Objective. The aim of the present study was to identify the differences that may exist in professional satisfaction and skills (clinical patient management and psychosocial skills) in students and graduates from two traditional medical schools and their counterparts from a problem-based medical school in the Netherlands. Also their satisfaction for their training was investigated. Method. Questionnaires were designed containing items reflecting the earlier mentioned differences between the students. Following an initial pilot study, the questionnaire used in this study was constructed accordingly. Sample. The questionnaires were sent to 180 near and recent graduates of these three schools. Results. A total of 127 questionnaires were returned (response rate of 70.5%). The students of the PBL curriculum felt better prepared in psychosocial and interpersonal skills. They felt more satisfied with their training, but were less enthusiastic with the profession. The results also suggest that in their own opinion students and graduates from the three schools do not differ in clinical patient management skills acquired in medical school. Conclusion. A limitation of this study lies in the fact that results are based on actual self-assessment of the students. One must be aware that self-assessment does not always provide for objective information. However, since this limitation applied equally to respondents of all three medical schools, the differences between the schools can be considered indicative of the effects resulting from the different curricula.

Objective: Adherence to guidelines is often low, as multiple barriers exist for guideline implementation. To tackle the implementation problem, awareness of the existence of guidelines is necessary for the health care process and setting as a whole. Purpose: Despite the importance of guidelines adherence, problems have been reported from hospitals in achieving this. This study gives insight into how boards of directors of general and specialist hospitals arrange the responsibilities for guideline adherence within their organisation, how they deal with guidelines for medical specialists and what opportunities exist for improvement. Methods: A survey was sent to 116 Dutch hospitals in 2015. Thirty-nine responses were included in the study for further analysis (net response rate of 36%). All data other than the open questions were analysed in SPSS using descriptives to answer the research question. Results: The findings demonstrated that the distribution of responsibility concerning guideline implementation is problematic. The boards of directors used a variety of information sources to keep informed about the status of implementation of the guidelines for medical specialists, mostly through medical specialists' peer reviews (visits) and internal audits. The study revealed several opportunities for improvements, for example, that a national database is necessary with all up-to-date guidelines, whereby changes and news are distributed directly to hospitals and other stakeholders. Conclusions: This paper offers recommendations for a thoughtful shift in distribution of responsibility, as in a more desired situation the ultimate responsibility of the board of directors would decrease and the responsibility of the medical specialists would increase.

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.

SummaryThe following report describes a previously healthy 2-year-old girl with herpes zoster ophthalmicus (HZO). The child presented with a painless vesicular skin eruption covering the left forehead. There was only a history of household exposure to varicella zoster virus (VZV) and the child had not been vaccinated against VZV. PCR assays on vesicular fluid identified VZV DNA. Treatment with acyclovir was started early in the clinical course. In addition, the girl was treated with locally administered ophthalmological acyclovir ointment. Besides some dermal excoriations, a complete resolution of the HZO was achieved without sequelae. BACKGROUND

Background Burnout is a psychological condition induced by work-related chronic interpersonal stressors. Interventions creating a sense of belonging and collegiality have been proposed as approaches for alleviating burnout. The current study aimed to: (1) explore the relationships between burnout, sense of belonging (relatedness with others), and work engagement; and (2) identify the key elements perceived by undergraduate medical students as positively contributing to collegiality, engagement, and a sense of belonging, in an undergraduate medical training setting. Methods An exploratory sequential mixed-methods design using questionnaires and semi-structured individual interviews collected quantitative and qualitative data among undergraduate medical students at Mahidol University, Thailand. The Maslach Burnout Inventory-Student Survey questionnaire was used to measure burnout. The Basic Psychological Need Satisfaction at Work Scale (BPNSS-21) and the Utrecht Work Engagement Scale-Student Version (UWESS-9) measured students’ basic psychological needs satisfaction at work and work engagement, respectively. Descriptive statistical analysis and confirmatory factor analysis were performed on BPNSS-21 and UWESS-9 data. Spearman’s correlation coefficient was used to identify the correlation between burnout and other factors. Twenty undergraduate medical students participated in the qualitative study. Qualitative analysis was conducted iteratively using constant comparison and the standard principles of primary, secondary, and tertiary coding for thematic analysis. Results Thai versions of the BPNSS-21 and UWESS-9 showed an acceptable fit for the Thai cultural context. Burnout had significant weak inverse associations with engagement (r = − 0.39, p < 0.005) and basic psychological needs satisfaction (r = − 0.37, p < 0.005). Sense of belonging had a significant weak inverse relationship with burnout (r = − 0.25, p < 0.005). The main themes emerging from qualitative analysis were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills. Conclusions Sense of belonging, engagement, and collegiality were related to burnout. The key features for promoting collegiality, the sense of belonging, and engagement were relevant tasks and learning activities, safety in the learning environment, peer interaction, program design factors, dynamics of collegiality while progressing through medical school, and personal stance and social skills.