Health behaviors of medical students decline towards residency: how could we maintain and enhance these behaviors throughout their training.

Rachel Wilf-Miron, Ilya Kagan, Mor Saban
Author Information
  1. Rachel Wilf-Miron: The Gertner Institute for Epidemiology and Health Policy Research, Ramat-Gan, Israel.
  2. Ilya Kagan: Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  3. Mor Saban: The Gertner Institute for Epidemiology and Health Policy Research, Ramat-Gan, Israel. morsab1608@gmail.com. ORCID

Abstract

BACKGROUND: We examined health behaviors and perceptions among medical students and compared them with the results of a previous survey among residents and senior physicians.
METHODS: This cross-sectional study was performed among second-year medical students (2015-2018) and among physicians (2015) using an online questionnaire. Univariate and multivariate analyses were performed.
RESULTS: Significantly more physicians perceived their health as bad, compared with students. Half of the residents, compared with one-third of senior physicians and one-fifth of students, reported high emotional stress. Residents reported the worst, and students - the best, eating habits. Logistic regression models demonstrated that lower emotional stress, healthy eating habits, adequate sleep, lower body mass index and not having a regular physician, explained good perceived health. Female gender, being a resident, bad perceived health, unhealthy eating habits, less sleep and not having a regular physician, were correlated with high emotional stress.
CONCLUSIONS: The healthy lifestyle of medical students declines towards residency. Given the workload and emotional stress of their chosen profession, it is advised that medical school curriculum provide students with measures to help them to adopt healthier lifestyles, allowing students and physicians to be better role models and the healthcare system to perform better.

