PurposeTo investigate the contributions of psychological needs (autonomy, competence, and relatedness) and coping strategies (self-compassion, leisure-time exercise, and achievement goals) to engagement and exhaustion in Canadian medical students. MethodsThis was an observational study. Two hundred undergraduate medical students participated in the study: 60.4% were female, 95.4% were 20–29 years old, and 23.0% were in year 1, 30.0% in year 2, 21.0% in year 3, and 26.0% in year 4. Students completed an online survey with measures of engagement and exhaustion from the Oldenburg Burnout Inventory–student version; autonomy, competence, and relatedness from the Basic Psychological Needs Scale; self-compassion from the Self-Compassion Scale–short form; leisure-time exercise from the Godin Leisure-Time Exercise Questionnaire; and mastery approach, mastery avoidance, performance approach, and performance avoidance goals from the Achievement Goals Instrument. Descriptive and inferential analyses were performed.ResultsThe need for competence was the strongest predictor of student engagement (β= 0.35, P= 0.000) and exhaustion (β= −0.33, P= 0.000). Students who endorsed mastery approach goals (β= 0.21, P= 0.005) and who were more self-compassionate (β= 0.13, P= 0.050) reported greater engagement with their medical studies. Students who were less self-compassionate (β= −0.32, P= 0.000), who exercised less (β= −0.12, P= 0.044), and who endorsed mastery avoidance goals (β= 0.22, P= 0.003) reported greater exhaustion from their studies. Students’ gender (β= 0.18, P= 0.005) and year in medical school (β= −0.18, P= 0.004) were related to engagement, but not to exhaustion. ConclusionSupporting students’ need for competence and raising students’ awareness of self-compassion, leisure-time exercise, and mastery approach goals may help protect students from burnout-related exhaustion and enhance their engagement with their medical school studies.

Residents would benefit from multiple opportunities for feedback from both male and female preceptors throughout their residency training. Faculty development to bring attention to potential gender bias may be useful to ensure equitable teaching and quality feedback for learners.

ObjectivesTo investigate relationships between students’ past level of involvement in physical activity/sport and their motivations for learning (achievement goals) and well-being in medical school. In doing so, we provide evidence to medical programs to inform admission processes and curriculum planning. MethodsA cross-sectional study was conducted. Out of 640 medical students, 267 completed an online questionnaire with measures of: achievement goals, academic burnout, physical activity/sport involvement, and demographics. Data were analyzed using descriptive and inferential statistics (frequency, mean, standard deviation, chi-square test, Cronbach alpha, Spearman correlation). ResultsStudents who had pursued physical activity/sport at higher levels of involvement had lower academic burnout scores and endorsed maladaptive achievement goals to a less degree. Specifically, the level of students’ involvement in physical activity/sport was negatively correlated with academic burnout (r=-0.15, p=0.014) and with achievement goals of performance approach (r=-0.15, p=0.014), performance avoidance (r=-0.21, p=0.001), and mastery avoidance (r=-0.24, p<0.001). ConclusionsPursuit of dedicated personal activities such as sport appears to be associated with the desired quality of motivation and well-being of medical students. A school culture that fosters resilience of newly admitted students through extracurricular activities and raises students’ awareness of maladaptive and adaptive achievement goals is likely to be beneficial in addressing academic burnout and improving the mental health of medical students.

BackgroundAlmost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding. This is particularly important given the benefits of breastfeeding.ObjectivesTo determine if breast reduction surgery impacts breastfeeding success and whether different surgical techniques differentially impact breast feeding success.MethodsDatabases were searched up to September 5, 2017. Studies were included if they reported the number of women successful at breastfeeding or lactation after breast reduction surgery, and if they reported either the total number of women who had children following breast reduction surgery, or the total number of women who attempted to breastfeed following surgery.ResultsOf 1,212 studies, 51 studies met the inclusion criteria; they were located worldwide and had 31 distinct breast reduction techniques. The percentage of breastfeeding success among studies was highly variable. However, when analyzed by the preservation of the column of parenchyma from the nipple areola complex to the chest wall (subareolar parenchyma), a clear pattern emerged. The median breastfeeding success was 4% (interquartile range (IQR) 0–38%) for techniques with no preservation, compared to 75% (IQR 37–100%) for techniques with partial preservation and 100% (IQR 75–100%) for techniques with full preservation.ConclusionsTechniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding. The preservation of the column of subareolar parenchyma should be disclosed to women prior to surgery. Guidelines on the best breast reduction techniques to be used in women of child bearing years may be advantageous to ensure women have the greatest potential for successful breastfeeding after breast reduction surgery.

Self-compassion has shown promise as an adaptive resource for coping with uncertainties and challenges. This study examined the relationship between self-compassion and professional wellbeing (work engagement, exhaustion, and professional life satisfaction) of physicians, who frequently face uncertainties and challenges in their clinical practice. Fifty-seven practicing physicians in Canada participated in the study. Overall, 65% of the participants were female; 47% were in the early-career stage; 49% were family medicine (FM) physicians, with the rest being non-FM specialists. It was hypothesized that (a) self-compassionate physicians would experience greater work engagement and less exhaustion from work than physicians reporting lower self-compassion and (b) self-compassionate physicians would experience greater professional life satisfaction through their greater work engagement and less exhaustion than physicians reporting lower self-compassion. Sequential regression analyses were performed. The results confirmed the hypothesized associations, indicating that self-compassionate physicians experienced more positive work engagement, felt less emotionally, physically, and cognitively exhausted due to work demands, and were more satisfied with their professional life than physicians who exhibited less compassion toward themselves in uncertain and challenging times. Future studies are needed to determine optimal ways to support practicing physicians and medical trainees in becoming more self-compassionate for their enhanced wellbeing and, ultimately, for the provision of effective patient care.

This study investigated the roles of basic psychological needs—autonomy, competence, and relatedness—in physicians’ professional well-being, specifically satisfaction with professional life, work-related engagement, and exhaustion. Using an online survey, quantitative data were collected from 57 practicing physicians. Overall, 65% of the participants were female; 49% were family medicine (FM) physicians, with the rest of the participants practicing in various non-FM specialties (e.g., internal medicine, pediatrics, surgery); and 47% were in the early-career stage (≤10 years in practice). Multivariate regression analyses indicated that of the three psychological needs, the need for relatedness had the largest unique contributions to physicians’ satisfaction with professional life, work-related engagement, and exhaustion, respectively. The unique contributions of the needs for autonomy and competence were relatively small. These findings extend basic psychological needs theory to the work domain of practicing physicians in an attempt to examine underpinnings of physicians’ professional well-being, a critical component of quality patient care.

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Creating learning environments that are supportive of students' need for competence, raising students' awareness of the value of learning from mistakes in competency acquisition, and providing opportunities for students to experience self-efficacy may foster beneficial mastery approach goals in medical students.