Why do undergraduate medical students choose medical humanities? A cross-sectional study at an Italian university

Why do undergraduate medical students choose medical humanities? 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A cross-sectional study at an Italian university Francesca Tusoni, Laura Giusti, Annalisa Iagnemma, Stefano Necozione, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4247752/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Nov, 2024 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Background Medical humanities can contribute positively to clinical practice and medical education. Therefore, in many countries, medical schools have been progressively incorporating medical humanities into their curriculum. In Italy, only a few medical schools offer a variety of medical humanities courses, often as elective. What induces Italian medical students to take a medical humanities course has not yet been explored. The aim of this study is to fill this gap by investigating whether academic performance, sociodemographic and psychological variables may influence student motivation. Methods We conducted a cross-sectional study in a medical school and collected data from 260 medical students, from the 3rd to the 6th years of study course. The students who took a course in Medical Humanities were compared with those who took not, analysing numeric variables (age, grade point average, psychometric scores) and categorical variables (gender, nationality, educational level, living conditions). Motivations were investigated by open-ended questions and categorized prior to analyses. Results The two subgroups showed no significant differences in sociodemographic characteristics, except for age, which was lower for the students who chose to take a medical humanities course (p < 0.001). Psychological scores were worse for the students taking a Medical Humanities course. However, only anxiety differed significantly (p < 0.05). Regarding academic performance, the number of examinations passed was similar between the groups, while the average grade was lower for the students taking the course (p < 0.01). Interest in the humanities and their educational potential were the main reasons for choosing to take a course in medical humanities (76.2%). Concurrent commitments and lack of time were the major obstacles to this choice (39%). Conclusions Age, anxiety levels and expectations of academic performance can play a decisive role in the choice of whether to attend a medical humanities course. Considering the workload due to curricular activities when scheduling elective courses could increase student participation. Medical Humanities Medical Education Visual Thinking Strategies Narrative Medicine Reflective Practice Motivation University Curriculum Figures Figure 1 Background The objective of a university study course is to educate students, adequately preparing them for their future profession. Therefore, it is very important that university education keeps up with changes in the world of work. The evolving landscape of medical practice has raised the need for a holistic, person-centred approach to health care [ 1 ]. Consequently, medical education should adapt to these new needs, providing students not only with medical knowledge but also with specific personal and professional skills. As a result, several medical schools have begun to incorporate the arts and humanities into their curricula [ 2 ]. Medical Humanities (MH) can be defined as an interdisciplinary movement that draws on the methods and intervention strategies of different humanistic disciplines to pursue the objectives of medical education [ 3 ]. The goal of MH is to induce health professions students to think critically about their future job, with the aim of becoming more humane professionals [ 4 ]. MH aims to improve students’ ability to address health, illness, and the daily experience of patients from a historical, social and cultural perspective, enabling them to improve their ability to listen to a patient story and to empathize functionally with the patient experience of suffering. Furthermore, the literature has shown that MH helps students develop personal skills fundamental to their profession, such as empathy, and communication, observation and reasoning skills [ 5 – 10 ]. In addition, stress reduction for medical professionals through an arts-in-medicine program has also been demonstrated [ 11 ]. Currently, it is increasingly important to train future medical professionals to face the difficult challenges of their work to their best. In fact, medical practice can challenge the ideals of future doctors and undermine their mental health. Therefore, it is necessary to cultivate specific skills for students that promote their mental health, strengthen their professionalism and improve their sense of work in future medical practice [ 12 ]. Although the role of humanities in medical education is crucial, it remains debated how to include humanities in the educational programs of medical schools [ 13 ]. In some countries, such as the United States, Canada, and the United Kingdom, many medical schools have included MH as compulsory courses in their curricula [ 14 , 15 ]. In Italy, medical degree programs include only a few mandatory courses in humanistic disciplines, i.e. Bioethics, History of Medicine and Psychology [ 16 ] Other humanities (e.g. Philosophy, Storytelling, Visual Arts) are usually not included as compulsory courses but can be included as elective courses. That is because Italian medical degree programs are defined by the Ministry of University and Research (MUR), at national level. The MUR sets up the core curriculum subjects, while universities have little decisional autonomy. Hence, the growing interest in these disciplines in our country has led to the introduction of elective courses in MH in several medical faculties: Sapienza University of Rome, University of Milan, Alma Mater Studiorum of Bologna, University of L’Aquila, etc. The introduction of MH in medical schools, as well as participation in the courses offered, has led to focus on motivational aspects. Student motivation is relevant for the quality of their learning experience [ 17 ]. Furthermore, student self-determined motivation (acting out of interest, curiosity) is associated with greater academic well-being, persistence, and achievement [ 18 ]. Many theories have been developed in the educational field to describe, explain and predict the direction, initiation, intensity and persistence of learning behaviours. The most cited theories of academic motivation include expectancy-value theory, social cognitive theory, self-determination theory, achievement goal theory and attribution theory [ 19 ]. Hattie et al. grouped various models of motivation by identifying personal, social and cognitive factors [ 20 ]. Fong emphasized the importance of contextualizing motivation, taking into account educational, social, future-oriented and sociocultural dynamics that may impact student motivation, such as in the context of the CoViD-19 pandemic [ 21 , 22 ]. In the present study, we focused on the impact of demographic characteristics, psychological status and school performance on student motivation. Many studies have shown a strong correlation between mental health and academic motivation. Students’ general well-being can influence his or her motivation, ability to concentrate, commitment to learning and social relationships [ 23 , 24 ]. Academic achievement has been shown to bidirectionally influence learners’ motivation [ 25 ]. Thus, prior academic achievement, which is cognitively represented in the self, helps reinforce motivation for new learning tasks. Among other factors, nonmodifiable factors (e.g. age, sex, and ethnicity) seem to affect the motivation of medical students [ 26 ]. Therefore, it is important to investigate what motivates students to take MH courses. To the best of our knowledge, previous studies have explored medical students’ perspectives on MH in other countries, but not in Italy [ 27 , 28 ]. Hence, our aim is twofold: first, to investigate why Italian undergraduate medical students choose to take a course in MH; and, second, to assess whether this choice is associated with demographic characteristics, psychological status, and academic performance. Methods This study reporting conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement [ 29 ]. Context According to the Bologna process, Italy has adopted the European Credit Transfer System (ECTS): under this system, university students obtain a certain number of ECTS credits for each exam they pass. At the end of the study course, they must have achieved 180 credits for a three-year degree (i.e. Bachelor of Science) and 120 credits for a master's degree, while short university courses require a lower number of credits. In Italian medical schools, courses are divided into compulsory and elective: however, even within the scope of elective courses, students are required to achieve a certain number of credits (8 ECTS). It is on the student to choose which courses to take, among several options. At the University of L’Aquila, three elective courses in MH are available for undergraduate medical students: a course on Visual Thinking Strategies (VTS) for 3rd -year students; a course on Narrative Medicine (NM) for 4th -year students and a course on Reflective Practices (RP) for 5th - and 6th -year students. VTS is a method developed by Abigail Housen, a psychologist, and Philip Yenawine, an art educator. This well-known method is widely used to help students develop critical thinking, communication and observation skills [ 30 , 31 ]. It has been successfully used within the context of medical education, also in Italy, where Ferrara et al. recently validated a new instrument to measure its effects [ 32 ]. NM is an approach to care based on narrative competence. The theorist of NM, Dr. Rita Charon, has suggested that narrative competence can be developed through education in literature, reflective writing, storytelling, and poetry [ 33 ]. In Italy, the use of Narrative Medicine was formalized in 2015, with the introduction of national guidelines, developed by the Italian Institute for Health (Istituto Superiore di Sanità) and the National Centre for Rare Diseases (Centro Nazionale Malattie Rare) [ 34 ]. The course on RP is not based on a specific method or approach, although it has been inspired by Schön’s theory on reflective practice [ 35 ]. The objective of this course is to induce students to reflect on problems and issues relating to their future profession, with the help of philosophers and medical professionals. Study design and participants We conducted a cross-sectional survey during the second semester of the academic year 2022–2023, between March 30th and May 10th. Participants included undergraduate medical students from the University of L’Aquila, in the centre of Italy. Students attending the 1st and 2nd years of medical school were excluded, because all the courses in MH that are held at the University of L’Aquila are reserved for students from the 3rd to the 6th years. A total of 260 students were enrolled in the study and written consent was obtained. The study was performed in accordance with the Declaration of Helsinki. The ethical committee of the University of L’Aquila (named Internal Review Board) approved the study protocol. Instruments and related measures All eligible participants were asked to participate in the study and received written explanation of the purpose and methods of the