Keywords

References

  1. Collaborators GBDCoD. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1151–210. [DOI: 10.1016/S0140-6736(17)32152-9]
  2. Krokstad S, Ding D, Grunseit AC, Sund ER, Holmen TL, Rangul V, Bauman A. Multiple lifestyle behaviours and mortality, findings from a large population-based Norwegian cohort study - the HUNT study. BMC Public Health. 2017;17(1):58. [DOI: 10.1186/s12889-016-3993-x]
  3. Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Prev Med. 2012;55(3):163–70. [DOI: 10.1016/j.ypmed.2012.06.017]
  4. Snyder L, American College of Physicians Ethics P, Human Rights C. American College of Physicians Ethics Manual: sixth edition. Ann Intern Med. 2012;156(1 Pt 2):73–104. [DOI: 10.7326/0003-4819-156-1-201201031-00001]
  5. Levine DM. The physician's role in health-promotion and disease prevention. Bull N Y Acad Med. 1987;63(10):950–6. [PMID: 3507880]
  6. OECD. Use of primary care services. In: Health at a Glance 2019: OECD Indicators; 2019. https://doi.org/10.1787/b9908b12-en . [DOI: 10.1787/4dd50c09-en]
  7. Brammli-Greenberg S , Medina Artom T , Yaari I , Belinsky A. 2019. Public Opinion on the Level of Services and Performance of the Healthcare System in 2016. https://brookdale.jdc.org.il/en/publication/public-opinion-on-the-level-of-services-and-performance-of-the-healthcare-system-in-2016/ .
  8. Frank E, Segura C, Shen H, Oberg E. Predictors of Canadian physicians' prevention counseling practices. Can J Public Health. 2010;101(5):390–5. [DOI: 10.1007/BF03404859]
  9. Howe M, Leidel A, Krishnan SM, Weber A, Rubenfire M, Jackson EA. Patient-related diet and exercise counseling: do providers' own lifestyle habits matter? Prev Cardiol. 2010;13(4):180–5. [DOI: 10.1111/j.1751-7141.2010.00079.x]
  10. Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9(3):287–90. [DOI: 10.1001/archfami.9.3.287]
  11. Frank E, Tong E, Lobelo F, Carrera J, Duperly J. Physical activity levels and counseling practices of U.S. medical students. Med Sci Sports Exerc. 2008;40(3):413–21. [DOI: 10.1249/MSS.0b013e31815ff399]
  12. Holtz KA, Kokotilo KJ, Fitzgerald BE, Frank E. Exercise behaviour and attitudes among fourth-year medical students at the University of British Columbia. Can Fam Physician. 2013;59(1):e26–32. [PMID: 23341676]
  13. Yu Y, Yang Y, Li Z, Zhou B, Zhao Y, Yuan S, Zhang R, Sebranek M, Veerman L, Li M, Gong E, Chen S, Ma W, Huang L, Cho K, Leeder S, Yan L. The association between medical students' lifestyles and their attitudes towards preventive counseling in different countries. BMC Public Health. 2015;15:1124. [DOI: 10.1186/s12889-015-2458-y]
  14. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21. [DOI: 10.1016/S0140-6736(09)61424-0]
  15. Clarfield AM, Manor O, Nun GB, Shvarts S, Azzam ZS, Afek A, Basis F, Israeli A. Health and health care in Israel: an introduction. Lancet. 2017;389(10088):2503–13. [DOI: 10.1016/S0140-6736(17)30636-0]
  16. Rosen B, Waitzberg R, Merkur S. Israel: health system review. Health Syst Transit. 2015;17(6):1–212. [PMID: 27050102]
  17. Wilf Miron R, Malatskey L, Rosen LJ. Health-related behaviours and perceptions among physicians: results from a cross-sectional study in Israel. BMJ Open. 2019;9(9):e031353. [DOI: 10.1136/bmjopen-2019-031353]
  18. Borgan SM, Jassim GA, Marhoon ZA, Ibrahim MH. The lifestyle habits and wellbeing of physicians in Bahrain: a cross-sectional study. BMC Public Health. 2015;15:655. [DOI: 10.1186/s12889-015-1969-x]
  19. Dayoub E, Jena AB. Chronic disease prevalence and healthy lifestyle behaviors among US health care professionals. Mayo Clin Proc. 2015;90(12):1659–62. [DOI: 10.1016/j.mayocp.2015.08.002]
  20. Gupta K, Fan L. Doctors: fighting fit or couch potatoes? Br J Sports Med. 2009;43(2):153–4. [DOI: 10.1136/bjsm.2008.051839]
  21. Stanford FC, Durkin MW, Blair SN, Powell CK, Poston MB, Stallworth JR. Determining levels of physical activity in attending physicians, resident and fellow physicians and medical students in the USA. Br J Sports Med. 2012;46(5):360–4. [DOI: 10.1136/bjsports-2011-090299]
  22. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, Olson RD. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–8. [DOI: 10.1001/jama.2018.14854]
  23. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, Medina FX, Battino M, Belahsen R, Miranda G, Serra-Majem L, Mediterranean Diet Foundation Expert G. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274–84. [DOI: 10.1017/S1368980011002515]
  24. 2015–2020 Dietary Guidelines for Americans. 8th Edition. 2016. Health.gov/DietaryGuidelines/1/guidelines .
  25. Frank E, Segura C. Health practices of Canadian physicians. Can Fam Physician. 2009;55(8):810–1 e817. [PMID: 19675268]
