Department of Sociology and Anthropology, University of Nebraska Omaha, 6001 Dodge St, Omaha, NE, 68182, USA.
Department of Psychiatry, University of Nebraska Medical Center, 985575 Nebraska Medical Center, Omaha, NE, 68198, USA.
BMC Med Educ. 2020 May 19;20(1):157. doi: 10.1186/s12909-020-02067-8.
By all indications, well-being among physicians is poor, which manifests in various outcomes, including burnout, depression/anxiety, low life satisfaction, alcohol/substance misuse, suicide ideation, and suicide. Despite the vast literature on physician burnout, there is relatively little research on how pre-clinical experiences in medical school may be an antecedent to subsequent poor health among physicians. Here we focus on two neglected areas within the literature by focusing on the pre-clinical stage of medical school and the positive, as opposed to exclusively the negative, aspects of the medical school experience as it affects well-being.
This study utilizes the metaphor of the Coping Reservoir Model as a theoretical and analytical framework for understanding medical student well-being by identify the 'depleting' and 'replenishing' inputs that are deposited into students' coping reservoirs. We analyze 105 medical students' reflective writings using a data analytic process consistent with an interpretive description approach, engaging in a hierarchical 3-step coding process to identify the main replenishing inputs deposited into students' coping reservoirs.
The main depleting inputs that we identify are consistent with those identified by The Coping Reservoir Model. In addressing our main research question regarding the replenishing inputs, results show the main positive factors are psycho-social resources, intellectual stimulation, and social support/relationships. Most importantly, relationships with patients shape all three of these positive factors and provide the main source of hope that the stress of medical school will get better.
What allows students to frame their experiences with hope and optimism are the connections they form with each other and with patients. The prolonged stress of medical school is made "worth it" in hopes that it will "get better" with more meaningful patient interaction in the future. These results that emphasize the positive aspects of medical school are discussed in context of their theoretical contributions to The Coping Reservoir Model and the practical implications for medical education to improve medical student well-being by facilitating human connection.
种种迹象表明，医生的幸福感较差，这表现在各种结果中，包括倦怠、抑郁/焦虑、生活满意度低、酒精/药物滥用、自杀意念和自杀。尽管有大量关于医生倦怠的文献，但相对而言，关于医学生在医学院的临床前经历如何成为医生后续健康状况不佳的前兆的研究却很少。在这里，我们关注文献中两个被忽视的领域，即关注医学院的临床前阶段和医学生体验的积极方面，而不仅仅是消极方面，因为这会影响幸福感。
本研究利用应对资源模型的隐喻作为理解医学生幸福感的理论和分析框架，通过识别“消耗”和“补充”输入来识别学生应对资源库中的输入。我们使用与解释性描述方法一致的数据分析过程来分析 105 名医学生的反思性写作，采用分层三步编码过程来识别存入学生应对资源库的主要补充输入。
我们确定的主要消耗输入与应对资源模型中确定的输入一致。在解决我们关于补充输入的主要研究问题时，结果表明主要的积极因素是心理社会资源、智力刺激和社会支持/关系。最重要的是，与患者的关系塑造了这三个积极因素，并提供了希望的主要来源，即医学院的压力会好转。
使学生能够以希望和乐观的态度来构建自己的体验的是他们与彼此和患者建立的联系。医学院的长期压力在希望未来与患者进行更有意义的互动时，“变得值得”。这些强调医学院积极方面的结果在应对应对资源模型的理论贡献及其对医学教育的实际影响方面进行了讨论，以通过促进人际联系来改善医学生的幸福感。