study. Furthermore, all the investigators were available for answering questions and providing details on the research project. Trained investigators administered the questionnaires only to those students who voluntarily gave written consent. The questionnaires were administered in person, by using an online platform, and no personal data were requested. An ad-hoc questionnaire was used to collect information on the demographic characteristics of the participants and to investigate indicators of academic performance. Demographic characteristics included age, gender, educational level, year of study course, home status, health status, being in a relationship, having a part-time job and practising physical activities. To evaluate academic performance, we asked the students to indicate their Grade Point Average (GPA) and whether they had passed all the exams scheduled for the previous course year. The questionnaire also included two items aimed at investigating the reasons that led students to take or not an MH course. The ad-hoc questionnaire is available as supplementary material. The psychological status of the participants was assessed by investigating anxiety symptoms, depressive mood tendencies, and stress. Anxiety symptoms were measured by using the Self-rating Anxiety Scale (SAS). The SAS is a 20-item self-report inventory developed by Zung to quantify somatic expressions of anxiety [ 36 ]. Each item is rated on a Likert scale, from 1 to 4, with five items needing a reverse score. This questionnaire has been widely used with different target populations, including Italian undergraduate medical students [ 37 ]. Depressive mood tendencies were measured by using the Beck Depression Inventory, second edition (BDI-II), which is a 21-item self-report inventory measuring the severity of depression in adolescents and adults [ 38 ]. The score for each item ranges from 0 to 3, with a maximum score of 63. The BDI-II enjoys great diffusion and has already been used in the context of medical schools, both with teachers and students [ 39 , 40 ]. Stress was measured by using the 10-item version of the Perceived Stress Scale (PSS-10), a self-report questionnaire that measures the degree to which individuals appraise situations in their lives as excessively uncontrollable and overloaded [ 41 ]. Each item is rated on a 5-point Likert scale, ranging from 0 to 4. The PSS-10 has already been used with undergraduate medical students [ 42 , 43 ]. Statistical analyses We performed descriptive analyses for all variables. Age, GPA, and SAS, BDI-II and PSS-10 scores are presented as medians and interquartile ranges (IQRs) because of their nonnormal distributions (Shapiro–Wilk test). Categorical variables are described as frequencies and percentages. Data were collected either from students who took an MH course (Taking an MH course, TMC) or from students who did not take such a course (Not taking an MH course, NTMC). To compare the two groups, we used the Wilcoxon Rank-sum test for continuous variables, and the Chi-squared test or Fisher’s exact test for categorical variables. Then, we used a logistic regression model to test whether the choice to take an MH course was associated with the variables that resulted significantly different between the two groups in the univariate analysis. The Variance Inflation Factor (VIF) was checked to exclude multicollinearity among predictors (VIF < 5). The statistical significance level was set at 5% (α = 0.05). We used open questions to explore motivations, categorized the answers into classes and analysed their frequencies. Except for the variable ‘motivation’, there are no missing in the data, because the participants were asked to answer all the questions. To perform all statistical analyses, we used the software R, version 4.3.2. Results Sociodemographic characteristics Four hundred students were asked to participate in the survey, but only 260 completed the questionnaire. However, the sample includes all the students (n=42) who took an MH course in the last academic year. The respondents were mainly female (65,4%) and their median age was 24 years. The majority of respondents were 5th and 6th year students (median age = 25), although most of them did not choose to take an MH course. (Fig. 1) Table 1 summarizes the sociodemographic characteristics of the overall sample and the subgroups. No significant differences were found between the groups, except for age, which was far greater in the NTMC group than in the TMC group (p < 0.001). Table 1 Sociodemographic characteristics of the overall sample and the subgroups Overall sample n (%), median (IQR) NTMC n (%), median (IQR) TMC n (%), median (IQR) NTMC vs TMC p-value n 260 (100) 218 (83.8) 42 (16.2) Age (years) 24(2) 24(2) 23(2) <0.001*** Gender Female 170 (65.4) 146 (67) 24 (57.1) 0.221 a Male 89 (34.2) 71 (32.6) 18 (42.9) Other 1 (0.4) 1 (0.5) - Nationality 1 Italian 256 (98.5) 214 (98.2) 42 (100) Other 4 (1.5) 4 (1.8) - Educational level Undergraduate 244 (93.8) 205 (94) 39 (92.9) 0.729 b Bachelor degree 8 (3.1) 8 (3.7) - Master degree 8 (3.1) 5 (2.3) 3 (7.1) Home status Not far away from home 40 (15.4) 33 (15.1) 7 (16.7) 0.986 c Far away from home 220 (84.6) 185 (84.9) 35 (83.3) Commuter students 11 (4.2) 10 (4.6) 1 (2.4) Found accommodation 209 (80.4) 175 (80.3) 34 (81.0) In a relationship 0.985 Yes 152 (58.5) 128 (58.7) 24 (57.1) No 108 (41.5) 90 (41.3) 18 (42.9) Health status Ever suffered from a major disease 51 (19.6) 45 (20.6) 6 (14.3) 0.461 Still affected 33 (64.7) 31 (68.9) 2 (33.3) 0.313 Still in treatment 26 (51) 24 (53.3) 2 (33.3) 0.386 Type of disease 0.320 chronic 31 (60.8) 29 (64.4) 2 (33.3) acute/subacute 16 (31.4) 13 (28.9) 3 (50) Part-time job 0.559 Yes 24 (9.2) 19 (8.7) 5 (11.9) No 236 (90.8) 199 (91.3) 37 (88.1) Practicing physical activity 0.399 d Never 20 (7.7) 18 (8.3) 2 (4.8) Occasionally 121 (46.5) 103 (47.2) 18 (42.9) Regularly 119 (45.8) 97 (44.5) 22 (52.4) NTMC = Students not taking an MH course, TMC = Students taking an MH course a Female vs other modalities, b Undergraduate vs graduate, c Not far away/Found accommodation vs Commuter students, d Regularly vs other modalities * p < 0.05, ** p < 0.01, *** p < 0.001 Motivations Students who chose to take an MH course reported motivations that we grouped into 6 categories, as shown in Table 2: the majority (40.5%) declared to be interested in humanities, 10 students (23.8%) declared to be curious about MH, and 5 students (11.9%) reported choosing MH to improve their personal and professional skills (i.e. empathy, and communication and relation ability). The other students in the TMC group did not show a real interest in MH, as they reported taking an MH course because they needed credits (11.9%) or just because it was available (2.4%). Only two students (4.8%) reported having received good feedback from other colleagues who had already attended the course in the previous academic year. Table 2 Reasons for taking a course in MH Reasons for TMC n (%) VTS n (%) NM n (%) RP n (%) n 42 12 22 8 Interest 17 (40.5) 3 (25) 8 (36.4) 6 (75) Curiosity 10 (23.8) 3 (25) 7 (31.8) - Need for credits 5 (11.9) 2 (16.7) 2 (9.1) 1 (12.5) Improving skills 5 (11.9) 3 (25) 2 (9.1) - Recommended 2 (4.8) 1 (8.3) 1 (4.5) - Availability 1 (2.4) - - 1 (12.5) Do not answer 2 (4.8) - 2 (9.1) - TMC = Students taking an MH course, VTS = Visual Thinking Strategies Group (3rd year students), NM = Narrative Medicine group (4th year students), RP = Reflective Practice group (5th and 6th year students) Among the students who did not choose to take an MH course, 61 (28%) reported that the reason was they did not need credits; 39% (n=85) of the NTMC group reported they could not attend the course because of concurrent commitments or lack of time (Table 3). Only 5 students (2.3%) declared they were not interested in MH and the same percentage reported having received bad feedback from students who had already taken the course in the previous academic year. Nineteen students did not report any motivation: 2 within the TMC group and 17 within the NTMC group. Table 3 Reasons for not taking a course in MH Reasons against NTMC n (%) VTS n (%) NM n (%) RP n (%) n 218 32 24 162 no need for credits 61 (28) 9 (28.1) 6 (25) 46 (28.4) Lack of time 47 (21.6) 13 (40.6) 9 (37.5) 25 (15.4) Concurrent commitments 38 (17.4) 1 (3.1) 6 (25) 31 (19.1) Not informed 28 (12.8) 5 (15.6) - 23 (14.2) Already attended 8 (3.7) 3 (9.4) - 5 (3.1) Misunderstood the question 6 (2.7) 1 (3.1) - 5 (3.1) Doesn't know 6 (2.7) - - 6 (3.7) Not interested 5 (2.3) - - 5 (3.1) Not recommended 1 (0.5) - - 1 (0.6) Forgot about 1 (0.5) - - 1 (0.6) Do not answer 17 (7.8) - 3 (12.5) 14 (8.6) NTMC = Students not taking an MH course, VTS = Visual Thinking Strategies Group (3rd year students), NM = Narrative Medicine group (4th year students), RP = Reflective Practice group (5th and 6th year students) Psychological status Depression and stress scores (BDI-II and PSS-10) were not significantly different between the groups, while anxiety scores (SAS) were significantly greater in the NTMC group than in the TMC group (p < 0.05). The resulting psychological scores are summarized in Table 4. Table 4 Psychological scores Overall sample median (IQR) NTMC median (IQR) TMC median (IQR) NTMC vs TMC p-value n 260 218 42 Anxiety (SAS) 38 (12) 39 (12.75) 34.5 (9.5) 0.018* Depression (BDI-II) 11 (13) 11.5 (14) 8.5 (10.75) 0.201 Stress (PSS-10) 20 (5.25) 20 (5) 19 (4) 0.149 NTMC = Students not taking an MH course, TMC = Students taking an MH course * p < 0.05, ** p < 0.01, *** p < 0.001 Academic performance We considered two indicators of academic performance: grade point average and having passed all the exams of the previous years (Table 5). Grade point average was significantly greater in the NTMC group, than in the TMC group (p = 0.005). Regarding the other indicator, the percentage of students who had passed all the exams scheduled for the previous years was moderately lower in the TMC group (38.1%) than in the NTMC group (48.2%). However, for this latter indicator there were no significant differences between the groups. Table 5 Indicators of academic performance Overall sample n (%), median (IQR) NTMC n (%), median (IQR) TMC n (%), median (IQR) NTMC vs TMC p-value n 260 218 42 Grade point average 27.23 (1.7) 27.43 (1.50) 27 (2.95) 0.005** Passed all required exams 0.303 Yes 121 (46.5) 105 (48.2) 16 (38.1) No 139 (53.5) 113 (51.8) 26 (61.9) NTMC = Students not taking an MH course, TMC = Students taking an MH course * p < 0.05, ** p < 0.01, *** p < 0.001 Univariate analysis revealed significant differences between the TMC group and the NTMC group in three variables: age, anxiety and GPA. We used these variables as predictors for a logistic regression model, to investigate their association with the choice to take an MH course. The model confirmed that younger age, lower SAS score (anxiety), and lower GPA were significantly associated with the choice of taking an MH course (Table 6). Table 6 Predictors of choosing a MH course OR 95% CI p-value Age (years) 0.72 0.57 - 0.89 0.004** GPA 0.71 0.56 - 0.89 0.004** Anxiety (SAS) 0.95 0.90 - 0.99 0.014* OR = Odds Ratio, CI = Confidence Interval, GPA = Grade Point Average, SAS = Self-rating Anxiety Scale * p < 0.05, ** p < 0.01, *** p < 0.001 Discussion The primary aim of our study was to explore the motivations that lead Italian medical students to take an elective course in medical humanities. As expected, the main reasons were interest (40.5%) or curiosity (23.8%) in the humanistic subjects. Moreover, our research showed that some students believe