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Background: Trends in New Zealand (NZ) medical students’ health and the influence of a wellbeing curricula are unknown. Methods: The author’s collected self-report data from NZ medical students on ‘Graduation Day’ from 2014 to 2018, using a serial cross-sectional survey design with validated scales assessing psychological health, stigma, coping, and lifestyle. Comparisons were made with NZ general population same-age peers. Analyses examined trends, differences between ‘cohorts’ of students receiving different exposures to a wellbeing curriculum, and correlations between students’ own lifestyle practices and their frequency of talking with patients about those topics. Results: Of 1,062 students, 886 participated. The authors found statistically significant self-reported increases from 2014 to 2018 for negative psychological indices, including scores for distress and burnout, suicidal thoughts in the preceding year, and the likelihood of being diagnosed with an anxiety disorder. There was a significant increase in numbers of students reporting having their own doctor as well as increased healthy coping strategies and a significant decrease in stigma scores. Academic cohorts of students who had completed a wellbeing curriculum were more likely to report high distress levels, having been diagnosed with a mood disorder, and being non-drinkers than students without wellbeing training. When compared to NZ peers, medical students smoked less, exercised more, and were less likely to have diagnosed mood and anxiety disorders, but reported more distress. The authors found a significant correlation between the amount of exercise students undertook and their likelihood to discuss exercise with patients. Conclusions: NZ medical students have better physical health than general population peers and are more likely to discuss exercise with patients if exercising themselves. However, cohorts of graduating students report increasing distress despite the implementation of a wellbeing curriculum. Research is needed into mechanisms between students’ self-awareness, willingness to report distress, stigma, mind-set, coping, and psychological outcomes, to inform curriculum developers.

OBJECTIVES: To explore the associations between self-reported quality of life (QoL) and harassment and the potential moderating effect of social support. DESIGN: Senior medical students were invited to participate in a survey consisting of a background section, the World Health Organisation QoL questionnaire (New Zealand version), a version of the generalised workplace harassment questionnaire, and the multidimensional scale of perceived social support. A series of multivariate statistical analyses were conducted. RESULTS: Two hundred and five students completed the online survey (response rate = 25%). The findings indicated a high incidence of verbal (90%) and covert harassment (87%), with relatively low levels of physical harassment (6%) and manipulation (6%). The correlational analyses indicated that low levels of QoL were associated with high levels of verbal and covert harassment and high levels of social support were directly associated with high levels of QoL. The moderation models indicated that social support conditionally influences the impact of verbal and covert harassment on social and psychological QoL. CONCLUSIONS: These findings imply that medical students experiencing harassment in clinical learning environments likely experienced lowered levels of QoL. Social support may moderate, in certain instances, the adverse impact of harassment on QoL.

Aims: A series of podcasts and videos was created to assist medical students with learning about suicide prevention. The aim of this research was to explore medical students experiences of using a suicide prevention learning resource. Methods: A multimedia repository of learning resources for suicide prevention was designed and created for use across all years of the medical programme at The University of Auckland. Emphasis was placed on ensuring that the resource was culturally safe. The impact of the learning resource was evaluated with a qualitative approach using focus group methodology. Two focus groups were audio-recorded, transcribed and a thematic analysis was conducted employing three cycles of coding. Results: Three themes were identified: perceiving that suicide is complex and sensitive; tailoring knowledge to match students’ developmental stage and context; and elements that facilitated interaction with the resource. Conclusions: Suicide is unsurprisingly a challenging topic for medical students. The students in this study actively engaged with this resource on suicide prevention, which supplemented their core learning of the topic. Early access to resources developed in a culturally safe way within a spiral curriculum empowers students to understand that they have an important contribution to make in preventing suicide. This may prepare them for encountering suicide with peers, family members and in clinical practice.

