L’objectif principal de cette étude était de réaliser une perspective globale de la santé mentale d’une population d’étudiants en médecine militaires, sur des années ciblées du cursus en déterminant la part de l’épuisement professionnel dans les symptômes rencontrés. Les objectifs secondaires étaient de proposer une compréhension intégrative et interdisciplinaire des problématiques psychiques, de mettre en évidence des facteurs de risque individuels, collectifs et situationnels favorisant l’apparition éventuelle de troubles psychiques, d’identifier des points de soutien institutionnels existants ou à développer.Une méthodologie mixte associant étude quantitative et qualitative était utilisée. Il s'agit d'une étude transversale répétée quantitative et descriptive par un questionnaire auto-administré anonyme. L’épuisement professionnel était évalué par le MBI- GS pour les étudiants de 1ère et de 2ème année, par le MBI-HSS pour les étudiants de 4ème et de 8ème année. 393 auto-questionnaires ont été distribués, 327 ont été recueillis et 261 ont été analysés, soit un taux de réponse global de 83,20%. La moyenne d’âge de la population était de 21, 5 ans, 46% étaient des hommes, 54% étaient des femmes ; 35,6% étaient en première année d’étude, 14,9% étaient en deuxième année, 23,8% étaient en quatrième année, enfin 25,7% étaient des internes en 8° année d’études ; parmi les internes, 82,1% étaient en médecine générale et 17,9% étaient internes de spécialité hospitalière. Ces scores correspondaient à un pourcentage global des étudiants présentant un fort épuisement émotionnel de 12,3% ; 25,3% exprimaient une forte dépersonnalisation et 18,6% un faible accomplissement personnel. Le pourcentage d’internes présentant un fort épuisement émotionnel était de 35,7% ; 38,0% exprimaient une forte dépersonnalisation et 37,1% un faible accomplissement personnel ; L’étude montrait que les scores médians d’épuisement émotionnel et de dépersonnalisation s’aggravaient au cours des études de manière significative (p <0,001) ; les scores médians d’accomplissement personnel restaient modérés de la première à la huitième année, n’augmentant pas en fin de parcours universitaire ; 9,8% des élèves de 4ème année et 21,2% des élèves de 8ème année présentaient des pensées de mort pour eux-mêmes ou avaient réalisé une tentative de suicide.L’étude qualitative par théorisation ancrée montrait que devenir médecin militaire implique des antécédents personnels marqués par l’idéal et l’identification ; il s’agit d’être à la fois d’être médecin mais aussi militaire dans une temporalité contrainte marquée par l’apprentissage parfois inadapté de la connaissance scientifique médicale et d’un éthos militaire, où l’influence des groupes est fondamentale ; les tensions entre savoir et pouvoir sont marquées, surtout dans la violence de la confrontation à la mort. Le ressenti variait entre les hommes et les femmes mais l’association des normes et des injonctions militaires au mode de vie médical entrainait pour une globalité des sentiments négatifs d’anxiété, de solitude et d’incertitude majeure envers l’avenir. Différentes stratégies de prévention et de prise en charge sont proposées. / The main objective of this study was to achieve a global mental health perspective in a population of military medical students, over targeted years of the curriculum by determining the extent of burnout. The secondary objectives were to propose an interdisciplinary understanding of psychic problems, to highlight individual, collective and situational risk factors favoring the possible appearance of psychic disorders, to identify institutional support points or to developed ones.A mixed methodology combining quantitative and qualitative study was used. This is a cross-sectional study repeated quantitatively and descriptively by an anonymous self-administered questionnaire. Professional burnout was assessed by the MBI-GS for 1st and 2nd year students, by the MBI-HSS for students in the 4th and 8th years.393 self-questionnaires were distributed, 327 were collected and 261 were analyzed, an overall response rate of 83.20%. The average age of the population was 21. 5 years, 46% were men, 54% were women; 35.6% were in the first year of study, 14.9% were in the second year, 23.8% were in the fourth year, and 25.7% were residents in the eighth year. Among the residents, 82.1% were general practitioners and 17.9% were specialty hospital residents. These scores corresponded to an overall percentage of students with a high emotional exhaustion of 12.3%. 25.3% expressed a strong depersonalization and 18.6% a low personal achievement. The percentage of residents with high emotional exhaustion was 35.7%; 38.0% expressed a strong depersonalization and 37.1% a low personal achievement. The study showed that median scores of emotional exhaustion and depersonalization was worsening significantly (p < 0.001). The median personal achievement scores remained moderate from the first to the 8th grade, not increasing at the end of the university; 9.8% of 4th year and 21.2% of 8th year students had suicidal ideation or made a suicide attempt.The qualitative study by grounded theory showed that becoming a military doctor implies personal antecedents marked by ideal and identification. It is a matter of being both a doctor and a military in a constrained temporality marked by the sometimes inadequate learning of medical scientific knowledge and a military ethos where the influence of groups is fundamental. The tensions between knowledge and power are marked, especially in the violence of confrontation with death. Feelings varied between men and women, but the association of military norms and injunctions with the medical lifestyle leads to an overall negative feeling of anxiety, loneliness and major uncertainty about the future. Different strategies for prevention and medical management are proposed

