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Ana Vilela Mendes (Anhembi Morumbi University, Medical School, Sao Paulo, Brazil) Rosana Trindade Santos Rodrigues (Anhembi Morumbi University, Medical School, Sao Paulo, Brazil) Karen Cristine Abrao (Anhembi Morumbi University, Medical School, Sao Paulo, Brazil)

Background: Given the growing concern about the quality of life of medical students and the prevalence of psychological harassment suffered by students during medical education, which may relate to psychological disorders such as alcoholism, suicide and burnout, medical schools should be thinking about specific mental health promotion programs. These disorders may promote damage in student life interfering with self-care, professional career, interpersonal relationships and quality of service delivery to the community. Summary of work: We developed an intervention project that aims to create room for reflection on the student's experiences during medical training and foster social support and healthier lifestyles. Students are invited to attend a monthly meeting, lasting 90 minutes. The group is led by psychologists of the Student's Support Service using methodologies that facilitate coping with demands and psychosocial suffering, grounded in systems thinking theory, communication theory and resilience.

Summary of results: At the end of the first year of project implementation we observed greater integration among students with significant expansion of their social support networks and higher incidence of self-care behaviors and resilience, identified by spontaneous search for individual assistance and greater flexibility before conflicts.

Conclusions: The results so far observed are motivators for continuing this project and emphasize the importance of implementing strategies for promotion and prevention in mental health in periods prior to development of the disease so that their effectiveness is maximized.

Take-home messages: Program promotion and prevention in mental health for students must be continuously offered during medical training.


Investigating the Reasons For Under Performance In Ethnic Minority Medical Students

R E Chandauka (Medical School, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, United Kingdom) Jean Marion Russell (Corporate Information and Computing Services, University of Sheffield, United Kingdom)

Pirashanthie Vivekananda-Schmidt (Medical Education, University of Sheffield, United Kingdom)

Background: It has been previously reported that ethnic minority students academically underperform compared to their white counterparts. This project aimed to identify whether amongst medical students, there is a relationship between ethnicity and the following factors: satisfaction with academic performance, sense of belonging and cultural influence.

Summary of work: An online questionnaire (quantitative and qualitative) was completed by 352 medical students from the University of Sheffield (70%), Keele University (21%) and London Universities (9%). Ethnic distribution was 73.3% Caucasians, 5.4% Mixed race and 21% Ethnic Minorities (EM).

Summary of results: EM were more dissatisfied with their academic performance (p<0.001) and less likely to feel they belonged to the medical community (p<0.05). Participants believed the causes for variations in performance were interplay of cultural influences, ethnic stereotyping, and communication skills. Regarding the ideal medical student's behavioural traits, Caucasian were more likely to choose confidence (p<0.05). Regarding what behavioural traits are emphasised during their upbringing, Caucasians chose extraversion (p<0.05), mixed race students openness to experience (p<0.05) and EM chose respectfulness (p<0.001). Students measured belonging using their relationships with other students and finding activities that met their interests within the medical school. Culture influenced behavioural traits and communication skills including accents and proficiency of English. These reinforced a stereotyping which was cited as having a possible negative impact on clinical experience/teaching for EM.

Conclusions: Clear differences exist between ethnicities in self-perceived satisfaction with academic performance, belonging and insight into characteristics important for their professional role. Further research should focus on better understanding of these differences and developing interventions to overcome them.


Drugs and vigil in health sciences students: cost of the academic performance

Eduardo Landerer (Universidad Andres Bello, Urology, Republica 330; 3° piso; Santiago, Republica de Cuba 1489; D 202; Providencia, Santiago 7500000, Chile) Vincenzo Borgna (Universidad Andres Bello, Urology, Santiago, Chile)

Carlos Gonzalez (Universidad Andres Bello, Veterinary, Santiago, Chile)

Rodolfo Paredes (Universidad Andres Bello, Veterinary, Santiago, Chile)

Background: The academic activities of the Health Sciences students are highly demanding and competitive, so they often must change sleep hours and leisure by study time. In this scenario, the consumption of drugs stimulating the central nervous system (CNSSD) appears as a good alternative to maintain a good level of qualifications.


Summary of work: Objective: To evaluate the use of CNSSD by students majoring in Medicine and Dentistry. During the 2nd half of 2012, we designed a descriptive study (cross-sectional) based on the application of a structured questionnaire to 344 students majoring in Dentistry and Medicine, between the 2nd and 5th year, with an academic curriculum of 40 hours weekly. The study was approved by the Ethics Committee of the Universidad Andres Bello. Only the entirely answered surveys were assessed. The results are shown as percentages with respect to the totals obtained. Summary of results: Of the respondents, only 14% reported not consuming any substance in relation to their studies. 50% of respondents referred to consumption of energy drinks, 37.4% consume CNSSD and 14.9% anxiolytics. The main reason for consumption is maintaining wakefulness for increase in the hours of study (68.6%). Only 14.1% have medical indication. Despite the high number of individuals using any substance, only 46.7% said they often got the expected effect.