that MH can help them improve their personal and professional skills, especially empathy, and communication and relational ability. This is consistent with the results of a previous study by Makowska et al., which explored Polish medical students’ expectations of MH courses [ 28 ]. The authors reported that study participants expected MH courses to prepare them to better interact and communicate with patients and colleagues. Furthermore, we compared the TMC group with the NTMC group to investigate differences between these groups. Among the sociodemographic features only age differed significantly: the median age of the NTMC group was greater than that of the TMC group. This can be explained by the different distributions of 5th - and 6th -year students between the groups (Fig. 1 ). In fact, although participation in the survey was greater among students in the last two years (median age = 25), only few of them chose to take an MH course. As the reported reasons suggest, the choice of not taking the course is due in many cases to lack of time and to concurrent commitments (Table 3). These results are consistent with those of a qualitative study performed at three medical schools in Poland by Makowska et al. [ 44 ]. As this study showed, Polish medical students feel their curriculum is overloaded; therefore, they believe that taking an MH course can be time-consuming, with poor time left for subjects that they consider more important. Furthermore, it must be considered that, in Italy, the time reserved for internship increases in the last two years of medical school. Consequently, 5th - and 6th -year students are busier than their colleagues in 1st -4th years, with less time available for taking elective courses. In addition, students in the last years are more likely to have already acquired the number of credits required for elective activities, as reported by 28% of the NTMC group. Note that only 2.3% of the NTMC group reported a lack of interest in humanistic disciplines. Previous studies on students’ mental well-being showed that medical students generally have greater levels of anxiety, stress, and depressive tendencies than their peers [ 39 , 43 , 45 ]. Mental health problems seem to be associated with a greater study load and a consequent reduction in the time available to carry out other activities [ 46 , 47 ]. This may explain why students who chose to take an MH course had lower levels of anxiety, depression, and stress than those who chose not to take it. (Table 4) However, only anxiety was significantly different between the groups. This finding is consistent with those of a recent study showing that motivation is significantly lower in students with a high level of anxiety [ 48 ]. In fact, motivation and anxiety, as personal dispositions, are closely interconnected [ 49 ]. We expected that students with better academic performance would be more likely to choose activities that have been shown to improve their personal and professional skills. It is known that students' motivation is strongly positively correlated with their academic performance. However, contrary to our expectations, we found that the GPA was significantly greater for those students who chose not to take an MH course. This can be explained by the findings of a recent study by Wu et al, showing that extrinsic motivation had no significant association with students’ academic performance [ 50 ]. Note that the percentage of students who had passed all the exams related to previous courses did not differ significantly between groups. (Table 5) The logistic regression model confirmed that age, anxiety, and GPA are negatively associated with the odds of a student choosing an MH course. Another aspect to reflect on is the distribution of students in the TMC group by year of degree course. Consider that Medical Humanities courses at the University of L'Aquila are differentiated by year of degree course: VTS classes are intended for 3rd -year students, NM classes are intended for 4th -year students, and RP classes are intended for 5th - and 6th -year students. More than half of the students who chose to take an MH course were enrolled in the 4th year of medical school. This may indicate that Narrative Medicine is more attractive than other humanistic disciplines or may be due to other factors related to the specific subgroup. Further investigations could better explain these results. It should be noted that RP was first introduced as an elective course last year, so we expect participation in the course to increase in the coming years. Study limitations and future research Our study has some limitations. First, the sample was unbalanced, because the study participants enrolled in the 5th and 6th years of medicine far outnumbered those enrolled in the 3rd and 4th years. Furthermore, the sample is not representative of all Italian medical students, since the study was conducted in only one medical school. These limitations could be addressed in future research, using different sampling methods and involving other medical schools that offer elective courses in medical humanities. Interestingly, we found that having concurrent commitments and lacking time were major barriers to taking an elective course in MH. Further research should explore which activities Italian medical students consider priorities for their training and whether they believe that MH should be included in curricular activities. Furthermore, it would be interesting to understand whether anxiety can somehow influence these beliefs. Conclusions Among the study participants, the choice to take an elective course in medical humanities was mainly dictated by the interest in these disciplines and their educational potential. This choice seems to be associated with lower anxiety levels and poorer academic performance. On the other hand, having concurrent commitments and lacking time represent the major obstacles to take this choice. When planning elective courses in medical humanities, considering the workload due to curricular activities could increase student participation. Future research should focus on the role of anxiety and academic pressure in determining student choices and behaviours. Abbreviations MH Medical Humanities MUR Ministero dell’Università e della Ricerca VTS Visual Thinking Strategies NM Narrative Medicine RP Reflective Practices CNMR Centro Nazionale Malattie Rare GPA Grade Point Average SAS Self-rating Anxiety Scale BDI-II Beck Depression Inventory, second edition PSS-10 Perceived Stress Scale, 10-item version IQRs Interquartile Ranges TMC (Students)Taking a Medical Humanities Course NTMC (Students) Not Taking a Medical Humanities Course VIF Variance Inflation Factor Declarations Ethics approval and consent to participate Ethics approval was obtained from the Internal Review Board of the University of L’Aquila (approval number 19/2023). The study was performed in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants of the study. Consent for publication Not applicable. Availability of data The datasets used for the statistical analysis are available from the corresponding author on reasonable request. Supplementary materials Ad-hoc Questionnaire (Socio-demographic features). Competing interests The authors declare that they have no competing interests. Funding The study received no funding. Authors' contributions All authours conceptualized the research project; F.T., A.I., A.F., V.F., S.R. collected the data; V.C. and F.T. analyzed the data; F.T. and A.I. wrote the original draft ; L.F., S.N., V.C., L.G. reviewed and edited the draft. All authors read and approved the final manuscript. Acknowledgements The authors would like to acknowledge Prof. Rita Roncone, for helping in administering the questionnaires, and Dr. Riccardo Mastrantonio, for the support provided in every step of the study. References Bleakley A. Invoking the Medical Humanities to Develop a #MedicineWeCanTrust. Acad Med. 2019;94(10):1422–1424. 10.1097/ACM.0000000000002870 . PMID: 31299677. Smydra R, May M, Taranikanti V, Mi M. Integration of Arts and Humanities in Medical Education: a Narrative Review. J Cancer Educ. 2022;37(5):1267–74. 10.1007/s13187-021-02058-3 . Epub 2021 Jul 28. PMID: 34319566. Kirklin D. The Centre for Medical Humanities, Royal Free and University College Medical School, London, England. Acad Med. 2003;78(10):1048-53. 10.1097/00001888-200310000-00023 . PMID: 14534108. Shapiro J, Coulehan J, Wear D, Montello M. Medical humanities and their discontents: definitions, critiques, and implications. Acad Med. 2009;84(2):192-8. 10.1097/ACM.0b013e3181938bca . PMID: 19174663. Ferrara V, Shaholli D, Iovino A, Cavallino S, Colizzi MA, Della Rocca C, La Torre G. Visual Thinking Strategies as a Tool for Reducing Burnout and Improving Skills in Healthcare Workers: Results of a Randomized Controlled Study. J Clin Med. 2022;11(24):7501. 10.3390/jcm11247501 . PMID: 36556117; PMCID: PMC9784727. Baker CJ, Shaw MH, Mooney CJ, Daiss SD, Clark SB. The Medical Humanities Effect: a Pilot Study of Pre-Health Professions Students at the University of Rochester. J Med Humanit. 2017;38(4):445–457. 10.1007/s10912-017-9446-4 . PMID: 28589308. Graham J, Benson LM, Swanson J, Potyk D, Daratha K, Roberts K. Medical Humanities Coursework Is Associated with Greater Measured Empathy in Medical Students. Am J Med. 2016;129(12):1334–7. 10.1016/j.amjmed.2016.08.005 . Epub 2016 Aug 24. PMID: 27566497. Krishna Bahadur GC, Arjyal A, Douglas AH, Subedi M, Gongal R. A quantitative evaluation of empathy using JSE-S Tool, before and after a Medical Humanities Module, amongst first-year medical students in Nepal. BMC Med Educ. 2022;22(1):159. 10.1186/s12909-022-03188-y . Erratum in: BMC Med Educ. 2022;22(1):214. PMID: 35260157; PMCID: PMC8903097. Naghshineh S, Hafler JP, Miller AR, Blanco MA, Lipsitz SR, Dubroff RP, Khoshbin S, Katz JT. Formal art observation training improves medical students' visual diagnostic skills. J Gen Intern Med. 2008;23(7):991–7. 10.1007/s11606-008-0667-0 . PMID: 18612730; PMCID: PMC2517949. Zhang X, Pang HF, Duan Z. Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis. BMC Med Educ. 2023;23(1):925. 10.1186/s12909-023-04932-8 . PMID: 38057775; PMCID: PMC10698992. Yang KT, Lin CC, Chang LY. A program to interest medical students in Changhua, Taiwan in the incorporation of visual arts in medicine. Educ Health (Abingdon). 2011;24(3):563. Epub 2011 Dec 7. PMID: 22267351. Cofini V, Perilli E, Moretti A, Bianchini V, Perazzini M, Muselli M, Lanzi S, Tobia L, Fabiani L, Necozione S, E-Learning Satisfaction. Stress, Quality of Life, and Coping: A Cross-Sectional Study in Italian University Students a Year after the COVID-19 Pandemic Began. Int J Environ Res Public Health. 2022;19(13):8214. 10.3390/ijerph19138214 . PMID: 35805872; PMCID: PMC9266753. Wald HS, McFarland J, Markovina I. Medical humanities in medical education and practice. Med Teach. 2019;41(5):492–6. 10.1080/0142159X.2018.1497151 . Epub 2018 Aug 23. PMID: 30134753. Howick J, Zhao L, McKaig B, Rosa A, Campaner R, Oke J, Ho D. Do medical schools teach medical humanities? Review of curricula in the United States, Canada and the United Kingdom. J Eval Clin Pract. 2022;28(1):86–92. 10.1111/jep.13589 . Epub 2021 Jun 8. PMID: 34105226. Hindin DI, Mazzei M, Chandragiri S, DuBose L, Threeton D, Lassa J, Azagury DE. A National Study on Training Innovation in US Medical Education. Cureus. 2023;15(10):e46433. 10.7759/cureus.46433 . PMID: 37927762; PMCID: PMC10622174. Patuzzo S, Ciliberti R, Medical, Humanities. Recognition and reorganization within the Italian University. Acta Biomed. 