Improve Management of Mental Well-being and Empathy in Chinese Medical Students: A Randomized Controlled Study

Background: The Chinese medical students suffer from high prevalent mental health-related issues and low empathy. Effective strategies to improve the situations are lacking. This study aims to investigate the efficacy of the well-designed interventional courses to enhance the mental health and empathy of the senior Chinese medical students. Methods: A total of 146 3rd and 4th year medical students were randomized to intervention group (n=74) and control group (n=72). A pilot study including 5 pre-clinical students and 5 interns was first carried out to determine the themes and contents of the interventional courses. The designed courses were delivered in the intervention group once a month for three times, while the control group had no specific intervention. Five self-assessment questionnaires including the General Self-Efficacy (GSE), Medical Outcomes Study Short Form 8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), Maslach Burnout Inventory (MBI), and Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS) that separately evaluated the level of self-efficacy (SE), quality of life (QoL), depression, burnout, and empathy were completed by the students before and one month after the courses. Qualitative data were collected via e-mails two year after the intervention.Results: Compared to the control group, the interventional group showed significantly higher scores of the empathy (111.0 [IQR 102.0, 118.0] vs 106.0 [IQR 93.0, 111.5]; P = .01) and QoL (32.0 [IQR 28.0, 35.0] vs 29.5 [IQR 26.0, 34.0]; P = .04). The rate of depression was significantly decreased in the interventional group compared to that in the control group (13.5% vs 29.2%; Chi-square test, P = .02). However, no significant differences of self-efficacy (25.6 ± 4.8 vs 24.3 ± 6.3; P = .16) and burnout (27.0% vs 34.7%; Chi-square test, P = .31) were observed between the two groups.Conclusions: The well-designed interventional courses had a positive impact on the mental well-being and empathy in senior Chinese medical students, which may help provide novel information for incorporation into the medical school curriculum.

[1]  Ning Ding,et al.  Time use in out-of-class activities and its association with self-efficacy and perceived stress: data from second-year medical students in China , 2020, Medical education online.

[2]  Lie Wang,et al.  Empathy, burnout, life satisfaction, correlations and associated socio-demographic factors among Chinese undergraduate medical students: an exploratory cross-sectional study , 2019, BMC Medical Education.

[3]  P. Xie,et al.  Depressive symptoms and quality of life among Chinese medical postgraduates: a national cross-sectional study , 2019, Psychology, health & medicine.

[4]  P. Gorwood,et al.  Burnout in medical students before residency: A systematic review and meta-analysis , 2019, European Psychiatry.

[5]  Hui-hua Xu,et al.  Empathy in Chinese eight-year medical program students: differences by school year, educational stage, and future career preference , 2018, BMC medical education.

[6]  Yuanli Liu,et al.  Impact of adverse media reporting on public perceptions of the doctor–patient relationship in China: an analysis with propensity score matching method , 2018, BMJ Open.

[7]  N. Roberts,et al.  Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis , 2018, Journal of the Royal Society of Medicine.

[8]  Jasmine Rana,et al.  Teaching & Learning Tips 4: Motivation and emotion in learning , 2018, International journal of dermatology.

[9]  R. MacIntyre,et al.  Burnout in medical students: a systematic review of experiences in Chinese medical schools , 2017, BMC Medical Education.

[10]  E. Bass,et al.  Teaching Medical Students to Communicate With Empathy and Clarity Using Improvisation. , 2017, Academic medicine : journal of the Association of American Medical Colleges.

[11]  Yu-Fang Guo,et al.  Positive psychotherapy for depression and self‐efficacy in undergraduate nursing students: A randomized, controlled trial , 2017, International journal of mental health nursing.

[12]  Maxime Tindong,et al.  Prevalence and factors associated with depression among medical students in Cameroon: a cross-sectional study , 2017, BMC Psychiatry.

[13]  A. Jackson,et al.  Associations of medical student empathy with clinical competence. , 2017, Patient education and counseling.

[14]  M. Huss,et al.  Coping with stress in medical students: results of a randomized controlled trial using a mindfulness-based stress prevention training (MediMind) in Germany , 2016, BMC medical education.

[15]  G. Sisti,et al.  Medical Students' Stress Levels and Sense of Well Being after Six Weeks of Yoga and Meditation , 2016, Evidence-based complementary and alternative medicine : eCAM.

[16]  Yun Zhao,et al.  Prevalence of depressive symptoms and its correlates among medical students in China: a national survey in 33 universities , 2016, Psychology, health & medicine.

[17]  P. Thiemann,et al.  Undergraduate medical students’ empathy: current perspectives , 2016, Advances in medical education and practice.

[18]  A. Fortin,et al.  Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students , 2016, Teaching and learning in medicine.