High levels of stress, burnout, and symptoms of poor mental health have been well known among practicing doctors for a number of years. Indeed, many health systems have formal and informal mechanisms to offer support and treatment where needed, though this varies tremendously across cultures. There is increasing evidence that current medical students, our doctors of the future, also report very high levels of distress, burnout, and substance misuse. We sampled large groups of medical students in 12 countries at the same time and with exactly the same method in order to aid direct comparison. 3766 students responded to our survey across five continents in what we believe is a global first. Our results show that students in all 12 countries report very high levels of 'caseness' on validated measures of psychiatric symptoms and burnout. Rates of substance misuse, often a cause of or coping mechanism for this distress, and identified sources of stress also varied across cultures. Variations are strongly influenced by cultural factors. Further quantitative and qualitative research is required to confirm our results and further delineate the causes for high rates of psychiatric symptoms and burnout. Studies should also focus on the implementation of strategies to safeguard and identify those most at risk.

The objective of this review is to map the details of school-based interventions used to improve health literacy of senior high school students.The global prevalence of poor adult health literacy is caused, in part, by limited health education in secondary schools. Enhancing adolescent health literacy could potentially improve adult health literacy, health behavior, and health outcomes.Studies investigating school-based interventions to improve health literacy of senior high school students, regardless of design, characteristics, and assessment tools, will be eligible for inclusion. Studies that provide combined data (senior high school students mixed with other students) or have a compulsory component outside of school will be excluded.MEDLINE, Embase, ProQuest Education Journals, Education Research Complete, SAGE Journals, and Index New Zealand will be searched for journal articles published in English since 1998. Two independent reviewers will screen titles and abstracts for eligibility, retrieve potentially relevant papers in full, and extract data from included studies. A third reviewer will resolve any disagreements. Quantitative analysis (eg, frequency analysis) will indicate geographic region of studies, design and targeted population (school grade of study participants); the mode of delivery (extracurricular or during school hours, implemented by teachers or other professionals), duration, and health literacy model anddomainoftheinterventions. Descriptive qualitative content analysis will be used to summarize, code and classify key characteristics of the interventions (eg, teaching models and strategies, content, and related skills) and main outcomes related to health literacy into meaningful categories.

The purpose of this scoping review was to outline the extent of available literature including the prevalence of video quality appraisal tools, characterize how online videos were used, and identify the gaps in the literature with implications for future research.The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR). Six databases were searched: (1) MEDLINE (Ovid), (2) EMBASE, (3) Cochrane, (4) ERIC, (5) CINAHL PLUS, and (6) Google Scholar for Medical Subject Headings terms online videos, postgraduate health education, and health professional/s.A total of 6948 articles were identified, of which 78 were included in the review. The articles included were primarily either experimental or observational studies, with most being from North America. Twelve concepts were identified: (1) procedural skills teaching; (2) video assessment; (3) validation of an assessment tool; (4) video feedback; (5) coaching; (6) broadcasting; (7) learner characteristics; (8) video characteristics; (9) video quality; (10) a quality assessment tool; (11) platforms and video library; and (12) health information governance.While there is a diverse and growing body of literature on this area, information is lacking about the quality appraisal of online videos.

The first consultation with a depressed patient is important because many patients do not return for subsequent visits. Therefore, the first consultation provides a unique opportunity for diagnosis (if required) and treatment, but there are risks of both under and over-diagnosis.To understand how general practitioners utilize diagnosis when patients present with a new episode of depression.We approached a random selection of twenty-one general practitioners (GPs) in Auckland, New Zealand and asked them to participate in a semi-structured telephone interview. The interviews explored "the first consultation for a depressed/distressed patient" were undertaken to theme saturation. Interviews were hand-written and later transcribed.We identified three major themes in GPs' approach to diagnosis. The issue of diagnosis was underpinned by a complex understanding of depression and the GP role. GPs did not always make a formal diagnosis, but the experience of a patient's distress/depression was understood by drawing on a range of factors and resources. These included time, screening tools, clinician experience, and patient affect. GPs were careful about how they communicated a diagnosis, both in their documentation and in their conversations with patients.At an initial appointment, the distressed/depressed patient can present to their GP with various symptoms and differing degrees of distress. GPs draw upon a variety of skills and resources to negotiate these complexities. The value of a diagnosis was questioned and issues such as impairment may be more useful concepts for GPs. This is the first study to report the findings of the first visit.