2018;88(4):512–3. 10.23750/abm.v88i4.6407 . PMID: 29350670; PMCID: PMC6166166. Pintrich PR, De Groot EV. A motivational science perspective on the role of student motivation in learning and teaching contexts. J Educ Psychol. 2003;95(4):667–86. https://doi.org/10.1037/0022-0663.95.4.667 . Bureau JS, Howard JL, Chong JXY, Guay F. Pathways to Student Motivation: A Meta-Analysis of Antecedents of Autonomous and Controlled Motivations. Rev Educ Res. 2022;92(1):46–72. 10.3102/00346543211042426 . Epub 2021 Sep 11. Urhahne D, Wijnia L. Theories of motivation in education: An integrative framework. Educational Psychol Rev. 2023;35(2). https://doi.org/10.1007/s10648-023-09767-9 . Article 45. Hattie J, Hodis FA, Kang SHK. (2020). Theories of motivation: Integration and ways forward. Contemporary Educational Psychology, 61, 101865. https://doi.org/10. 1016/j. cedps ych. 2020. 101865. Fong CJ. (2022). Academic motivation in a pandemic context: A conceptual review of prominent theories and an integrative model. Educational Psychology. Advance online publication. https://doi.org/10.1080/01443 410 . 2022. 20268 91. Giusti L, Mammarella S, Salza A, Del Vecchio S, Ussorio D, Casacchia M, Roncone R. Predictors of academic performance during the covid-19 outbreak: impact of distance education on mental health, social cognition and memory abilities in an Italian university student sample. BMC Psychol. 2021;9(1):142. 10.1186/s40359-021-00649-9 . Bmn K. The Role of Meditation on Mental Health of the Students During Covid-19. Int Res J Ayurveda Yoga. 2022. 10.47223/irjay.2022.5318 . Metakides C, Pielemeier L, Lytras T, Mytilinaios DG, Themistocleous SC, Pieridi C, Tsioutis C, Johnson EO, Ntourakis D, Nikas IP. Burnout and motivation to study medicine among students during the COVID-19 pandemic. Front Med (Lausanne). 2023;10:1214320. 10.3389/fmed.2023.1214320 . Pinquart M, Ebeling M. (2020). Students’ expected and actual academic achievement – A metaanalysis. International Journal of Educational Research, 100, 101524. https://doi.org/10. 1016/j. ijer. 2019. 101524. Kusurkar RA, Ten Cate TJ, Van Asperen M, Croiset G. Motivation as an independent and a dependent variable in medical education: a review of the literature. Med Teach. 2011;33(5):e242–62. Petrou L, Mittelman E, Osibona O, Panahi M, Harvey JM, Patrick YAA, Leedham-Green KE. The role of humanities in the medical curriculum: medical students' perspectives. BMC Med Educ. 2021;21(1):179. 10.1186/s12909-021-02555-5 . PMID: 33761941; PMCID: PMC7992827. Makowska M, Dec-Pietrowska J, Szczepek AJ. Expectations of Polish undergraduate medical students for medical humanities classes: a survey-based pilot study. BMC Med Educ. 2023;23(1):775. 10.1186/s12909-023-04771-7 . PMID: 37853376; PMCID: PMC10585903. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. 10.1016/S0140-6736(07)61602-X . PMID: 18064739. Housen AC. Aesthetic thought, critical thinking and transfer. Arts Learn Res J. 2002;18(1):99–132. Yenawine P. Visual Thinking Strategies: Using Art to Deepen Learning Across School Disciplines. Cambridge, MA: Harvard Education; 2013. Ferrara V, De Santis S, Melchiori FM. Art for improving skills in medical education: the validation of a scale for measuring the Visual Thinking Strategies method. Clin Ter. 2020 May-Jun;171(3):e252-e259. 10.7417/CT.2020.2223 . PMID: 32323715. Charon R, Hermann N, Devlin MJ. Close Reading and Creative Writing in Clinical Education: Teaching Attention, Representation, and Affiliation. Acad Med. 2016;91(3):345–50. 10.1097/ACM.0000000000000827 . PMID: 26200577; PMCID: PMC4721945. Centro Nazionale Malattie Rare, Istituto Superiore di Sanità. (2015) Linee di indirizzo per l’utilizzo della Medicina Narrativa in ambito clinic-assistenziale, per le malattie rare e cronico-degenerative. Retrieved from https://www.iss.it/-/medicina-narrativa-1 . Schön D. The reflective practitioner. San Francisco: Jossey-Bass; 1983. Zung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971 Nov-Dec;12(6):371-9. 10.1016/S0033-3182(71)71479-0 . PMID: 5172928. Villani L, Pastorino R, Molinari E, Anelli F, Ricciardi W, Graffigna G, Boccia S. Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: a web-based cross-sectional survey. Global Health. 2021;17(1):39. 10.1186/s12992-021-00680-w . PMID: 33823897; PMCID: PMC8022300. Beck AT, Steer RA, Brown GK. Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corp; 1996. Bert F, Lo Moro G, Corradi A, Acampora A, Agodi A, Brunelli L, Chironna M, Cocchio S, Cofini V, D'Errico MM, Marzuillo C, Pasquarella C, Pavia M, Restivo V, Gualano MR, Leombruni P, Siliquini R, Collaborating Group. Prevalence of depressive symptoms among Italian medical students: The multicentre cross-sectional PRIMES study. PLoS ONE. 2020;15(4):e0231845. 10.1371/journal.pone.0231845 . PMID: 32302354; PMCID: PMC7164645. Casacchia M, Cifone MG, Giusti L, Fabiani L, Gatto R, Lancia L, Cinque B, Petrucci C, Giannoni M, Ippoliti R, Frattaroli AR, Macchiarelli G, Roncone R. Distance education during COVID 19: an Italian survey on the university teachers' perspectives and their emotional conditions. BMC Med Educ. 2021;21(1):335. 10.1186/s12909-021-02780-y . PMID: 34107926; PMCID: PMC8187887. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. PMID: 6668417. Quintiliani L, Sisto A, Vicinanza F, Curcio G, Tambone V. Resilience and psychological impact on Italian university students during COVID-19 pandemic. Distance learning and health. Psychol Health Med. 2022;27(1):69–80. Epub 2021 Feb 18. PMID: 33602027. Leombruni P, Corradi A, Lo Moro G, Acampora A, Agodi A, Celotto D, Chironna M, Cocchio S, Cofini V, D'Errico MM, Marzuillo C, Pavia M, Restivo V, Veronesi L, Gualano MR, Bert F, Siliquini R, On Behalf Of The Primes Collaborating Group. Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(9):5010. 10.3390/ijerph19095010 . PMID: 35564409; PMCID: PMC9100187. Makowska M, Szczepek AJ, Nowosad I, Weissbrot-Koziarska A, Dec-Pietrowska J. Perception of Medical Humanities among Polish Medical Students: Qualitative Analysis. Int J Environ Res Public Health. 2022;20(1):270. 10.3390/ijerph20010270 . PMID: 36612590; PMCID: PMC9819447. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, Ho RC. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(15):2735. 10.3390/ijerph16152735 . PMID: 31370266; PMCID: PMC6696211. Pukas L, Rabkow N, Keuch L, Ehring E, Fuchs S, Stoevesandt D, Sapalidis A, Pelzer A, Rehnisch C, Watzke S. Prevalence and predictive factors for depressive symptoms among medical students in Germany - a cross-sectional study. GMS J Med Educ. 2022;39(1): Doc13. 10.3205/zma001534 . PMID: 35368844; PMCID: PMC8953191. Damiano RF, de Oliveira IN, Ezequiel ODS, Lucchetti AL, Lucchetti G. The root of the problem: identifying major sources of stress in Brazilian medical students and developing the Medical Student Stress Factor Scale. Braz J Psychiatry. 2021;43(1):35–42. 10.1590/1516-4446-2019-0824 . PMID: 32696807; PMCID: PMC7861167. Majali S. Positive Anxiety and Its Role in Motivation and Achievements among University Students. Int J Instruction. 2020;13:975–86. Su CH. The effects of students' learning anxiety and motivation on the learning achievement in the activity theory based gamified learning environment. EURASIA J Math Sci Technol Educ. 2017;13(5):1229–58. Wu H, Li S, Zheng J, Guo J. Medical students' motivation and academic performance: the mediating roles of self-efficacy and learning engagement. Med Educ Online. 2020;25:1742964. Additional Declarations No competing interests reported. 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A cross-sectional study at an Italian university","fulltext":[{"header":"Background","content":"\u003cp\u003eThe objective of a university study course is to educate students, adequately preparing them for their future profession. Therefore, it is very important that university education keeps up with changes in the world of work. The evolving landscape of medical practice has raised the need for a holistic, person-centred approach to health care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Consequently, medical education should adapt to these new needs, providing students not only with medical knowledge but also with specific personal and professional skills. As a result, several medical schools have begun to incorporate the arts and humanities into their curricula [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMedical Humanities (MH) can be defined as an interdisciplinary movement that draws on the methods and intervention strategies of different humanistic disciplines to pursue the objectives of medical education [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The goal of MH is to induce health professions students to think critically about their future job, with the aim of becoming more humane professionals [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. MH aims to improve students\u0026rsquo; ability to address health, illness, and the daily experience of patients from a historical, social and cultural perspective, enabling them to improve their ability to listen to a patient story and to empathize functionally with the patient experience of suffering. Furthermore, the literature has shown that MH helps students develop personal skills fundamental to their profession, such as empathy, and communication, observation and reasoning skills [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition, stress reduction for medical professionals through an arts-in-medicine program has also been demonstrated [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, it is increasingly important to train future medical professionals to face the difficult challenges of their work to their best. In fact, medical practice can challenge the ideals of future doctors and undermine their mental health. Therefore, it is necessary to cultivate specific skills for students that promote their mental health, strengthen their professionalism and improve their sense of work in future medical practice [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the role of humanities in medical education is crucial, it remains debated how to include humanities in the educational programs of medical schools [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In some countries, such as the United States, Canada, and the United Kingdom, many medical schools have included MH as compulsory courses in their curricula [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In Italy, medical degree programs include only a few mandatory courses in humanistic disciplines, i.e. Bioethics, History of Medicine and Psychology [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Other humanities (e.g. Philosophy, Storytelling, Visual Arts) are usually not included as compulsory courses but can be included as elective courses. That is because Italian medical degree programs are defined by the Ministry of University and Research (MUR), at national level. The MUR sets up the core curriculum subjects, while universities have little decisional autonomy. Hence, the growing interest in these disciplines in our country has led to the introduction of elective courses in MH in several medical faculties: Sapienza University of Rome, University of Milan, Alma Mater Studiorum of Bologna, University of L\u0026rsquo;Aquila, etc.