[19]  Jiwei Qian,et al.  Explaining medical disputes in Chinese public hospitals: the doctor–patient relationship and its implications for health policy reforms , 2016, Health Economics, Policy and Law.

[20]  Erping Long,et al.  Expectations of medical students in China , 2016, The Lancet.

[21]  Richard D Moore,et al.  Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care. , 2016, Patient education and counseling.

[22]  S. Sarkar,et al.  Barriers to healthcare seeking among medical students: a cross sectional study from South India , 2015, Postgraduate Medical Journal.

[23]  H. Jin,et al.  To be or not to be a doctor, that is the question: a review of serious incidents of violence against doctors in China from 2003–2013 , 2015, Journal of Public Health.

[24]  L. Dyrbye,et al.  Distress Among Matriculating Medical Students Relative to the General Population , 2014, Academic medicine : journal of the Association of American Medical Colleges.

[25]  Min Zhao,et al.  Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. , 2014, General hospital psychiatry.

[26]  Hong Wang,et al.  Efficacy of Williams LifeSkills training for improving psychological health: A pilot comparison study of Chinese medical students , 2014, Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists.

[27]  L. Dyrbye,et al.  Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. , 2014, JAMA internal medicine.

[28]  R. Sherer,et al.  Depression and suicidal ideation in medical students in China: a call for wellness curricula , 2014, International journal of medical education.

[29]  Jie Zeng,et al.  A gloomy future for medical students in China , 2013, The Lancet.

[30]  Ya-Lin Zhang,et al.  Validity and reliability of Patient Health Questionnaire‐9 and Patient Health Questionnaire‐2 to screen for depression among college students in China , 2013, Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists.

[31]  Zhifei Liu,et al.  Empathy in Chinese medical students: psychometric characteristics and differences by gender and year of medical education , 2013, BMC medical education.

[32]  A. Bjørndal,et al.  Mindfulness training for stress management: a randomised controlled study of medical and psychology students , 2013, BMC Medical Education.

[33]  J. Coverdale,et al.  A Systematic Review of Stress-Management Programs for Medical Students , 2013, Academic Psychiatry.

[34]  M. Yusoff,et al.  Prevalence and associated factors of stress, anxiety and depression among prospective medical students. , 2013, Asian journal of psychiatry.

[35]  Kevin W Eva,et al.  The Role of Emotion in the Learning and Transfer of Clinical Skills and Knowledge , 2012, Academic medicine : journal of the Association of American Medical Colleges.

[36]  William V. Harper,et al.  A Multi-institutional Study Exploring the Impact of Positive Mental Health on Medical Students’ Professionalism in an Era of High Burnout , 2012, Academic medicine : journal of the Association of American Medical Colleges.

[37]  Animesh Jain,et al.  Prevalence of depression and its associated factors using Beck Depression Inventory among students of a medical college in Karnataka , 2012, Indian journal of psychiatry.

[38]  Li Jie New generations of Chinese doctors face crisis , 2012, The Lancet.

[39]  J. Ripp,et al.  The prevalence and correlations of medical student burnout in the pre-clinical years: A cross-sectional study , 2012, Psychology, health & medicine.

[40]  T. Oei,et al.  A Review on Assessment and Treatment for Depression in Malaysia , 2011, Depression research and treatment.

[41]  Stephen Quinn,et al.  A randomised controlled trial of the effects of mindfulness practice on medical student stress levels , 2011, Medical education.

[42]  D. Thompson,et al.  A Program for Reducing Depressive Symptoms and Suicidal Ideation in Medical Students , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[43]  Muhamad Saiful Bahri Yusoff,et al.  Prevalence and Sources of Stress among Universiti Sains Malaysia Medical Students. , 2010, The Malaysian journal of medical sciences : MJMS.

[44]  William V. Harper,et al.  Burnout and Serious Thoughts of Dropping Out of Medical School: A Multi-Institutional Study , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[45]  B. Blatt,et al.  Found in Translation: Exporting Patient-Centered Communication and Small Group Teaching Skills to China , 2009, Medical education online.

[46]  R. Lew,et al.  A Cross-sectional Measurement of Medical Student Empathy , 2007, Journal of General Internal Medicine.

[47]  Tait D. Shanafelt,et al.  Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students , 2006, Academic medicine : journal of the Association of American Medical Colleges.

[48]  T. Wilkinson,et al.  The impact on students of adverse experiences during medical school , 2006, Medical teacher.

[49]  J. Ware,et al.  Usefulness of the SF-8™ Health Survey for comparing the impact of migraine and other conditions , 2003, Quality of Life Research.

[50]  W. Graham Resident burnout. , 2002, Annals of internal medicine.