 22, 2023. Participants included a national sample of 904 students (out of a total of 969) enrolled in medical schools. To investigate the relationships among all the constructs, PLS-SEM analysis was conducted by using the SmartPLS 3.3.9 software in this study.

The student's perception of medical humanities was significantly influenced by several factors: years of medical school education (β  = -.077; P = .045), work burnout (β = -.208; P < .001), and perceived stress (β = -.467; P < .001). Work burnout was impacted by clinical clerkship experience (β = .106; P = .001), whereas perceived stress was influenced by the number of years in medical school (β = 0.102; P = .002). Additionally, work burnout acts as an intermediate variable between clinical clerkship experience and students' perception of medical humanities.

This study illuminated the complex relationship between medical education, burnout, stress, and students' perception of medical humanities issues. It underscores the critical importance of balancing technical proficiency with humanistic values in medical training. Implementing strategies that support students' well-being and foster empathy is essential in nurturing a compassionate and effective healthcare workforce.

Aimed to examine the relationship between Individual participation, social support, self-efficacy and career planning among medical students of obstetrics and gynecology.

Utilizing a cross-sectional survey, We evaluated 292 medical students specializing in obstetrics and gynecology across various educational stages. Questionnaires measured academic self-efficacy, social support, personal involvement, and career planning. We applied descriptive statistics, linear regression, and mediation effect analyses with the SPSS AU tool.

This study evaluated the career planning status of 292 medical students rotating through obstetrics and gynecology at various educational stages using a cross-sectional survey. Linear regression analysis revealed that age has a negative impact on career planning scores, with each additional year reducing the score by an average of 0.065 points. Gender (with males scoring lower) and residence (with students from rural areas scoring higher) also had significant effects (all p <0.05). Positive factors included self-efficacy in academic ability, career planning guidance from parents and friends, participation in career planning-related training, medical practice projects, and medical competitions, all of which significantly and positively influenced career planning scores, the aforementioned factors account for 40.5% of the variation in career planning. Mediation effect analysis showed that social support and personal participation have significant indirect effects on career planning through self-efficacy, accounting for 7.746% and 5.338% of the total effect, respectively, and both have significant direct positive impacts on career planning, with total effects of 0.526 (95% CI [0.393, 0.658], p = 0.000 < 0.001) and 0.470 (95% CI [0.292, 0.648], p = 0.000 < 0.001), respectively. These results highlight the importance of enhancing social support and personal participation to improve career planning capabilities among medical students (all p < 0.05).

Enhancing social support and personal participation can improve career planning capabilities in medical students by boosting self-efficacy.

Healthcare professionals experience stressors that begin during training and persist into their careers that adversely impact their well-being. This study aims to identify students' and professionals' stress levels, satisfaction with wellness domains, barriers to wellness, and stress management practices.

This study was a cross-sectional self-reported survey study.

The study included students (N = 242) and professionals (N = 237) from medicine, nursing, pharmacy, physical therapy, social work, and counseling/psychology.

The Managing Health & Wellness in Health Professions Training and Practice survey was used to capture wellness practices and barriers among participants. Results: Students reported significantly higher perceived stress compared to professionals (P < 0.001). Total wellness is significantly higher among professionals compared to students (P < 0.001). A higher stress rate is significantly related to being female, having a lower wellness score, and facing more barriers (P < 0.001). Intellectual health is the most valuable wellness domain for providers (M = 3.71, SD = 0.9) and students (M = 3.43, SD = 0.85), followed by spiritual health for providers (M = 3.4, SD = 1.1), and work/learning environment for students (M = 3.33, SD = 0.93). Professionals and students are least satisfied with their physical and financial health. Barriers include fatigue, workload/productivity in clinical practice, work hours, and burnout.

Healthcare professionals exhibit a variety of stress management practices, encounter barriers, and prioritize different wellness domains. Healthcare systems should incorporate self-care education into their curricula and implement systemic changes to foster a thriving healthcare workforce.

The clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout.

Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout.

Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= -0.12, p=.025; PS: B= -0.37, p<.001). The relationship between stress and residents' level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout.

Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors.

Background: Burnout is a major problem for physical and mental health of medical residents. The key for maintaining well-being and quality of care of residents is the assessing tool. The study evaluated the psychometric properties of the Arabic version of the Maslach Burnout Inventory Human Services Survey (MBI-HSS) among Tunisian medical residents by assessing its factor structure, construct validity, reliability, and gender invariance. Methods: A total of 552 residents, aged 27.01 ± 1.92, 219 males (39.7%) and 333 females (60.3%) completed the Arabic version of the A-MBI-MR. The exploratory (EFA) and confirmatory factor (CFA) analyses were performed to identify the factor structure, with assessments of internal consistency of the model, including gender measurement invariance. Results: The results indicate a high average variance extracted (AVE > 0.50) and factor loading of the scale, signifying robust construct validity and clearly suggesting that the items serve as essential indicators for assessing several dimensions of burnout. The reliability analysis demonstrates excellent and acceptable internal consistency across all areas of emotional exhaustion, personal accomplishment, and depersonalization (Cronbach's α = 0.95, 0.98, and 0.871) respectively. The CFA confirmed the three-factor structure of the A-MBI-MR, with fit indices indicating an adequate model fit: CFI = 0.945, TLI = 0.938, GFI = 0.951, RMSEA = 0.074, RMSEA CI (0.066, 0.081), RMSEA p-value= 0.000, SRMR = 0.044. Results from the measurement invariance analysis of the MBI scale demonstrated robust invariance between male and female participants. Conclusions: The MBI-MR in Arabic for medical residents is reliable, valid, and effective for measuring burnout levels in Arabic-speaking regions.

The imposter phenomenon is the unwillingness to acknowledge one's triumphs, which is common among doctors. Research on the imposter phenomenon among mental health professionals is limited, and the relationship between imposter phenomenon, burnout, and compassion fatigue has not been studied. The current study intended to test a hypothesized model of the specific impact paths among burnout, compassion fatigue, maladaptive perfectionism, and imposter phenomenon among mental health professionals.

A descriptive, cross-sectional online survey was conducted from June 2023 to September 2023. The sample (n = 160) consisted of psychiatrists. A path analysis was used to test the relationships among study variables and assess model fit.

A strong correlation was found between the imposter phenomenon and burnout and compassion fatigue when controlling age and months of work for both genders. Maladaptive perfectionism, directly and indirectly, affected the imposter phenomenon through burnout and compassion fatigue.

This study found that burnout and maladaptive perfectionism impact the imposter phenomenon in psychiatrists. To mitigate the effects of the imposter phenomenon on mental health professionals, societal norms that contribute to burnout and perfectionism must be reassessed.

Higher education institutions (HEIs) have recently integrated Schwartz Rounds (Rounds) as innovative ways of supporting health professional students' reflective practice, interprofessional learning and compassionate care. Emerging evidence suggests that Rounds benefit students' shared sense of belonging and insight into emotional aspects of training and care, providing safe places to share experiences and reflect. Our review examines the current literature regarding health students' evaluation of Rounds in HEIs, exploring experiences and perceived benefits of participating. We consider methodological issues with the existing literature and propose ways of addressing these in future research.

Systematic searches were conducted on EBSCO, PsycINFO, PubMed and ASSIA to identify available literature relating to Schwartz Rounds in higher education. Eight studies - six with a mixed method design and two qualitative - were included in the review. Study quality and risk of bias were assessed. Evaluation survey data and themes generated from qualitative responses were considered together and a narrative synthesis was constructed.

Despite challenges with differing measurements and scale usage, five themes were identified reflecting the experience and perceived benefits for students attending Rounds. Students highlighted the value of peer connection and communication; normalisation of emotions; collaborative reflection and self-awareness; and the relevance of Rounds in their daily work and patient care. Students also commented on barriers to participation including Rounds' multidisciplinary nature, their group size, and the presence of staff. The majority of students rated Rounds as excellent or exceptional and agreed they should be integrated into the curriculum.