OBJECTIVES: Medical students’ experiences of harassment and its influence on quality of life were examined. DESIGN: A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified. RESULTS: The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as ‘Antecedents’ of ‘harassment’ and ‘Consequences’ on quality of life. CONCLUSIONS: Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.

Medical students are exposed to multiple factors during their academic and clinical study that have been shown to contribute to high levels of depression, anxiety, and stress. The purpose of this article was to explore the issue of depression in the medical student population, including prevalence, causes, and key issues, along with suggestions for early identification and support from one medical school in New Zealand. After establishing that the prevalence of depression is higher for medical students than the general population, the key issues explored include assessment used in the program, characteristics of the student population (such as Type A personality and perfectionism), resilience, selection procedures, students' motivation, and the nature of the clinical environment. This review includes several recommendations to improve students' psychological health such as positioning well-being within an overarching comprehensive workplace wellness model and integrating peer and faculty-led support into the day-to-day running of the institution. It also highlights the advantages of the addition of a well-being curriculum, as skills to prevent and manage distress and depression are relevant in supporting the competencies required by medical practitioners. It concludes that medical schools need wide-ranging strategies to address the complexities associated with the particular student population attracted to medicine and calls for educators to act, by noticing opportunities where they can introduce such initiatives into their medical programs.

Workplace harassment in higher education adversely impacts workforce productivity and has deleterious health effects on victims. The aim of this study was to review the literature pertaining to workplace harassment in higher education. This systematic literature search was conducted in December 2013 and completed in January 2014. Refereed journal publications from 1994 to 2013 inclusive were identified. The strategy was conducted on seven major databases. A total of 3278 articles were initially screened, and after review 51 refereed journal articles were included in the final analysis. A thematic analysis identified six themes: causation, types, employee roles, measurement, consequences and interventions. The published evidence, mainly from North America, suggests that workplace harassment is prevalent in higher education, such as gender harassment, workplace bullying, and mobbing. This review highlighted issues associated with: (1) confirming direct causation of harassment due to the high prevalence of correlational research in this area; (2) establishing and standardising measures of harassment that would have cross-cultural applicability and validity; (3) the demand for more comparative research to cater for the globally mobile workforce; (4) the requirement for greater monitoring and evaluation of the efficacy of policies and programmes purporting to be effective in dealing with harassment in the higher education workplace; and (5) the need for more contextually laden research to examine the unique nuances operating in countries, such as those in the Asia Pacific region, not well represented in the literature.

Medical students are thought to have increased pressures in study life beyond that of their peers. This could impact their psychological wellbeing, burnout and substance use, impeding a smooth transition into the health workforce. A cross-sectional electronic survey of one of New Zealand's two medical schools was undertaken, and students in all years were invited to participate through email. Two hundred and twenty students completed the survey. Forty-six students (21%) reported that they were currently seeing a GP or Allied Healthcare Professional (AHP) for their mental ill-health. Seventy-seven students (35%) reported having taken cannabis during medical school. The number of respondents reaching the threshold for CAGE, and thus demonstrating problem drinking, was 40 (18%). Additionally, burnout levels were scored, with 150 students (68%) classifying as disengaged and 169 (77%) as suffering from exhaustion on the Oldenburg burnout measure. Going forwards, organizational bodies including governments and medical schools should place emphasis on the importance of optimizing medical student wellbeing, including resilience training and improved workforce wellbeing planning, to positively impact not just medical students as they progress to doctors, but for patients, and the healthcare system as a whole.

This review examines the quality of the research exploring mindfulness within tai chi chuan and the way this integrative practice benefits health and learning for higher education students. A narrative review based on a systematic search was conducted. Ten English and three Chinese databases were utilised to appraise the relevant literature. The initial search identified 874 potentially appropriate English articles and 265 Chinese articles. A final review of 52 Chinese and 8 English articles was conducted. We used an evidence classification framework to determine the research rigour of the 60 articles (levels 1 to 4). We found that the majority of the studies reviewed were deemed to be either descriptive studies or based on opinion. From a narrative synthesis of patterns emerging within the purported benefits of tai chi chuan cited in the reviewed papers, we identified four clear categories, namely physiological outcomes, motor function and balance, learning, and psychological status. We found that more literature was published in Chinese than English, suggesting the need for reviews to be conducted across language databases. Moreover, we established that tai chi chuan as an integrative meditational exercise can enhance health and learning for higher education students.