  26. Thornorarinsdottir H, Faurholt-Jepsen M, Ullum H, Frost M, Bardram JE, Kessing LV. The validity of daily self-assessed perceived stress measured using smartphones in healthy individuals: cohort study. JMIR Mhealth Uhealth. 2019;7(8):e13418. [DOI: 10.2196/13418]
  27. Hosmer DW Jr, Lemeshow S, Sturdivant RX. Applied logistic regression (Vol. 398). Hoboken: Wiley; 2013.
  28. Van der Veer T, Frings-Dresen MH, Sluiter JK. Health behaviors, care needs and attitudes towards self-prescription: a cross-sectional survey among Dutch medical students. PLoS One. 2011;6(11):e28038. [DOI: 10.1371/journal.pone.0028038]
  29. Ayala EE, Berry R, Winseman JS, Mason HR.  A cross-sectional snapshot of sleep quality and quantity among US medical students. Academic Psychiatry. 2017;41(5):664-8.
  30. A Survey of Physical Activity Habits among Israeli Adults, 21 and Older. 2012. https://www.health.gov.il/publicationsfiles/activities21_01122012.pdf .
  31. Social Survey 2017: Health and lifestyle. Central Bureau of Statistics. 2018.
  32. Health Minister's Report on Smoking in Israel 2018. 2019. https://www.health.gov.il/PublicationsFiles/smoking_2018.pdf .
  33. Selected Data on Sleep from the 2017 Social Survey. 2018. https://www.cbs.gov.il/he/mediarelease/DocLib/2018/387/19_18_387b.pdf .
  34. Malatskey L, Essa-Hadad J, Willis TA, Rudolf MCJ. Leading healthy lives: lifestyle medicine for medical students. Am J Lifestyle Med. 2019;13(2):213–9. [DOI: 10.1177/1559827616689041]
  35. Cohen JS, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ. 2005;5:21. [DOI: 10.1186/1472-6920-5-21]
  36. Olson SM, Odo NU, Duran AM, Pereira AG, Mandel JH. Burnout and physical activity in Minnesota internal medicine resident physicians. J Grad Med Educ. 2014;6(4):669–74. [DOI: 10.4300/JGME-D-13-00396]
  37. Weight CJ, Sellon JL, Lessard-Anderson CR, Shanafelt TD, Olsen KD, Laskowski ER. Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program. Mayo Clin Proc. 2013;88(12):1435–42. [DOI: 10.1016/j.mayocp.2013.09.010]
  38. Buddeberg-Fischer B, Klaghofer R, Stamm M, Siegrist J, Buddeberg C. Work stress and reduced health in young physicians: prospective evidence from Swiss residents. Int Arch Occup Environ Health. 2008;82(1):31–8. [DOI: 10.1007/s00420-008-0303-7]
  39. The National Program for Strengthening Healthcare System Workers and Preventing Burnout. Finding of the 2019 Survey - Medical Sector. 2019. https://www.health.gov.il/Subjects/HRinHealthSystem/PreventingBurnoutProgram/Documents/sectors/sectors_02.pdf .
  40. Muscato D, Phillips EM, Trilk JL. Lifestyle medicine education collaborative (LMEd):“champions of change” medical school leaders workshop. Am J Lifestyle Med. 2018;12(5):382–6. [DOI: 10.1177/1559827618766494]
  41. Razavi AC, Monlezun DJ, Sapin A, Stauber Z, Schradle K, Schlag E, Harlan TS. Multisite culinary medicine curriculum is associated with cardioprotective dietary patterns and lifestyle medicine competencies among medical trainees. Am J Lifestyle Med. 2020;14(2):225–33. [DOI: 10.1177/1559827619901104]
  42. Busireddy KR, Miller JA, Ellison K, Ren V, Qayyum R, Panda M. Efficacy of interventions to reduce resident physician burnout: a systematic review. J Grad Med Educ. 2017;9(3):294–301. [DOI: 10.4300/JGME-D-16-00372.1]
  43. CMA National Physician Health Survey. A National Snapshot. 2018. https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf .
  44. Trilk J, Nelson L, Briggs A, Muscato D. Including lifestyle medicine in medical education: rationale for American College of Preventive Medicine/American Medical Association resolution 959. Am J Prev Med. 2019;56(5):e169–75. [DOI: 10.1016/j.amepre.2018.10.034]

MeSH Term

Cross-Sectional Studies
Female
Health Behavior
Humans
Internship and Residency
Israel
Students, Medical

Word Cloud

Created with Highcharts 10.0.0studentshealthmedicalphysiciansstressbehaviorsamongemotionalcomparedperceivedeatinghabitsresidentsseniorperformedbadreportedhighmodelslowerhealthysleepregularphysiciantowardsbetterHealthBACKGROUND:examinedperceptionsresultsprevioussurveyMETHODS:cross-sectionalstudysecond-year2015-20182015usingonlinequestionnaireUnivariatemultivariateanalysesRESULTS:SignificantlyHalfone-thirdone-fifthResidentsworst-bestLogisticregressiondemonstratedadequatebodymassindexexplainedgoodFemalegenderresidentunhealthylesscorrelatedCONCLUSIONS:lifestyledeclinesresidencyGivenworkloadchosenprofessionadvisedschoolcurriculumprovidemeasureshelpadopthealthierlifestylesallowingrolehealthcaresystemperformdeclineresidency:maintainenhancethroughouttrainingEmotionalMedicalPerceivedPhysicians

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