Our findings on Schwartz Rounds in higher education suggest they support student reflective practice and confidence in providing compassionate, high-quality patient care. However, the quality of research in this area is mixed, reflecting the relatively recent integration of Rounds in Higher education, and the challenges of implementing and evaluating new interventions in educational settings.

Doctors, particularly those in training in the UK, are exposed to high levels of stress in their work, which can lead to burnout and mental health problems. According to the health and safety executive (HSE) Management UK standards, employers should recognise and minimise work-related stress for staff. Our review looks to examine if known risk factors for suicide and self-harm in doctors align with the themes of the HSE management standards on stress control i.e., demand, control, support, relationships, role, and change and if so, could this be used to build a self-awareness digital application. Four research databases were searched using combinations of text words and thesaurus terms and predefined inclusion/exclusion criteria for relevant article retrieval. A thematic analysis was undertaken, aligning articles to their respective HSE standards. Twenty-six articles met the full inclusion criteria. 96.2% (25/26 papers) mentioned or aligned at least one of the HSE management standards, with 44% discussing three or more. Work-related risk factors for self-harm and suicide in doctors link well to the HSE management standards. We conceptualise a self-monitoring digital well-being tool for doctors to monitor stress.

Near-peer advising (NPA) is an effective intervention to address gaps in medical education by pairing advisees with advisors of similar social, educational, and professional levels.

We implemented an NPA program within a core obstetrics and gynecology (OBGYN) clerkship. The near-peer advisor's role was to lead orientation sessions, send clerkship resources, provide mid- and end-clerkship in-person check-ins, and serve as a feedback liaison between students and clerkship leadership. A postclerkship survey explored how the NPA program impacted clerkship students' learning and experience including setting up for clinical success, implementing feedback, developing an organizational system, providing study resources, navigating interpersonal relationships, and understanding clerkship logistics. Descriptive statistics were reported and qualitative themes were identified using content analysis.

At the three clerkship sites there were 179 students who completed the OBGYN clerkship between February 2022 and March 2023. Of those, 36 (20.1%) completed the postsurvey and 22 (61.1%) of clerkship students reported the NPA program had a positive impact on their clerkship experience. The program helped students perform successfully in clinical settings (n = 18, 54.5%), implement feedback (n = 9, 27.3%), develop an organizational system for studying (n = 13, 39.4%), access study resources (n = 19, 57.6%), navigate interpersonal relationships (n = 7, 21.2%) and understand clerkship logistics (n = 14, 42.4%). Qualitative themes included clearer orientation, improved studying preparedness, and providing safety-net resources.

The majority of clerkship students found NPAs a useful resource to assist them in effectively participating in the OBGYN clerkship, developing an organizational system of learning, and navigating team dynamics. NPA interventions are a feasible, effective, and accessible method to improve student experience in the core OBGYN clerkship.

Phenomenon: Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. Approach: In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center. Findings: We organized focus group results into four overarching categories related to disrespectful communication: characteristics and context (including specific phrasing that members from each department interpreted as disrespectful, effects of listener engagement/disengagement, and the tendency for communication that is not in-person to result in misunderstanding and conflict); differences across training levels (with disrespectful communication more likely when participants were at different training levels); the individual correspondent's tendency toward perceived rudeness; and negative/long-term impacts of disrespectful communication on the individual and environment (including avoidance and effects on patient care). Insights: In the context of predominantly positive descriptions of interdepartmental communication, participants described episodes of perceived disrespectful behavior that often had long-lasting, negative impacts on the quality of the learning environment and clinical work. We created a conceptual model illustrating the process and outcomes of these interactions. We make several recommendations to reduce disrespectful communication that can be applied throughout the hospital to potentially improve patient care, interdepartmental collaboration, and trainee and faculty quality of life.

Health care professionals often generate novel solutions to solve problems during day-to-day patient care. However, less is known about generating novel and useful (i.e., creative) ideas in the face of health care system failure. System failures are high-impact and increasingly frequent events in health care organizations, and front-line professionals may have uniquely valuable expertise to address such occurrences.