Background The poor health consequences of stress are well recognized, and students in higher education may be at particular risk. Tai Chi integrates physical exercise with mindfulness techniques and seems well suited to relieve stress and related conditions. Methods We conducted a systematic review of the health benefits of Tai Chi for students in higher education reported in the English and Chinese literature, using an evidence hierarchy approach, allowing the inclusion of studies additional to randomized controlled trials. Results Sixty eight reports in Chinese and 8 in English were included — a combined study sample of 9263 participants. Eighty one health outcomes were extracted from reports, and assigned evidence scores according to the evidence hierarchy. Four primary and eight secondary outcomes were found. Tai Chi is likely to benefit participants by increasing flexibility, reducing symptoms of depression, decreasing anxiety, and improving interpersonal sensitivity (primary outcomes). Secondary outcomes include improved lung capacity, balance, 800/1000m run time, quality of sleep, symptoms of compulsion, somatization and phobia, and decreased hostility. Conclusions Our results show Tai Chi yields psychological and physical benefits, and should be considered by higher education institutions as a possible means to promote the physical and psychological well-being of their students., Highlights • We reviewed the benefits of Tai Chi in 9263 tertiary students from 76 studies. • Tai Chi is likely to yield psychological and physical benefits for tertiary students. • Physical benefits include improved flexibility, lung capacity and balance. • Psychological benefits include reduced symptoms of depression and anxiety. • Education institutions should consider such benefits for the well-being of students.

Depression is commonly understood as a psychological condition characterised by ≥2 weeks of low mood often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause. The prevalence of major depression in primary care is estimated to be about 13% (range 4–23%). Because doctors are usually trained to focus on physical aspects first, some may perceive that it is less problematic to miss a mental health diagnosis1 or may even evade enquiring about psychosocial issues to avoid opening Pandora’s Box (ironically in which lies hope).1 Some perceive that low mood related to loss may be better understood within a model of grief, choosing not to diagnose depression. Others have concerns about stigma or the impact on insurance claims if ‘depression’ is documented.2 Empathic listening is key to gaining a shared understanding of the patient’s problems, including relevant cultural aspects. Actively listening shows respect, enhances rapport, builds trust, and enables a healing partnership. In addition to mental health concerns, there may be loneliness, comorbid physical conditions, family violence, sexual and physical abuse, crime, war, migration, or homelessness. Although there are reasons to avoid official labelling in primary care, it is important to identify psychological distress with or without the label. Making a mental health diagnosis for clinicians in primary care is challenging, and a depression diagnosis may be more accurate if made over more than …

International students form a significant proportion of students studying within universities in Western countries. The quality of life perceptions of international medical students in comparison with domestic medical students has not been well documented. There is some evidence to suggest that international medical students may have different educational and social experiences in relation to their domestic peers. This study investigates the levels of quality of life experienced by international and domestic students studying medicine. A total of 548 medical students completed the abbreviated version of the World Health Organization Quality of Life questionnaire. The focus of the analysis was to evaluate differences between international and domestic students in their early clinical years. The responses were analysed using multivariate analysis of variance methods. International medical students are experiencing lower social and environmental quality of life compared with domestic peers. International medical students in New Zealand have expressed quality of life concerns, which likely have an impact on their academic achievement, feelings of wellness, acculturation, and social adaptation. The findings reinforce the need for creating stronger social networks and accessible accommodation, as well as developing systems to ensure safety, peer mentorship and student support., published_or_final_version

Background: The purpose of this systematic review was to appraise the empirical evidence pertaining to medical students and the integration of mindfulness and physical exercise regimens. Methods: A systematic review was undertaken. Five databases were used to survey the salient literature. Results: The initial search identified 353 potentially relevant articles of which 17 articles were considered for the final review. The findings indicated that the research was mainly conducted in the USA with some research originating from Europe, Canada, Jamaica, and India. In addition, a range of research designs were applied to measure or discuss the efficacy of the integrated intervention. Four key categories captured the essence of the results of our review, namely: (1) quality of evidence and research methods; (2) types of interventions; (3) measurement protocols; and (4) benefits of integrating mindfulness and physical exercises. Conclusions: This systematic review demonstrated that when mindfulness and physical exercises are integrated there are likely to be positive health outcomes for medical students. In the studies that yielded the highest level of evidence it was clear that this combination enhanced mental health, and reduced stress levels amongst students, and the benefits may assist with interpersonal development, such as greater empathetic levels and improved interpersonal responsivity.