It is important for doctors to be clinically competent and this clinical competence is influenced by their clinical reasoning ability. Most research in this area has focussed on clinical reasoning ability measured in a problem - solving context. For this study, clinical reasoning is described as the process of working through a clinical problem which is distinct from a clinical problem solving approach that focuses more on the outcome of a correct diagnosis. Although the research literature into clinical problem solving and clinical reasoning is extensive, little is known about how undergraduate medical students develop their clinical reasoning ability. Evidence to support the validity of existing measures of undergraduate medical student clinical reasoning is limited. In order better to train medical students to become competent doctors, further investigation into the development of clinical reasoning and its measurement is necessary. Therefore, this study explored the development of medical students' clinical reasoning ability as they progressed through the first two years of a student - directed undergraduate problem - based learning ( PBL ) program. The relationships between clinical reasoning, knowledge base, critical thinking ability and learning approach were also explored. Instruments to measure clinical reasoning and critical thinking ability were developed, validated and used to collect data. This study used both qualitative and quantitative approaches to investigate the development of students' clinical reasoning ability over the first two years of the undergraduate medical program, and the factors that may impact upon this process. 113 students participated in this two - year study and a subset sample ( N = 5 ) was investigated intensively as part of the longtitudinal qualitative research. The clinical reasoning instrument had good internal consistency ( Cronbach alpha coefficient 0.94 for N = 145 ), inter - rater reliability ( r = 0.84, p < 0.05 ), and intrarater reliability ( r = 0.81, p < 0.01 ) when used with undergraduate medical students. When the instrument designed to measure critical thinking ability was tested with two consecutive first year medical student cohorts ( N = 129, N = 104 ) and one first year science student cohort ( N = 92 ), the Cronbach Alpha coefficient was 0.23, 0.45 and 0.67 respectively. Students ' scores for clinical reasoning ability on the instrument designed as part of this research were consistent with the qualitative data reported in the case studies. The relationships between clinical reasoning, critical thinking ability, and approach to learning as measured through the instruments were unable to be defined. However, knowledge level and the ability to apply this knowledge did correlate with clinical reasoning ability. Five student - related factors extrapolated from the case study data that influenced the development of clinical reasoning were ( 1 ) reflecting upon the modeling of clinical reasoning, ( 2 ) practising clinical reasoning, ( 3 ) critical thinking about clinical reasoning, ( 4 ) acquiring knowledge for clinical reasoning and ( 5 ) the approach to learning for clinical reasoning. This study explored students' clinical reasoning development over only the first two years of medical school. Using the clinical reasoning instrument with students in later years of the medical program could validate this instrument further. The tool used to measure students' critical thinking ability had some psychometric weaknesses and more work is needed to develop and validate a critical thinking instrument for the medical program context. This study has identified factors contributing to clinical reasoning ability development, but further investigation is necessary to explore how and to what extent factors identified in this study and other qualities impact on the development of reasoning, and the implications this has for medical training. / Thesis (Ph.D.)-- Medicine Learning and Teaching Unit, 2006.

Thesis (Ph.D.)--McMaster University, 2006. / Supervisor: Lee R. Brooks and Geoffrey R. Norman. Includes bibliographical references (leaves 81-90). Mode of access: World Wide Web.

Thesis (Ph. D.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains vi, 68 p. : ill. Includes abstract. Includes bibliographical references (p. 55-62).

Background Antibiotics resistance is a major public health threat worldwide. Super bugs, for example, drug resistant tuberculosis or Staphylococcus aureus, are increasingly common in the communities. Hong Kong is one of the areas which have the highest antibiotics resistant strains prevalence rate in the world. Irrational use of antibiotics is an important contributing factor to the emergence of antibiotics resistance. Physician stewardship in the prescription of antibiotics is pivotal in the prevention of antibiotics resistance emergence. Medical students are going to be practicing doctors after graduation from medical school. But few studies had been conducted to investigate their knowledge and attitude towards antibiotics resistance and use, and relations with anticipated antibiotics prescription behaviour. Method 145 medical students at the University of Hong Kong were recruited in this study to complete a self-administered questionnaire. There were in total 14 questions in this questionnaire, covering 2 major themes 1.Self-report of current and past antibiotic use and behaviour; 2.Anticipated prescription behaviour of antibiotics upon graduation and practice in the future. Chi-square test was used to investigate the association between attitude and knowledge of antibiotics with their anticipated prescription behavior upon graduation and practice. Multivariable logistic regression model was used to adjust for potential confounders. Results 67.6 % of the participants hold the correct knowledge of the proper use of antibiotics. Compare with the participants who hold the wrong knowledge, they were to 0.18 times more likely to inappropriately prescribe antibiotics for non-complicated Upper respiratory tract infections (URTI). (OR: 0.18, 95 % CI: (0.08, 0.43); p <0.001). Respectively 33.6 % and 4.9% of all the participants perceived the severity of antibiotics resistance in Hong Kong as “Severe” and “Very severe “. Those who rated “Severe” or above were 0.37 times more likely to inappropriately prescribe antibiotics for non-complicated URTIs compared with the participants who rated “Neutral” or below. (OR: 0.37, 95 % CI: (0.15, 0.91); p = 0.03). Logistic regression model was employed to test the interaction effect. Result showed that clinical training significantly interacted with antibiotics knowledge (p < 0.01)and perceived severity of antibiotics resistance (p = 0.02) in their relations with inappropriate prescription for non-complicated URTIs. Conclusion For the medical students who have received clinical training, those who were more aware of the severity of antibiotics resistance in Hong Kong were less likely to inappropriately prescribe antibiotics for non-complicated URTI. For the medical students who have not received clinical training, correct knowledge of antibiotic use is associated with less inappropriate antibiotics prescription behaviour. These suggest that knowledge and attitude towards antibiotics resistance and use are important factors that may impact on physician stewardship in antibiotics use in the community. / published_or_final_version / Public Health / Master / Master of Public Health

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Thesis (Ph. D.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on February 20, 2008) Vita. Includes bibliographical references.