Our interdisciplinary team, blending expertise in health care management, economics, psychology, and clinical practice, reviewed the literature on creativity and system failures in health care to generate a conceptual model that describes this process. Drawing on appraisal theory, we iteratively refined the model by integrating various theories with key concepts of system failures, creativity, and health care worker's well-being.

The SFC model provides a conceptualization of creativity from front-line care professionals as it emerges in situations of failure or crisis. It describes the pathways by which professionals respond proactively to a systems failure with creative ideas to effectively address the situation and affect these workers' well-being.

Our conceptual model guides health care managers and leaders to use managerial practices to shape their systems and support creativity, especially when facing system failures. It introduces a framework for examining system-failing creativity (SFC) and general creativity, aiming to improve health care quality, health care workers' well-being, and organizational outcomes.

Otolaryngology residents often encounter work-related stress and challenges during training. Sociodemographic factors influence experiences during residency; however, the impact of race and gender on otolaryngology trainee well-being during residency remains understudied.

Online survey.

US residency programs.

An anonymous online survey consisting of 59 multiple-choice questions was sent to 104 directors of Accreditation Council for Graduate Medical Education otolaryngology residency programs to distribute to residents. Respondents were queried regarding demographics and experiences with bias. Residents self-identified gender and race. Black, Hispanic/Latinx, Middle Eastern/North African, and multiracial residents were categorized as underrepresented minorities (URM).

Sixty-one US otolaryngology residents responded to the survey, the majority of whom were women (60.7%) and white (62%). Many residents endorsed a belief that receipt of research and training opportunities was negatively impacted by bias due to race (29.5%) or gender (45.9%). More women (27%) than men (13%) reported maximal burnout, and fewer men (17.4%) than women (40.5%) expressed low confidence in ability to independently care for patients. More male (47.8%) and white (31.6%) residents strongly agreed they were thriving. 94.6% of women and 33.3% of URM residents reported being mistaken for a nonphysician, compared to 0% of white male respondents.

Otolaryngology residents perceived differential treatment based on race and gender, with women and URM residents experiencing greater exclusion and bias, as well as increased misidentification and decreased ability to thrive. Future work includes increasing sample size for generalizability and developing interventions that uphold equity in residency training environments.

The negative impact of medical training on trainee mental health continues to be a concern. Situated within a sociocultural milieu, Generation Z and Generation Y, defined by their highly involved parents and the widespread use of technology, currently dominate undergraduate and graduate medical education respectively. It is necessary to explore medical trainees' generational characteristics and job-related factors related to stress, burnout, depression, and resilience. This might provide different perspectives and potential solutions to medical trainees' mental health.

A cross-sectional study was conducted among medical trainees (students and residents) from two institutions in Qatar. A self-administered online survey included measures for trainees' social media overuse, their parent's parenting style, the educational support by the clinical teacher, job (demands, control, and support), and work-life balance and their relation with their stress, burnout, depression, and resilience. Relationships were tested with multiple linear regression analyses.

Of the 326 medical trainees who responded, 142 (44%) trainees - 93 students and 49 residents - completed all items and were included in the analysis. Social media overuse and inability to maintain a work-life balance were associated with higher levels of stress, depression, and student burnout. Higher levels of job support were associated with lower levels of stress, depression, and resident burnout, and a higher level of resilience. Job control was associated with lower burnout levels. Parenting style was unrelated to trainees' mental health.

The two generations 'Y' and 'Z' dominating current medical training showed more stress-related complaints when there is evidence of social media overuse and failure to maintain a work-life balance, while job support counterbalances this, whereas parenting style showed no effect. Measures to enhance medical trainees' mental health may include education about the wise use of social media, encouraging spending more quality social time, and enhancing job support and job control.