Conclusions: CNSSD consumption is common among students of Health Sciences, for keeping vigil in order to increase the hours of study. Sources of funding: FIAC UAB1102


A study to explore perceptions of stress in UK medical students

Alice Rutter (University of Sheffield, Faculty of Medicine, Sheffield, United Kingdom) (Presenter: Steve Churchill, University of Sheffield, Faculty of Medicine, Beech Hill Rd, Sheffield S10 2RX, United Kingdom)

Background: Existing literature suggests that levels of stress are high in medical student population. Aim: Investigate medical student perceived (1) levels of stress, (2) causes of stress, and (3) coping strategies employed by the students.

Summary of work: Students from Sheffield, Nottingham, UCL, and Keele Medical Schools were invited to participate. Data collection was through an online questionnaire and three focus group interviews with one school. Analysis: Descriptive statistics and thematic analysis of free text and qualitative responses. Summary of results: 332 students responded to the questionnaire, responses were qualified through the focus groups. 92.2% of participants self reported experiencing levels of stress that adversely affected their health. However, most viewed stress as normal, even a necessary part of medical training. The leading stressor was exams followed by feelings of inadequacy. The latter was largely attributed to competitiveness within the population and confidence issues that arose from this. Not being able to cope with stress was perceived as an admission of failure. Conclusions: Medical students expect, accept, and often ignore stress; it is perceived to be the norm. Stress is a multifactorial issue, and academic pressures are a key

source. Stress is reported to have a significant impact on students' quality of life, health and academic ability. Take-home messages: The self reported significant impact of stress on students' quality of life and ability mean that action is needed. (Acknowledgements: Jill Thompson, Paul Bissell, Pirashanthie Vivekananda-Schmidt)


How to Improve Occupational Therapy Students' Social Skills: The Current Situations and Prospects in Tokyo, Japan

Kaoru Inoue (Tokyo Metropolitan University, The Graduate School of Human Health Sciences, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 1168551, Japan) Chihiro Sasaki (Tokyo College of Welfare, Tokyo, Japan) Atsuko Tanimura (Tokyo Metropolitan University, The Graduate School of Human Health Sciences, Tokyo) Yu Ishibashi (Tokyo Metropolitan University, The Graduate School of Human Health Sciences, Tokyo, Japan)

Background: In Japan, most occupational therapy students are in their late teens and have little social and work experience. Meanwhile, Japanese seniors regard social manner as extremely important. Instructors may ask: Which social manners should students know before working on site? What kinds of situations can be most confusing for students to deal with? In many cases, students who venture into clinical training without much knowledge of social manner often fail to learn efficiently because they stumble over basic social exchange with senior patients.

Summary of work: The purpose of this research is to identify what students can do and what they cannot do so that instructors can help them go through clinical training without extra distraction. We created questionnaires about 12 specific social situations during clinical training, based on past experiences of 11 occupational therapy instructors from Tokyo Metropolitan University. 74 occupational therapists and 36 students answered the questionnaires, and we analyzed the data, using Mann-Whitney U test, 0.05<p,

PASW statistics 20.

Summary of results: Our results indicate that many students know appropriate manner on a theoretical level, but do not know exactly how to execute it in an actual situation. Borrowing from Benjamin Bloom's educational taxonomy, we can say that they recognize some specific knowledge but still have not acquired necessary skills and attitudes to carry it out. Conclusions: Occupational therapy instructors are responsible to grasp how much students can do (instead of "know") and help them learn appropriate social manner before their clinical training. Take-home messages: Frequent internal communication between instructors and students is the key to make clinical training successful.



Prevalence of needlestick injury and Hepatitis B vaccination status in Medical students in Maharat Nakhon Ratchasima Hospital, Thailand

Wilawan Thipmontree (Maharat Nakhonratchasima Hospital, Internal Medicine, 55/6 Changpueng Road, Nakhonratchasima 30000, Thailand)

Background: Needlestick injuries are a risk for blood-borne infection such as Hepatitis B, Hepatitis C and Human Immunodeficiency Virus. This study aimed to determine prevalence of needlestick injuries and HBV status of medical students in Nakhonratchasima medical center, Thailand.

