Background: Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.

Aims: Because of the high patient load in Thailand, we need a practical measurement to help primary physicians detect depression. This study aimed to examine the reliability and validity of the Thai version of the World Health Organization-Five WellBeing Index (WHO-5-T), which is short and easy to use as a screening tool for major depression in primary care patients. Methods: The English version of the WHO-FiveWell-Being Index was translated into Thai. Backtranslations, cross-cultural adaptation and field testing of the pre-final version with final adjustments were performed accordingly. The WHO-5-T was administered randomly to 300 patients in our primary care clinic. Then the patients were further assessed using the Mini International Neuropsychiatric Interview and the Hamilton Rating Scale for Depression as the gold standard of diagnosis and symptom severity, respectively. Results: Conclusions:The Thai version of the WHO-Five WellBeing Index was found to be a reliable and valid self-assessment to screen for major depression in primary care setting at a cut-off point of <12.

BackgroundIntroducing reflective writing to a medical curriculum requires the acceptance and participation of teachers. The purpose of this study was to explore medical teachers’ views on the benefits of introducing a reflective writing exercise into an undergraduate medical curriculum, including their levels of satisfaction and their concerns. We also investigated effects on the teachers’ personal and professional development arising from their roles as novice facilitators.MethodsA qualitative approach was employed using semi-structured interviews. During an attachment to Primary Care Medicine course, fourth-year medical students (n = 180) in the Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand were assigned to write a reflective essay titled, “A Significant Event in My First Clinical Year”. After reading the essays and facilitating between one to three small group discussions based on these, each of the 18 teachers enrolled in our study completed an in-depth face to face interview. Transcripts of these were studied, using thematic content analysis to identify emerging themes.ResultsThe novice facilitators felt that facilitated reflection was both valuable and appropriate for students. They also perceived that it had a positive impact on their own personal and professional lives. In the early phase of implementing this activity, teachers expressed concerns about 1) their ability and confidence as facilitators in small group discussion 2) their ability to deal with emotions raised within their groups 3) the effectiveness of the activity 4) poor presentation and possible fabrication of student work.ConclusionsMost teachers regarded this activity as being beneficial to them, to student learning, and to the curriculum. Their insights, including concerns about the level of skill needed for facilitation, provide valuable material for planning a comprehensive faculty development programme.

Objectives:To examine the psychometric properties of the Maslach Burnout Inventory-Student Survey (MBI-SS) Thai version and to determine the frequency of burnout and correlation between burnout and associated factors. Methods:A cross-sectional study was conducted among undergraduate medical students using convenience sampling (n=545, 76.1% response rate, female 52.1%). Data were collected by a self-report survey. The MBI-SS was translated in Thai and tested for internal consistency using Cronbach's coefficient alpha. A confirmatory factor analysis was performed using as fit indices of the chi-square and degree of freedom ratio (χ 2 /df), Comparative Fit Index (CFI), the Goodness of Fit Index (GFI), the Non-normed Fit Index (NNFI), Akaike information criterion (AIC) and the Root Mean Square Error of Approximation (RMSEA). Spearman and Kendall's tau-b were used to identify correlations between burnout, depression and other factors. Results:Interrater reliability was acceptable with Kappa of 0.83. Confirmatory factor analysis demonstrated good fit indices (χ 2 /df=197.62/83, CFI=0.97, GFI=0.95, NNFI=0.96, AIC=271.62 and RMSEA=0.06). Burnout had a weak, positive association with the PHQ-9 (r=0.294, df=2, p< 0.001). The screening depression score had a significant, modest positive association with emotional exhaustion (r=0.469, df=4, p<0.001) and cynicism (r=0.411, df=4, p< 0.001), and a weak inverse association with professional efficacy (r=−0.273, df=4, p< 0.001). Conclusions:The Thai version of the MBI-SS had adequate psychometric properties among Thai medical students and can be used to assess burnout among undergraduate medical students in Thailand. Burnout was associated with risk for depression. Further studies on other associated factors contributing to depression are suggested.

Background Mistreatment is a behavior that reflects disrespect for the dignity of others. Mistreatment can be intentional or unintentional, and can interfere with the process of learning and perceived well-being. This study explored the prevalence and characteristics of mistreatment, mistreatment reporting, student-related factors, and consequences among medical students in Thai context. Methods We first developed a Thai version of the Clinical Workplace Learning Negative Acts Questionnaire-Revised (NAQ-R) using a forward-back translation process with quality analysis. The design was a cross-sectional survey study, using the Thai Clinical Workplace Learning NAQ-R, Thai Maslach Burnout Inventory-Student Survey, Thai Patient Health Questionnaire (to assess depression risk), demographic information, mistreatment characteristics, mistreatment reports, related factors, and consequences. Descriptive and correlational analyses using multivariate analysis of variance were conducted. Results In total, 681 medical students (52.4% female, 54.6% in the clinical years) completed the surveys (79.1% response rate). The reliability of the Thai Clinical Workplace Learning NAQ-R was high (Cronbach’s alpha 0.922), with a high degree of agreement (83.9%). Most participants (n = 510, 74.5%) reported that they had experienced mistreatment. The most common type of mistreatment was workplace learning-related bullying (67.7%), and the most common source was attending staff or teachers (31.6%). People who mistreated preclinical medical students were most often senior students or peers (25.9%). People who mistreated clinical students were most commonly attending staff (57.5%). Only 56 students (8.2%) reported these instances of mistreatment to others. Students’ academic year was significantly related to workplace learning-related bullying (r = 0.261, p < 0.001). Depression and burnout risk were significantly associated with person-related bullying (depression: r = 0.20, p < 0.001, burnout: r = 0.20, p = 0.012). Students who experienced person-related bullying were more often the subject of filed unprofessional behavior reports, concerning conflict or arguments with colleagues, being absent from class or work without reasonable cause, and mistreatment of others. Conclusions Mistreatment of medical students was evident in medical school and was related to the risk for depression and burnout, as well as the risk of unprofessional behavior. Trial registration TCTR20230107006(07/01/2023).

Background: Family practice is the key element of a primary care system. A shortage of family physicians is an important issue in Thailand. However, Thai medical students still show low interest in pursuing a career in family medicine. The objective of this research is to study how a curriculum, an extra-curricular activity, and a hidden curriculum in a medical school affect medical students’ attitude toward family medicine as their career choice.Methods: This research is a mixed-method study with a sequential-explanatory design. The quantitative part is an online questionnaire to obtain a distribution of interest in a career of family physician. It was distributed among 181 senior medical students of Ramathibodi medical school; out of which 64 have participated. In the qualitative part, a total of 14 students who met the inclusion criteria were chosen from the questionnaire and from a snowball sampling to participate in an in-depth interview. Thereafter, a content analysis was done to identify themes.Results: Four out of 64 participants showed interest in a career of family physician, but only one participant was strongly interested. As the whole curriculum focuses mostly on specialty contents, only the family medicine department teaches holistic care and students find it difficult to understand. Some students perceive that a psychosocial assessment intrudes too much into a patient’s personal life and is not a physician task. The examination-based curriculum causes them to lack spare time to participate in any extra-curricular activity. The students received both positive and negative comments about family physicians from other specialists. However, this hidden curriculum does not have a direct impact on the student’s decision to choose their career path. Important factors that influence the decision are their personal interests, masteries, family factors, a work-life balance, and a humanized environment. Conclusions: Experiences in medical school have an impact on medical students’ attitudes toward family physician as a career choice. A disease-oriented care model is still dominating Thai medical education. Therefore, the curriculum needs to be reformed to promote the importance of holistic care. This will lead to an increase in the production of Thai family physicians.

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