\u003c/p\u003e \u003cp\u003eThe introduction of MH in medical schools, as well as participation in the courses offered, has led to focus on motivational aspects. Student motivation is relevant for the quality of their learning experience [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, student self-determined motivation (acting out of interest, curiosity) is associated with greater academic well-being, persistence, and achievement [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany theories have been developed in the educational field to describe, explain and predict the direction, initiation, intensity and persistence of learning behaviours. The most cited theories of academic motivation include expectancy-value theory, social cognitive theory, self-determination theory, achievement goal theory and attribution theory [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHattie et al. grouped various models of motivation by identifying personal, social and cognitive factors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Fong emphasized the importance of contextualizing motivation, taking into account educational, social, future-oriented and sociocultural dynamics that may impact student motivation, such as in the context of the CoViD-19 pandemic [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In the present study, we focused on the impact of demographic characteristics, psychological status and school performance on student motivation.\u003c/p\u003e \u003cp\u003eMany studies have shown a strong correlation between mental health and academic motivation. Students\u0026rsquo; general well-being can influence his or her motivation, ability to concentrate, commitment to learning and social relationships [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAcademic achievement has been shown to bidirectionally influence learners\u0026rsquo; motivation [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Thus, prior academic achievement, which is cognitively represented in the self, helps reinforce motivation for new learning tasks. Among other factors, nonmodifiable factors (e.g. age, sex, and ethnicity) seem to affect the motivation of medical students [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, it is important to investigate what motivates students to take MH courses. To the best of our knowledge, previous studies have explored medical students\u0026rsquo; perspectives on MH in other countries, but not in Italy [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Hence, our aim is twofold: first, to investigate why Italian undergraduate medical students choose to take a course in MH; and, second, to assess whether this choice is associated with demographic characteristics, psychological status, and academic performance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study reporting conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eContext\u003c/p\u003e \u003cp\u003eAccording to the Bologna process, Italy has adopted the European Credit Transfer System (ECTS): under this system, university students obtain a certain number of ECTS credits for each exam they pass. At the end of the study course, they must have achieved 180 credits for a three-year degree (i.e. Bachelor of Science) and 120 credits for a master's degree, while short university courses require a lower number of credits. In Italian medical schools, courses are divided into compulsory and elective: however, even within the scope of elective courses, students are required to achieve a certain number of credits (8 ECTS). It is on the student to choose which courses to take, among several options.\u003c/p\u003e \u003cp\u003eAt the University of L\u0026rsquo;Aquila, three elective courses in MH are available for undergraduate medical students: a course on Visual Thinking Strategies (VTS) for 3rd -year students; a course on Narrative Medicine (NM) for 4th -year students and a course on Reflective Practices (RP) for 5th - and 6th -year students.\u003c/p\u003e \u003cp\u003eVTS is a method developed by Abigail Housen, a psychologist, and Philip Yenawine, an art educator. This well-known method is widely used to help students develop critical thinking, communication and observation skills [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. It has been successfully used within the context of medical education, also in Italy, where Ferrara et al. recently validated a new instrument to measure its effects [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNM is an approach to care based on narrative competence. The theorist of NM, Dr. Rita Charon, has suggested that narrative competence can be developed through education in literature, reflective writing, storytelling, and poetry [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In Italy, the use of Narrative Medicine was formalized in 2015, with the introduction of national guidelines, developed by the Italian Institute for Health (Istituto Superiore di Sanit\u0026agrave;) and the National Centre for Rare Diseases (Centro Nazionale Malattie Rare) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe course on RP is not based on a specific method or approach, although it has been inspired by Sch\u0026ouml;n\u0026rsquo;s theory on reflective practice [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The objective of this course is to induce students to reflect on problems and issues relating to their future profession, with the help of philosophers and medical professionals.\u003c/p\u003e \u003cp\u003eStudy design and participants\u003c/p\u003e \u003cp\u003eWe conducted a cross-sectional survey during the second semester of the academic year 2022\u0026ndash;2023, between March 30th and May 10th. Participants included undergraduate medical students from the University of L\u0026rsquo;Aquila, in the centre of Italy. Students attending the 1st and 2nd years of medical school were excluded, because all the courses in MH that are held at the University of L\u0026rsquo;Aquila are reserved for students from the 3rd to the 6th years. A total of 260 students were enrolled in the study and written consent was obtained. The study was performed in accordance with the Declaration of Helsinki. The ethical committee of the University of L\u0026rsquo;Aquila (named Internal Review Board) approved the study protocol.\u003c/p\u003e \u003cp\u003eInstruments and related measures\u003c/p\u003e \u003cp\u003eAll eligible participants were asked to participate in the study and received written explanation of the purpose and methods of the study. Furthermore, all the investigators were available for answering questions and providing details on the research project. Trained investigators administered the questionnaires only to those students who voluntarily gave written consent. The questionnaires were administered in person, by using an online platform, and no personal data were requested.\u003c/p\u003e \u003cp\u003eAn ad-hoc questionnaire was used to collect information on the demographic characteristics of the participants and to investigate indicators of academic performance. Demographic characteristics included age, gender, educational level, year of study course, home status, health status, being in a relationship, having a part-time job and practising physical activities. To evaluate academic performance, we asked the students to indicate their Grade Point Average (GPA) and whether they had passed all the exams scheduled for the previous course year. The questionnaire also included two items aimed at investigating the reasons that led students to take or not an MH course. The ad-hoc questionnaire is available as supplementary material.\u003c/p\u003e \u003cp\u003eThe psychological status of the participants was assessed by investigating anxiety symptoms, depressive mood tendencies, and stress. Anxiety symptoms were measured by using the Self-rating Anxiety Scale (SAS). The SAS is a 20-item self-report inventory developed by Zung to quantify somatic expressions of anxiety [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Each item is rated on a Likert scale, from 1 to 4, with five items needing a reverse score. This questionnaire has been widely used with different target populations, including Italian undergraduate medical students [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDepressive mood tendencies were measured by using the Beck Depression Inventory, second edition (BDI-II), which is a 21-item self-report inventory measuring the severity of depression in adolescents and adults [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The score for each item ranges from 0 to 3, with a maximum score of 63. The BDI-II enjoys great diffusion and has already been used in the context of medical schools, both with teachers and students [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStress was measured by using the 10-item version of the Perceived Stress Scale (PSS-10), a self-report questionnaire that measures the degree to which individuals appraise situations in their lives as excessively uncontrollable and overloaded [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Each item is rated on a 5-point Likert scale, ranging from 0 to 4. The PSS-10 has already been used with undergraduate medical students [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStatistical analyses\u003c/p\u003e \u003cp\u003eWe performed descriptive analyses for all variables. Age, GPA, and SAS, BDI-II and PSS-10 scores are presented as medians and interquartile ranges (IQRs) because of their nonnormal distributions (Shapiro\u0026ndash;Wilk test). Categorical variables are described as frequencies and percentages. Data were collected either from students who took an MH course (Taking an MH course, TMC) or from students who did not take such a course (Not taking an MH course, NTMC). To compare the two groups, we used the Wilcoxon Rank-sum test for continuous variables, and the Chi-squared test or Fisher\u0026rsquo;s exact test for categorical variables.\u003c/p\u003e \u003cp\u003eThen, we used a logistic regression model to test whether the choice to take an MH course was associated with the variables that resulted significantly different between the two groups in the univariate analysis. The Variance Inflation Factor (VIF) was checked to exclude multicollinearity among predictors (VIF\u0026thinsp;\u0026lt;\u0026thinsp;5).\u003c/p\u003e \u003cp\u003eThe statistical significance level was set at 5% (α\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eWe used open questions to explore motivations, categorized the answers into classes and analysed their frequencies.\u003c/p\u003e \u003cp\u003eExcept for the variable \u0026lsquo;motivation\u0026rsquo;, there are no missing in the data, because the participants were asked to answer all the questions. To perform all statistical analyses, we used the software R, version 4.3.2.