The aim of this study was to develop an evidence-based self-help website, Computer Assisted Learning for the Mind (CALM) designed to improve mental health amongst medical students; and to assess the proportion, demographics and mental health of students who chose to use the site.All 2nd and 3rd year medical students from one New Zealand university were invited to participate. Demographics and mental health scores of those accessing CALM were compared with those not accessing it. Outcome measures included depression (PHQ-9) and anxiety (GADS-7) scores recorded at baseline. Anonymous identifiers were used to track website use.Baseline questionnaires were completed by 279/321 (87%) of eligible students. CALM was accessed by 80/321 (25%) of the students over a 5 week period. Those who accessed CALM and could be linked by unique identifier (n=49) had significantly higher anxiety scores (p=0.01) but not higher depression scores (p=0.067) at baseline, than those who did not access CALM (n=230). Of those students with both PHQ-9 scores and GAD-7 scores =10 (at risk of significant depression and anxiety) at baseline, 41% went on to access CALM.The CALM website was used by 25% of medical students, particularly those with poorer anxiety scores. Self-selection to a web-based resource may provide assistance to those most in need, but further research would be needed to assess effectiveness.

There is an argument that clinicians are medicalising normal human suffering in many of their patients. In his, book Beyond Depression , Chris Dowrick says '… our culture is imbued with an expectation of happiness, and that in consequence we tend to see negative emotional experiences as aberrant and deviant'.1 He proposes 'an approach to patients which emphasises listening and understanding rather than diagnosis and prescription.' Many GPs will be sympathetic to these views, but nevertheless have to respond to patients’ needs while wrestling with time pressure and limited access to non-drug therapies. The temptation is to follow the biomedical model of diagnosis and treatment. Depressive symptoms range on a continuum from everyday sadness to suicidal despair, and a challenge for practitioners is deciding at what level to intervene. A clinical definition of depression is therefore necessary to inform clinical decisions, enable research to be conducted, and justify insurance payments. The most widely accepted definition of depression comes from the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association. The DSM-5 outlines three degrees of severity (mild, moderate, and severe) based on a required number of symptoms and the degree of functional impairment. The presence or absence of psychotic features, such as hallucinations or paranoia, help determine specific treatments. The National Institute of Health and Care Excellence (NICE) recommends the use of depression symptom inventories to assess severity and to monitor improvement.2 Commonly used inventories include the patient health questionnaire 9 (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). While they are not considered diagnostic tools they have been validated against gold standard clinical interviews and can be very handy for use in a busy primary care clinic. Their main use is in giving a measure of severity and in monitoring the progress of treatment. …

The introduction of a new domain of learning for Personal and Professional Skills in the medical program at the University of Auckland in New Zealand has involved the compilation of a portfolio for assessment. This departure from the traditional assessment methods predominantly used in the past has been challenging to design, introduce, and maintain as a relevant and authentic assessment method. We present the portfolio format along with the process for its introduction and appraise the challenges, strengths, and limitations of the approach within the context of the current literature. We then outline a cyclical model of evaluation used to monitor and fine-tune the portfolio tasks and implementation process, in response to student and assessor feedback. The portfolios have illustrated the level of insight, maturity, and synthesis of personal and professional qualities that students are capable of achieving. The Auckland medical program strives to foster these qualities in its students, and the portfolio provides an opportunity for students to demonstrate their reflective abilities. Moreover, the creation of a Personal and Professional Skills domain with the portfolio as its key assessment emphasizes the importance of reflective practice and personal and professional development and gives a clear message that these are fundamental longitudinal elements of the program.