Summary of work: Retrospective study was performed between 1 October 2010 and 30 September 2012. Summary of results: Thirty six medical students incurred needlestick injuries and prevalence of needlestick injuries were 7.4% (36/483 persons). Most of them (25/36, 69.4 %) were 6th year medical students. The event occurred at the frequency of 55.5% ward, 30.5% operating room and 14% emergency room. Suturing was the most common procedure causing NSI. Their reasons for the injuries were recklessness (25/36,69.4%), lack of skill (9/36,25.0%) and inappropriate equipment (2/36,5.6%). All of them already have immunity against


Conclusions: Needlestick injuries were common in medical students. NSI prevention should involve hygienic discipline, skill training and proper equipment provision, respectively, since vaccine can prevent only hepatitis B infection.

Take-home messages: Vaccine effectiveness is limited, therefore human precaution should be complementary.


Brazilian multicentric randomized study of depression and anxiety among medical students

Fernanda Brenneisen Mayer (School of Medicine of the University of Sao Paulo, Center for Development of Medical Education, Av. Dr. Arnaldo, 455 - 2° andar, sala 2354, Sao Paulo 01246-903, Brazil) Paulo SP Silveira (School of Medicine of the University of Sao Paulo, Department of Pathology, Sao Paulo, Brazil) Munique Almeida (School of Medicine of the University of Sao Paulo, Center for Development of Medical Education, Sao Paulo, Brazil)

Daniel Silvestre (School of Medicine of the University of Sao Paulo, Department of Pathology, Sao Paulo, Brazil) Bruno Perotta (Evangelical Medical School of Parana, Department of Medicine, Curitiba, Brazil) Patricia Tempski (School of Medicine of the University of Sao Paulo, Center for Development of Medical Education, Sao Paulo, Brazil)

Background: Depression and anxiety symptoms in medical students can influence their health-related quality of life and performance in Medical School. Summary of work: We performed a multicentric randomized cross-sectional study, including twenty-

three Medical Schools and 1350 (81,8%) medical students, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory. Medical course was divided into three Groups: First (1st and 2nd years),

Second (3th and 4th) and Third (5th and 6th).

Summary of results: Forty-one per cent of the students surveyed had depressive symptoms (BDI> 9). The high scores towards depressive symptoms were more frequent among female medical students (p<0,001). Fifty per cent of female medical students manifested depressive symptoms considering the three studied groups. Male scores were higher in the 3th and 4th years (chi-square=0.03). Mean values of State-Trait anxiety were 45 points, corresponding to moderate scores of anxiety. Females manifested higher anxiety scores than males (p<0,001). There was a positive relationship between levels of State (r=0,591, p<0.001) and Trait (r=0,718, p<0.001) anxiety and depression scores.

Conclusions: Our results showed a high prevalence of depression and anxiety symptoms among medical students in Brazil, particularly in females. There was a significant gender difference in the first and third group concerning depression scores. This difference was not observed in the middle years of Medical School because male scores were higher in these years. Take-home messages: Medical educators must create opportunities to medical students for discussions about their mental and physical health.


Relationship between initial expectations and academic well-being in medical students of Chile

Liliana Ortiz (University of Concepcion, Medical Education Department, Concepcion, Chile) Cristhian Perez (University of Concepcion, Medical Education Department, Concepcion, Chile) Javiera Ortega (University of Concepcion, Medical Education Department, Concepcion, Chile) Paula Parra (University of Concepcion, Medical Education Department, Concepcion, Chile) Olga Matus (University of Concepcion, Medical Education Department, Concepcion, Chile) Eduardo Fasce (University of Concepcion, Medical Education Department, Concepcion, Chile) Carolina Marquez, University of Concepcion, Medical Education Department, Victor Lamas 1290, Barrio universitario s/n, Concepcion 4070386, Chile)

Background: First year medical students not only face transition and must adapt to university entrance but in addition they must face high academic and personal demands. Actual research indicates that students can be damaged in an affective emotional level that can affect their psychological comfort influencing their academic performance. The aim of this study is to analyze the relationship between academic expectations and academic well-being, regarding high engagement and low academic burnout in students of the first year of medical schools in Chile.


Summary of work: The relationship between academic expectations that students present entering medical schools and the academic well-being they exhibit at the end of the academic semester was assessed in an intentional sample of 184 first year medical students from three Chilean universities, 98 (53,26%) men and 86 (46,74%) women. Academic Expectation Scale, Utrecht Work Engagement Scale Student Questionnaire (UWES-S-17) and Maslach Burnout Inventory (MBI HSS) were answered.

Summary of results: Students with higher levels of involvement and academic satisfaction at the end of the first academic semester are the ones that show higher expectations of the medical school, teachers and relationship with classmates. Additionally the ones that entered with higher academic expectations in each area showed higher personal accomplishment. Conclusions: The results highlight the relationship existing between initial academic expectations and academic well-being in medical students after their first academic semester. This study may provide useful information about students' adaptation process to university.