Clinical rotations or clerkships are a necessary part of medical education but are associated with significant psychiatric morbidity, including burnout and psychological distress. This review aims to explore the role of resilience as a protective factor and assess the effectiveness of resilience-building interventions. We conducted a narrative review using the Medline database via PubMed. The search strategy included the terms "resilience," "burnout," and "medical students." A total of 52 articles were included and synthesized narratively. Burnout affects 40% to 80% of medical students, with higher rates during their clinical years. Resilience was consistently found to be a stable, protective factor that buffers against stress and burnout. Most research focused on medical students, regardless of whether they are in clinical training. However, the effectiveness of resilience interventions varied. Interventions such as psychological workshops and curriculum changes showed mixed results, with competence-based approaches showing the most promise for long-term benefits. Resilience is a critical target for improving medical students' psychological health and reducing burnout during clinical training. Future interventions should focus on combining psychological support with competence-based training to equip students for the challenges ahead.

To examine graduating medical student reports of burnout by sex, race and ethnicity, and sexual orientation and explore trends within intersectional demographic groups from 2019-2021 in a national sample.

The authors obtained medical student responses to the 2019-2021 Association of American Medical Colleges (AAMC) Graduation Questionnaires (GQs) linked to data from other AAMC sources. The dataset included year of GQ completion, responses to a modified Oldenburg Burnout Inventory (exhaustion subscale range: 0-24; disengagement subscale range: 0-15), and demographics previously shown to relate to the risk of burnout in medical students, residents, or physicians. Multivariable linear regression analysis was performed to evaluate independent associations between demographics and burnout.

Overall response rate was 80.7%. After controlling for other factors, mean exhaustion scores were higher among Asian (parameter estimate [PE] 0.38, 95% confidence interval [CI] 0.21, 0.54), bisexual (PE 0.97, 95% CI 0.76, 1.17), and gay or lesbian (PE 0.55, 95% CI 0.35, 0.75) students than those who did not identify with each of those respective groups. Mean disengagement scores were lower among female (PE -0.47, 95% CI -0.52, -0.42), Hispanic (PE -0.11, 95% CI -0.22, -0.01), and White (PE -0.10, 95% CI -0.19, 0.00) students and higher among Asian (PE 0.17, 95% CI 0.07, 0.27), Black or African American (PE 0.31, 95% CI 0.18, 0.44), bisexual (PE 0.54, 95% CI 0.41, 0.66), and gay or lesbian (PE 0.23, 95% CI 0.11, 0.35) students than those who did not identify with each of those respective groups. From 2019-2021, mean exhaustion and disengagement scores were relatively stable or improved across nearly all intersectional groups.

Male, Asian, Black or African American, and sexual minority students had a higher risk of burnout, while female, Hispanic, White, and heterosexual or straight students had a lower risk of burnout.

The pressure of internal competition at the college level has increased in recent years in China with an impact on nursing students' learning and well-being. This study aimed to investigate the current situation and factors affecting professional identity, learner well-being and self-regulated learning of undergraduate nursing students in the Neijuan ecology of the "double tops" universities, and to explore the relationships between these three variables.

A cross-sectional design was adopted to conduct an online survey of 322 Chinese undergraduate nursing students from seven "double tops" universities. The survey included socio-demographics characteristics, students' professional identity, learner well-being, and self-regulated learning.

Results of Pearson correlation analysis showed that professional identity was significantly and positively correlated with learner well-being (R = 0.795, p < 0.001); professional identity was significantly and positively correlated with self-regulated learning (R = 0.843, p < 0.001); and, self-regulated learning was significantly and positively correlated with learner well-being (R = 0.852, p < 0.001). After mediation effect testing, self-regulated learning had a mediating effect between professional identity and learner well-being (95 % CI 0.366-0.548, p < 0.001). Professional identity had a positive predictive effect on self-regulated learning (a = 0.570, p < 0.001), and self-regulated learning also had a positive predictive effect on learner well-being (b = 0.798, p < 0.001). The direct effect of professional identity on learner well-being (0.225) and its mediating effect (0.455) account for 33.1 % and 66.9 % of the total effect (0.680), respectively.