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSociodemographic characteristics\u003c/p\u003e\n\u003cp\u003eFour hundred students were asked to participate in the survey, but only 260 completed the questionnaire. However, the sample includes all the students (n=42) who took an MH course in the last academic year. The respondents were mainly female (65,4%) and their median age was 24 years. The majority of respondents were 5th and 6th year students (median age = 25), although most of them did not choose to take an MH course. (Fig. 1)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 summarizes the sociodemographic characteristics of the overall sample and the subgroups. No significant differences were found between the groups, except for age, which was far greater in the NTMC group than in the TMC group (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Sociodemographic characteristics of the overall sample and the subgroups\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"484\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall sample\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNTMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNTMC vs TMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e260 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e218 (83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e42 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e24(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e24(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e23(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e170 (65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e146 (67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e24 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.221\u003cstrong\u003e\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e89 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e71 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e18 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNationality\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\" rowspan=\"3\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eItalian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e256 (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e214 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e42 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e4 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e4 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e244 (93.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e205 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e39 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.729\u003cstrong\u003e\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e8 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e8 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eMaster degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e8 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e5 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e3 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHome status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003eNot far away from home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e40 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e33 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e7 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\" rowspan=\"4\"\u003e\n \u003cp\u003e0.986\u003csup\u003e\u0026nbsp;c\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eFar away from home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e220 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e185 (84.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e35 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eCommuter students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e11 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e10 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eFound accommodation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e209 (80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e175 (80.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e34 (81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIn a relationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e152 (58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e128 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e24 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e108 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e90 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e18 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003eEver suffered from a major disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e51 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e45 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e6 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\n \u003cp\u003e0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Still affected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e33 (64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e31 (68.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Still in treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\n \u003cp\u003e26 (51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e24 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003eType of disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003echronic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e31 (60.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e29 (64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eacute/subacute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e16 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e13 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e3 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePart-time job\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.559\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e24 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e19 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e5 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e236 (90.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e199 (91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e37 (88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.52577319587629%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePracticing physical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.257731958762887%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.876288659793815%\" rowspan=\"4\"\u003e\n \u003cp\u003e0.399\u003csup\u003e\u0026nbsp;d\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e20 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e18 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e2 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eOccasionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e121 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e103 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e18 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.6078431372549%\"\u003e\n \u003cp\u003eRegularly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.137254901960784%\"\u003e\n \u003cp\u003e119 (45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e97 (44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.627450980392158%\"\u003e\n \u003cp\u003e22 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNTMC = Students not taking an MH course, TMC = Students taking an MH course\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eFemale vs other modalities, \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eUndergraduate vs graduate, \u003csup\u003ec\u0026nbsp;\u003c/sup\u003eNot far away/Found accommodation vs Commuter students, \u003csup\u003ed\u0026nbsp;\u003c/sup\u003eRegularly vs other modalities\u003c/p\u003e\n\u003cp\u003e* p \u0026lt; 0.05, ** p \u0026lt; 0.01, *** p \u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003eMotivations\u003c/p\u003e\n\u003cp\u003eStudents who chose to take an MH course reported motivations that we grouped into 6 categories, as shown in Table 2: the majority (40.5%) declared to be interested in humanities, 10 students (23.8%) declared to be curious about MH, and 5 students (11.9%) reported choosing MH to improve their personal and professional skills (i.e. empathy, and communication and relation ability). The other students in the TMC group did not show a real interest in MH, as they reported taking an MH course because they needed credits (11.9%) or just because it was available (2.4%). Only two students (4.8%) reported having received good feedback from other colleagues who had already attended the course in the previous academic year.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Reasons for taking a course in MH\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReasons for\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTMC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVTS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003eInterest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e17 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e3 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e8 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e6 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003eCuriosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e10 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e3 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e7 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003eNeed for credits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e5 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e2 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003eImproving skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e5 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e3 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003eRecommended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e2 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e1 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003eAvailability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.990990990990994%\"\u003e\n \u003cp\u003eDo not answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44144144144144%\"\u003e\n \u003cp\u003e2 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.837837837837839%\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.864864864864865%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTMC = Students taking an MH course, VTS = Visual Thinking Strategies Group (3rd year students), NM = Narrative Medicine group (4th year students), RP = Reflective Practice group (5th and 6th year students)\u003c/p\u003e\n\u003cp\u003eAmong the students who did not choose to take an MH course, 61 (28%) reported that the reason was they did not need credits; 39% (n=85) of the NTMC group reported they could not attend the course because of concurrent commitments or lack of time (Table 3). Only 5 students (2.3%) declared they were not interested in MH and the same percentage reported having received bad feedback from students who had already taken the course in the previous academic year. Nineteen students did not report any motivation: 2 within the TMC group and 17 within the NTMC group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Reasons for not taking a course in MH\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReasons against\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNTMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVTS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNM\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eno need for credits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e61 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e9 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e6 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e46 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eLack of time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e47 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e13 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e9 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e25 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eConcurrent commitments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e38 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e6 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e31 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eNot informed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e28 