Roslan, Nurhanis Syazni
(2021)
Development, validation and evaluation of a professional resilience training module for medical interns.
Masters thesis, Universiti Sains Malaysia.
Abstract
Medical internship is a period of structured supervised practical training after
the completion of medical school. Interns face long hours, exponential knowledge
growth, and at the same time saving lives of patients. This overwhelming responsibility
sets the stage for them to develop mental health problems. In the alarming scenario
of mental health problems, research have highlighted the role of resilience in helping
individuals to thrive in adversities. This study aims to develop an evidence-based and
effective training module to promote professional resilience among interns. In the
development phase, the researcher adopted the mixed method triangulation study
design. The researcher conducted a multi-centre cross-sectional study to examine the
prevalence and predictors of burnout, depression, anxiety and stress among medical
interns. The researcher then conducted an in depth interview (IDI) study to explore
the enablers and barriers to resilience development in the internship training. The
Professional Resilience Skills Training (Pro-ReST) module was then designed guided
by the findings from the mixed method study and educational model. The researcher
conducted content validation with experts related to internship training and face
validation with graduated medical students. Based on the refined module, the
researcher conducted a parallel single-blinded placebo controlled randomized
controlled trial (RCT) and diary study (embedded mixed method study) with interns
from two training hospitals over a period of 10 weeks. In Phase 1, the findings
revealed a high prevalence of interns with depression, anxiety, stress and burnout
symptoms. Low level of resilience and maladaptive coping strategies consistently
predicted burnout, depression, anxiety and stress in the internship training. The IDI
findings revealed that resilience development during internship is not only driven by
tenacity, but also hardiness, growth, reflective skills and control. The Pro-ReST
module that was developed based on the DEAL model (Detection, and Evaluation of
stressor, Action and Learning), focused on coping skills, and had an excellent Content
and Face Validity Index. In Phase 3, the RCT revealed a significantly higher resilience
level, planning and lower anxiety, stress symptoms, humour, self-distraction, denial,
restrain, and venting in the intervention arm as compared to the control arm. However,
the module also increased self-blame coping in the intervention group. The diary study
revealed that many participants were more aware of their stressors and able to
evaluate their coping strategies. This study found that the Pro-ReST module is
effective in enhancing resilience among interns. However, interns resilience is not the
total solution to mental health problems, and best works alongside systemic
intervention at the organizational level.
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