The learner well-being of undergraduate Chinese nursing students is in the middle to upper range, and it is crucial to enhance professional identity and develop students' self-regulated learning to improve their learner well-being. This study provides empirical evidence to support the mediating effect of self-regulated learning on the relationship between professional identity and learner well-being among undergraduate nursing students in "double tops" universities. Universities are expected to strengthen career planning guidance and professional competence training for students as early as possible in order to develop quality nursing education programs that produce graduates who enter and remain in the workforce.

Globally, resident doctors face challenges like long work hours, critical decision-making stress, and exposure to death and distress, prompting concern for their wellbeing. This study addresses the need for interventions to improve their working conditions, vital for enhancing quality of life, patient care and retaining a skilled workforce.

Following PRISMA guidelines, a systematic literature review until 3 January 2024 explored interventions for resident Ddoctors pre- and post-COVID-19. It evaluated intervention effectiveness, metrics and feasibility, excluding studies with high bias risk.

The review identified diverse interventions, from mentoring to wellness resources, showing significant improvements in job satisfaction, mental health and professional growth among resident doctors. Due to methodological variations, a narrative synthesis was conducted.

Effective interventions addressing resident doctors' challenges can notably enhance their wellbeing and job satisfaction. Scaling such interventions is vital for fostering supportive work environments, sustaining the healthcare workforce and improving patient care quality.

Background/Objectives: The Ministry of Health, Labor and Welfare in Japan has been promoting physicians' working style reforms since 2019. This study aimed to update the relationship between working hours, depressive symptoms, and suicidal ideation among obstetricians and gynecologists, based on the physicians' working style reforms. Methods: A questionnaire-based survey was conducted among obstetricians and gynecologists, and valid responses were obtained from 1164 physicians. Multivariable logistic regression analysis was performed to identify significant associations. Results: Of the respondents, 49.8% were female, and most physicians were aged 30-39 (32.1%). Precisely, 57.4% worked in public hospitals, and 47.9% worked in urban areas. Physicians working 40 ≤ x < 60 h per week accounted for the largest proportion of physicians. Depressive symptoms and suicidal ideation accounted for 16.4% and 3.6% of participants, respectively. The following factors were significantly associated with depressive symptoms as a dependent variable: other occupation, having two or three children, working 60-80 h or >100 h per week, and working in rural areas. None of these variables was significantly associated with suicidal ideation. Conclusions: The physicians' working style reforms have reduced the number of working hours for obstetricians and gynecologists. However, rates of depressive symptoms and suicidal ideation have not improved.

Impostor syndrome and burnout are highly prevalent among medical students and trainees, significantly impacting their mental health and professional development. The advent of online educational interventions provides a promising solution, offering accessibility and flexibility to tackle these issues. This systematic review aims to evaluate the effectiveness of online educational interventions in alleviating impostor syndrome and burnout among medical learners.

A comprehensive literature search was conducted across PubMed, Cochrane Library, Embase, Scopus and PsycInfo, identifying relevant studies published up to March 2024. Studies focusing on online interventions targeting impostor syndrome and burnout among medical students, residents, and fellows were included, and their quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

Among the screened studies, six met our inclusion criteria, comprising four randomized controlled trials, one qualitative study, and one mixed-methods study. Their mean MERSQI score was 14.67 (SD 1.23), indicating a high methodological quality. The interventions adopted in these studies varied, including group coaching sessions, workshops, and provision of educational resources. Notably, two randomized trials demonstrated significant reductions in impostor syndrome symptoms after online interventions, compared with the control groups. On the other hand, results for burnout outcomes were equivocal, with some studies reporting improved emotional exhaustion scores and decreased burnout risk, while others found no significant differences.

Current evidence suggests that structured online educational interventions, particularly those incorporating coaching and cognitive reframing strategies, can effectively reduce impostor syndrome among medical trainees. However, the impact on burnout remains inconclusive. Further research is needed to optimize online program components and implementation strategies to comprehensively address both impostor syndrome and burnout in this population.

As this is a systematic review rather than a clinical trial, no clinical trial number is applicable. Nonetheless, this systematic review has been prospectively registered with PROSPERO (registration number: CRD42024541034), in line with best practice recommendations for systematic reviews.