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e5 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e23 (14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eAlready attended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e8 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e3 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e5 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eMisunderstood the question\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e6 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e5 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eDoesn\u0026apos;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e6 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e6 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eNot interested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e5 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e5 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eNot recommended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eForgot about\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.99186991869919%\"\u003e\n \u003cp\u003eDo not answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.853658536585366%\"\u003e\n \u003cp\u003e17 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e3 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.447154471544716%\"\u003e\n \u003cp\u003e14 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNTMC = Students not taking an MH course, VTS = Visual Thinking Strategies Group (3rd year students), NM = Narrative Medicine group (4th year students), RP = Reflective Practice group (5th and 6th year students)\u003c/p\u003e\n\u003cp\u003ePsychological status\u003c/p\u003e\n\u003cp\u003eDepression and stress scores (BDI-II and PSS-10) were not significantly different between the groups, while anxiety scores (SAS) were significantly greater in the NTMC group than in the TMC group (p \u0026lt; 0.05). The resulting psychological scores are summarized in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Psychological scores\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"406\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.764127764127764%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall sample\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNTMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNTMC vs TMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.764127764127764%\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.764127764127764%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety (SAS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e38 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\"\u003e\n \u003cp\u003e39 (12.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e34.5 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.764127764127764%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression (BDI-II)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e11 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\"\u003e\n \u003cp\u003e11.5 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e8.5 (10.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.764127764127764%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStress (PSS-10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e20 (5.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.216216216216218%\"\u003e\n \u003cp\u003e20 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e19 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.673218673218674%\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNTMC = Students not taking an MH course, TMC = Students taking an MH course\u003c/p\u003e\n\u003cp\u003e* p \u0026lt; 0.05, ** p \u0026lt; 0.01, *** p \u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003eAcademic performance\u003c/p\u003e\n\u003cp\u003eWe considered two indicators of academic performance: grade point average and having passed all the exams of the previous years (Table 5). Grade point average was significantly greater in the NTMC group, than in the TMC group (p = 0.005).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the other indicator, the percentage of students who had passed all the exams scheduled for the previous years was moderately lower in the TMC group (38.1%) than in the NTMC group (48.2%). However, for this latter indicator there were no significant differences between the groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Indicators of academic performance\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"400\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall sample\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNTMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%), median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNTMC vs TMC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade point average\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e27.23 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e27.43 (1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e27 (2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\"\u003e\n \u003cp\u003e0.005**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePassed all required exams\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.25%\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e121 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e105 (48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e16 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e139 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25%\"\u003e\n \u003cp\u003e113 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e26 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNTMC = Students not taking an MH course, TMC = Students taking an MH course\u003c/p\u003e\n\u003cp\u003e* p \u0026lt; 0.05, ** p \u0026lt; 0.01, *** p \u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003eUnivariate analysis revealed significant differences between the TMC group and the NTMC group in three variables: age, anxiety and GPA. We used these variables as predictors for a logistic regression model, to investigate their association with the choice to take an MH course.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe model confirmed that younger age, lower SAS score (anxiety), and lower GPA were significantly associated with the choice of taking an MH course (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6 Predictors of choosing a MH course\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"335\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.059701492537314%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.686567164179106%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.37313432835821%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.880597014925375%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.059701492537314%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.686567164179106%\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.37313432835821%\"\u003e\n \u003cp\u003e0.57 - 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.880597014925375%\"\u003e\n \u003cp\u003e0.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.059701492537314%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGPA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.686567164179106%\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.37313432835821%\"\u003e\n \u003cp\u003e0.56 - 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.880597014925375%\"\u003e\n \u003cp\u003e0.004**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.059701492537314%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety (SAS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.686567164179106%\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.37313432835821%\"\u003e\n \u003cp\u003e0.90 - 0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.880597014925375%\"\u003e\n \u003cp\u003e0.014*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOR = Odds Ratio, CI = Confidence Interval, GPA = Grade Point Average, SAS = Self-rating Anxiety Scale * p \u0026lt; 0.05, ** p \u0026lt; 0.01, *** p \u0026lt; 0.001\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary aim of our study was to explore the motivations that lead Italian medical students to take an elective course in medical humanities. As expected, the main reasons were interest (40.5%) or curiosity (23.8%) in the humanistic subjects. Moreover, our research showed that some students believe that MH can help them improve their personal and professional skills, especially empathy, and communication and relational ability. This is consistent with the results of a previous study by Makowska et al., which explored Polish medical students\u0026rsquo; expectations of MH courses [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The authors reported that study participants expected MH courses to prepare them to better interact and communicate with patients and colleagues.\u003c/p\u003e \u003cp\u003eFurthermore, we compared the TMC group with the NTMC group to investigate differences between these groups. Among the sociodemographic features only age differed significantly: the median age of the NTMC group was greater than that of the TMC group. This can be explained by the different distributions of 5th - and 6th -year students between the groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In fact, although participation in the survey was greater among students in the last two years (median age\u0026thinsp;=\u0026thinsp;25), only few of them chose to take an MH course. As the reported reasons suggest, the choice of not taking the course is due in many cases to lack of time and to concurrent commitments (Table\u0026nbsp;3). These results are consistent with those of a qualitative study performed at three medical schools in Poland by Makowska et al. [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. As this study showed, Polish medical students feel their curriculum is overloaded; therefore, they believe that taking an MH course can be time-consuming, with poor time left for subjects that they consider more important. Furthermore, it must be considered that, in Italy, the time reserved for internship increases in the last two years of medical school. Consequently, 5th - and 6th -year students are busier than their colleagues in 1st -4th years, with less time available for taking elective courses. In addition, students in the last years are more likely to have already acquired the number of credits required for elective activities, as reported by 28% of the NTMC group. Note that only 2.3% of the NTMC group reported a lack of interest in humanistic disciplines.