Take-home messages: Medical students' academic well-being and expectation is a useful indicator of academic success in the first years of university. (sponsored by regular FONDECYT #1121002)


Variations of subjective and physiological stress and clinical reasoning according to extrinsic and intrinsic stressors

Pierre Pottier (University of Nantes, CHU Nantes, Internal Medicine, Place Alexis Ricordeau, Nantes 44093, France)

Jean-Benoit Hardouin (University of Nantes, Biostatistics, Nantes, France)

Anne-Gaelle Leloupp (CHU Nantes, Biochemistry, Nantes, France)

Jean-Marie Castillo (University of Nantes, Family Medicine, Nantes, France)

Angelique Bonnaud (University of Nantes, CHU Nantes, Social Sciences, Nantes, France) Vicki Leblanc (University of Toronto, Wilson Center for research in medical education, Toronto, Canada)

Background: The effect of acute stress on medical clinical performance is equivocal. Indeed, both enhancements and impairments have been reported, especially as a function of the intensity of response to stress. According to literature, peripheral or extrinsic stressors (ES) and task-contingent or intrinsic stressors (IS) can be distinguished within a stressful situation. The objective of this study was to assess the impact of those different kinds of stressors on medical clinical performance.

Summary of work: A prospective, randomized, cross over study was undertaken with year 3 medical students conducting two medical consultations with simulated patients. Students have been randomly assigned to four groups according to the presence and the order of ES

and IS at consultation 1 and 2. Subjective and physiological stress responses have been assessed before and after both consultations. As dimensions of clinical performance clinical abilities in performing a clinical examination, communications skills, diagnostic accuracy and diagnostic argumentation have been assessed.

Summary of results: Subjective responses to stress assessed with the Spielberger and Tomaka questionnaires were higher in case of IS: (43.5 vs. 40.9 F=6.5; p=.01 and 1.5 vs. 1.0 p<.0001, respectively) while ES did not modify stress measures. Having the scenario including intrinsic stressors at the first consultation increased salivary cortisols in both consultations (7.3 ng/mL +/- 3.6 vs 5.9 ng/mL +/-3.3, p<.0001). Globally, markers of clinical performance were enhanced in presence of ES and decreased in presence of IS. Conclusions: ES and IS have different effect on stress and opposite impact on clinical performance. Take-home messages: ES and IS have different effect on stress and opposite impact on clinical performance.


Specialty Selection Satisfaction and Regret Among Medical School Postgraduates At King Abdulaziz University

Muhammed Mashat (King Abdulaziz University, Faculty of Medicine, Medical Education, Jeddah, Saudi Arabia) Nawaf Aboalfaraj (King Abdulaziz University, Faculty of Medicine, Medical Education, Jeddah, Saudi Arabia) Hussam Daghistani (King Abdulaziz University, Faculty of Medicine, Medical Education, Jeddah, Saudi Arabia) Basem El-Deek (King Abdulaziz University, Faculty of Medicine, Medical Education, Jeddah, Saudi Arabia)

Background: The field of medicine has wide options of specialties, where specialty selection is a life-altering decision that plays a crucial role in career satisfaction, and in turn patient-care. This study explores significant factors regarding specialty selection satisfaction and regret from the perspective of postgraduates in their medical field.

Summary of work: Data analysis of a cross sectional study was carried out on a sample of 172 medical school postgraduates working at King Abdulaziz University. A questionnaire was used to conduct the study. Summary of results: From the data obtained, there is a statistically significant (p<0.05) association between specialty selection satisfaction and specialty selection regret. The analysis showed that 11% of the sample regret their choice of specialty. The analysis also showed that the level of satisfaction increases as the status of the postgraduates increase. Furthermore, nine factors were identified to be statistically significant with specialty selection satisfaction; income, high length of training, vast options of subspecialties, interesting and exciting field, high level of education depth, research opportunities, reasonable work hours, stress and employment opportunities. However, only three of those factors (income, interesting and exciting field, and

employment opportunities) were statistically significant to the point of specialty selection regret. Conclusions: The results of the present study identify some of the key factors that have a potential impact on specialty satisfaction and regret among medical school postgraduates.

Take-home messages: The study highlights the importance of career counselling. Further work may involve investigating alternative hospitals, the perspective of medical students in various specialties, together with exploring potential ways to solve the problem.

SESSION 10: Simultaneous Sessions

Wednesday 28 August: 0830-1015

10A Symposium: Changing the Culture of Learner Evaluation: Moving from Likert Scales to Narrative Description

Location: Congress Hall, PCC

Janice L Hanson (University of Colorado Denver, School of Medicine, USA)

J Lindsey Lane