Psychological flexibility (PF) is defined as the ability to pursue valuable life goals despite the existence of distress. The Personalized Psychological Flexibility Index (PPFI) is a new measure of psychological flexibility that can address existing deficiencies. This study aimed to translate and validate the psychometric characteristics of the Chinese version of the PPFI among medical college students.

The study was conducted in two phases. Phase 1 involved the translation and cross-cultural adaptation of the PPFI according to guidelines recommended by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Phase 2 was a cross-sectional survey conducted on 945 medical college students in China. The psychometric performances of the scale were assessed using construct validity, divergent validity, criterion validity, incremental validity, internal consistency, and test-rest reliability.

The exploratory factor analysis (EFA, n1 = 440) showed that the Chinese version of the PPFI consisted of 3 factors, with a total of 15 items. The confirmatory factor analysis (CFA, n2 = 440) showed that the three-factor structure fit well (χ2/ df =2.469, SRMR = 0.051, RMSEA = 0.058, GFI = 0.94, CFI = 0.985). The total Chinese PPFI score had a moderate positive association with the Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT, r = 0.344) and a negative association with the Acceptance and Action Questionnaire-II (AAQ-II, r = -0.334). Furthermore, the Chinese PPFI demonstrated good internal consistency (Cronbach's α = 0.826) and test-retest reliability (ICC = 0.817, p < 0.001).

The 15-item Chinese version of the PPFI is a reliable and valid tool for measuring PF in Chinese medical students. However, additional studies are needed to validate its psychometric properties in more generalizable samples and other contexts.

Medical students' efforts to learn person-centered thinking and behavior can fall short due to the dissonance between person-centered clinical ideals and the prevailing epistemological stereotypes of medicine, where physicians' life events, relations, and emotions seem irrelevant to their professional competence. This paper explores how reflecting on personal life experiences and considering the relevance for one's future professional practice can inform first-year medical students' initial explorations of professional identities. In this narrative inquiry, we undertook a dialogical narrative analysis of 68 essays in which first-year medical students reflected on how personal experiences from before medical school may influence them as future doctors. Students wrote the texts at the end of a 6-month course involving 20 patient encounters, introduction to person-centered theory, peer group discussions, and reflective writing. The analysis targeted medical students' processes of interweaving and delineating personal and professional identities. The analysis yielded four categories. (1) How medical students told their stories of illness, suffering, and relational struggles in an interplay with context that provided them with new perspectives on their own experiences. Students formed identities with a person-centered orientation to medical work by: (2) recognizing and identifying with patients' vulnerability, (3) experiencing the healing function of sharing stories, and (4) transforming personal experiences into professional strength. Innovative approaches to medical education that encourage and support medical students to revisit, reflect on, and reinterpret their emotionally charged life experiences have the potential to shape professional identities in ways that support person-centered orientations to medical work.

Burnout and fatigue have overlaps in their symptoms. The common denominator is exhaustion. Physical activity has been shown to be a risk-reducing factor for the development or manifestation of symptoms. There is also evidence of an effect of physical activity in the acute phase, rehabilitation, and aftercare of burnout as well as in diseases that are associated with the occurrence of fatigue and their treatments.In burnout research, physical activity is considered a risk-reducing factor and coping strategy, but there are no specific exercise recommendations with regard to symptom severity. In the area of tiredness/fatigue, the overall picture is inconsistent: there are already targeted recommendations for exercise therapy in a multimodal approach for individual clinical pictures. For example, there is high evidence for the use of appropriately dosed physical activity in cancer patients in adjuvant therapy and aftercare. Other diseases associated with the occurrence of fatigue, such as long- and post-COVID, have not yet been sufficiently researched to make clear statements about a dose-response relationship. For some diseases, there are already targeted recommendations for exercise therapy in a multimodal approach.This paper aims to provide an overview of the current state of exercise research in burnout and fatigue and thus, on the one hand, make therapy recommendations for practitioners and patients, and on the other hand, shed light on the evidence in those areas in which there are (still) no general and individualized exercise recommendations and guidelines.