Scott Compton

Background: The clinical education of medical students relies on having direct patient experiences, which can be challenging when the patient population speaks multiple languages. In Singapore, students regularly encounter patients with whom they do not speak the same language. Objective: The purpose of this study was to examine the role of student–patient language discordance (SPLD) on students’ clinical education experience. Methods: In this sequential mixed-methods study, medical students who have completed at least 1 year of clinical education at the Duke-NUS Medical School in Singapore were asked to complete an online survey to obtain their self-reported language proficiency in local languages, experiences interacting with patients who do not speak English, and perceptions of the impact on clinical learning. A follow-up interview with selected participants was conducted. Results: Overall, 35.9% of eligible students responded to the survey. Demographic analysis of respondents adequately represented the school’s overall student population. Non-Mandarin-speaking respondents reported that learning medicine in a multilingual environment negatively impacts clinical learning due to significantly more frequent challenges to clerking patients and feeling hindered from learning from doctors due to language barriers. However, no difference was observed in the performance on clinical exams of the three groups. Qualitative interviews uncovered possible reasons for the confounding results and two interrelated themes that highlight clinical learning experiences and challenges in a multilingual environment. Conclusion: Students perceive SPLD as a hindrance toward their clinical education experience. Follow-up interviews uncovered the quandary of using translators and how language discordance impacts student’s professional identity formation.

Compton and Sarraf‐Yazdi explore the role of context, drawing Connections across articles focused on the concept of Situation to advocate for collaborative communities with multidisciplinary expertise to improve scholarship in the field.

Background: Burnout is a serious issue plaguing the medical profession with potential negative consequences on patient care. Burnout symptoms are observed as early as medical school. Based on a Job Demands-Resources model, this study aims to assess associations between specific job resources measured at the beginning of the first year of medical school with burnout symptoms occurring later in the first year.Methods: The specific job resources of grit, tolerance for ambiguity, social support and gender were measured in Duke-NUS Medical School students at the start of Year 1. Students were then surveyed for burnout symptoms at approximately quarterly intervals throughout the year. Using high ratings of cynicism and exhaustion as the definition of burnout, we investigated the associations of the occurrence of burnout with student job resources using multivariable logistic regression analysis.Results: Out of 59 students, 19 (32.2%) indicated evidence of burnout at some point across the first year of medical school. Stepwise multivariable logistic regression analysis identified grit as having a significant protective effect against experiencing burnout (Odds Ratio, 0.84; 95%CI 0.74 to 0.96). Using grit as a single predictor of burnout, area under the ROC curve was 0.76 (95%CI: 0.62 to 0.89).Conclusions: Grit was identified as a protective factor against later burnout, suggesting that less gritty students are more susceptible to burnout. The results indicate that grit is a robust character trait which can prognosticate burnout in medical students. These students would potentially benefit from enhanced efforts to develop grit as a personal job resource.

Background Burnout is a serious issue plaguing the medical profession with potential negative consequences on patient care. Burnout symptoms are observed as early as medical school. Based on a Job Demands-Resources model, this study aims to assess associations between specific job resources measured at the beginning of the first year of medical school with burnout symptoms occurring later in the first year. Methods The specific job resources of grit, tolerance for ambiguity, social support and gender were measured in Duke-NUS Medical School students at the start of Year 1. Students were then surveyed for burnout symptoms at approximately quarterly intervals throughout the year. Using high ratings of cynicism and exhaustion as the definition of burnout, we investigated the associations of the occurrence of burnout with student job resources using multivariable logistic regression analysis. Results Out of 59 students, 19 (32.2%) indicated evidence of burnout at some point across the first year of medical school. Stepwise multivariable logistic regression analysis identified grit as having a significant protective effect against experiencing burnout (Odds Ratio, 0.84; 95%CI 0.74 to 0.96). Using grit as a single predictor of burnout, area under the ROC curve was 0.76 (95%CI: 0.62 to 0.89). Conclusions Grit was identified as a protective factor against later burnout, suggesting that less gritty students are more susceptible to burnout. The results indicate that grit is a robust character trait which can prognosticate burnout in medical students. These students would potentially benefit from enhanced efforts to develop grit as a personal job resource.

Objectives: The coronavirus disease 2019 (COVID‐19) pandemic has led to widespread disruptions in the clinical education of medical students. In managing students’ return to the clinical setting, medical schools face the challenge of balancing education, service and risk considerations. To compound this challenge, medical students may prefer not to re‐enter during a period of great uncertainty, leading to substantive downstream sequelae on individual, institutional and national levels. Understanding students’ views on resuming clinical experiences, therefore, is an important consideration. The purpose of this study was to assess medical students’ preference for re‐entering the clinical setting during the COVID‐19 pandemic and to explore personal and environmental characteristics associated with that preference. Methods: We conducted an electronic survey of currently enrolled medical students at the Duke‐NUS Medical School, less than a month into the COVID‐19 pandemic. Survey items were aligned with a conceptual framework related to medical students’ preference for returning to the clinical setting. The framework consisted of three domains: (a) non‐modifiable demographic information; (b) factors thought to be modifiable through the course of medical education, including burnout, tolerance for ambiguity, motivation and professionalism, and (c) students’ perception of COVID‐19 infection risk to self. Results: Approximately one‐third (n=63) of 179 students preferred not to return to the clinical setting. Results of a multivariable analysis indicated that compared to this group, the two‐thirds (n=116) of students favouring return showed evidence of greater autonomous (or internal) motivation, a greater sense of professional responsibility and a lower self‐perception of harbouring risk to patients. Conclusions: Students’ preference on returning to the clinical environment stems from the interplay of several key factors, and is substantively associated with perceptions of professional responsibility and their own potential risk to the health care system. Mindfully considering and addressing these issues may help medical schools in their preparation for returning students to the clinical setting.

Burnout is considered to be at the opposite end of the continuum from engagement. People who experience burnout first go through various intermediate patterns that lead to burnout, which in medical students is associated with reduced empathy, intention to leave school, and suicidal ideation. Thus, understanding how to mitigate burnout is of primary importance. In this study, we investigate if students’ positive perceptions of the educational program’s alignment with adult education principles decreased symptoms suggestive of typical patterns of intermediate burnout.

Sean Wu1, Julia Farquhar1, 2, Scott Compton 1Duke-NUS Medical School, Singapore; 2School of Medicine, Duke University, USA Abstract Purpose: Evidence suggests that Team Based Learning (TBL) is an effective teaching method for promoting student learning.