\u003c/p\u003e \u003cp\u003ePrevious studies on students\u0026rsquo; mental well-being showed that medical students generally have greater levels of anxiety, stress, and depressive tendencies than their peers [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Mental health problems seem to be associated with a greater study load and a consequent reduction in the time available to carry out other activities [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. This may explain why students who chose to take an MH course had lower levels of anxiety, depression, and stress than those who chose not to take it. (Table\u0026nbsp;4) However, only anxiety was significantly different between the groups. This finding is consistent with those of a recent study showing that motivation is significantly lower in students with a high level of anxiety [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In fact, motivation and anxiety, as personal dispositions, are closely interconnected [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe expected that students with better academic performance would be more likely to choose activities that have been shown to improve their personal and professional skills. It is known that students' motivation is strongly positively correlated with their academic performance. However, contrary to our expectations, we found that the GPA was significantly greater for those students who chose not to take an MH course. This can be explained by the findings of a recent study by Wu et al, showing that extrinsic motivation had no significant association with students\u0026rsquo; academic performance [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Note that the percentage of students who had passed all the exams related to previous courses did not differ significantly between groups. (Table\u0026nbsp;5)\u003c/p\u003e \u003cp\u003eThe logistic regression model confirmed that age, anxiety, and GPA are negatively associated with the odds of a student choosing an MH course.\u003c/p\u003e \u003cp\u003eAnother aspect to reflect on is the distribution of students in the TMC group by year of degree course. Consider that Medical Humanities courses at the University of L'Aquila are differentiated by year of degree course: VTS classes are intended for 3rd -year students, NM classes are intended for 4th -year students, and RP classes are intended for 5th - and 6th -year students. More than half of the students who chose to take an MH course were enrolled in the 4th year of medical school. This may indicate that Narrative Medicine is more attractive than other humanistic disciplines or may be due to other factors related to the specific subgroup. Further investigations could better explain these results. It should be noted that RP was first introduced as an elective course last year, so we expect participation in the course to increase in the coming years.\u003c/p\u003e \u003cp\u003eStudy limitations and future research\u003c/p\u003e \u003cp\u003eOur study has some limitations. First, the sample was unbalanced, because the study participants enrolled in the 5th and 6th years of medicine far outnumbered those enrolled in the 3rd and 4th years. Furthermore, the sample is not representative of all Italian medical students, since the study was conducted in only one medical school. These limitations could be addressed in future research, using different sampling methods and involving other medical schools that offer elective courses in medical humanities.\u003c/p\u003e \u003cp\u003eInterestingly, we found that having concurrent commitments and lacking time were major barriers to taking an elective course in MH. Further research should explore which activities Italian medical students consider priorities for their training and whether they believe that MH should be included in curricular activities. Furthermore, it would be interesting to understand whether anxiety can somehow influence these beliefs.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAmong the study participants, the choice to take an elective course in medical humanities was mainly dictated by the interest in these disciplines and their educational potential. This choice seems to be associated with lower anxiety levels and poorer academic performance. On the other hand, having concurrent commitments and lacking time represent the major obstacles to take this choice. When planning elective courses in medical humanities, considering the workload due to curricular activities could increase student participation. Future research should focus on the role of anxiety and academic pressure in determining student choices and behaviours.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMH Medical Humanities\u003c/p\u003e\n\u003cp\u003eMUR Ministero dell\u0026rsquo;Universit\u0026agrave; e della Ricerca\u003c/p\u003e\n\u003cp\u003eVTS Visual Thinking Strategies\u003c/p\u003e\n\u003cp\u003eNM Narrative Medicine\u003c/p\u003e\n\u003cp\u003eRP Reflective Practices\u003c/p\u003e\n\u003cp\u003eCNMR Centro Nazionale Malattie Rare\u003c/p\u003e\n\u003cp\u003eGPA Grade Point Average\u003c/p\u003e\n\u003cp\u003eSAS Self-rating Anxiety Scale\u003c/p\u003e\n\u003cp\u003eBDI-II Beck Depression Inventory, second edition\u003c/p\u003e\n\u003cp\u003ePSS-10 Perceived Stress Scale, 10-item version\u003c/p\u003e\n\u003cp\u003eIQRs Interquartile Ranges\u003c/p\u003e\n\u003cp\u003eTMC (Students)Taking a Medical Humanities Course\u003c/p\u003e\n\u003cp\u003eNTMC (Students) Not Taking a Medical Humanities Course\u003c/p\u003e\n\u003cp\u003eVIF Variance Inflation Factor \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Internal Review Board of the University of L\u0026rsquo;Aquila (approval number 19/2023). The study was performed in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants of the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used for the statistical analysis are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eSupplementary materials\u003c/p\u003e\n\u003cp\u003eAd-hoc Questionnaire (Socio-demographic features).\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe study received no funding.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eAll authours conceptualized the research project; F.T., A.I., A.F., V.F., S.R. collected the data; V.C. and F.T. analyzed the data; F.T. and A.I. wrote the original draft ; L.F., S.N., V.C., L.G. reviewed and edited the draft. \u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge Prof. Rita Roncone, for helping in administering the questionnaires, and Dr. Riccardo Mastrantonio, for the support provided in every step of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBleakley A. Invoking the Medical Humanities to Develop a #MedicineWeCanTrust. Acad Med. 2019;94(10):1422\u0026ndash;1424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ACM.0000000000002870\u003c/span\u003e\u003cspan address=\"10.1097/ACM.0000000000002870\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31299677.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmydra R, May M, Taranikanti V, Mi M. Integration of Arts and Humanities in Medical Education: a Narrative Review. J Cancer Educ. 2022;37(5):1267\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13187-021-02058-3\u003c/span\u003e\u003cspan address=\"10.1007/s13187-021-02058-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2021 Jul 28. PMID: 34319566.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirklin D. The Centre for Medical Humanities, Royal Free and University College Medical School, London, England. Acad Med. 2003;78(10):1048-53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00001888-200310000-00023\u003c/span\u003e\u003cspan address=\"10.1097/00001888-200310000-00023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 14534108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro J, Coulehan J, Wear D, Montello M. Medical humanities and their discontents: definitions, critiques, and implications. Acad Med. 2009;84(2):192-8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ACM.0b013e3181938bca\u003c/span\u003e\u003cspan address=\"10.1097/ACM.0b013e3181938bca\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 19174663.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrara V, Shaholli D, Iovino A, Cavallino S, Colizzi MA, Della Rocca C, La Torre G. Visual Thinking Strategies as a Tool for Reducing Burnout and Improving Skills in Healthcare Workers: Results of a Randomized Controlled Study. J Clin Med. 2022;11(24):7501. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm11247501\u003c/span\u003e\u003cspan address=\"10.3390/jcm11247501\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 36556117; PMCID: PMC9784727.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaker CJ, Shaw MH, Mooney CJ, Daiss SD, Clark SB. The Medical Humanities Effect: a Pilot Study of Pre-Health Professions Students at the University of Rochester. J Med Humanit. 2017;38(4):445\u0026ndash;457. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10912-017-9446-4\u003c/span\u003e\u003cspan address=\"10.1007/s10912-017-9446-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 28589308.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGraham J, Benson LM, Swanson J, Potyk D, Daratha K, Roberts K. Medical Humanities Coursework Is Associated with Greater Measured Empathy in Medical Students. Am J Med. 2016;129(12):1334\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amjmed.2016.08.005\u003c/span\u003e\u003cspan address=\"10.1016/j.amjmed.2016.08.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2016 Aug 24. PMID: 27566497.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrishna Bahadur GC, Arjyal A, Douglas AH, Subedi M, Gongal R. A quantitative evaluation of empathy using JSE-S Tool, before and after a Medical Humanities Module, amongst first-year medical students in Nepal. BMC Med Educ. 2022;22(1):159. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-022-03188-y\u003c/span\u003e\u003cspan address=\"10.1186/s12909-022-03188-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Erratum in: BMC Med Educ. 2022;22(1):214. PMID: 35260157; PMCID: PMC8903097.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaghshineh S, Hafler JP, Miller AR, Blanco MA, Lipsitz SR, Dubroff RP, Khoshbin S, Katz JT. Formal art observation training improves medical students' visual diagnostic skills. J Gen Intern Med. 2008;23(7):991\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11606-008-0667-0\u003c/span\u003e\u003cspan address=\"10.1007/s11606-008-0667-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 18612730; PMCID: PMC2517949.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Pang HF, Duan Z. Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis. BMC Med Educ. 2023;23(1):925. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-023-04932-8\u003c/span\u003e\u003cspan address=\"10.1186/s12909-023-04932-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 38057775; PMCID: PMC10698992.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang KT, Lin CC, Chang LY. A program to interest medical students in Changhua, Taiwan in the incorporation of visual arts in medicine. Educ Health (Abingdon). 2011;24(3):563. Epub 2011 Dec 7. PMID: 22267351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCofini V, Perilli E, Moretti A, Bianchini V, Perazzini M, Muselli M, Lanzi S, Tobia L, Fabiani L, Necozione S, E-Learning Satisfaction. Stress, Quality of Life, and Coping: A Cross-Sectional Study in Italian University Students a Year after the COVID-19 Pandemic Began. Int J Environ Res Public Health. 2022;19(13):8214. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19138214\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19138214\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35805872; PMCID: PMC9266753.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWald HS, McFarland J, Markovina I. Medical humanities in medical education and practice. Med Teach. 2019;41(5):492\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/0142159X.2018.1497151\u003c/span\u003e\u003cspan address=\"10.1080/0142159X.2018.1497151\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2018 Aug 23. PMID: 30134753.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowick J, Zhao L, McKaig B, Rosa A, Campaner R, Oke J, Ho D. Do medical schools teach medical humanities? Review of curricula in the United States, Canada and the United Kingdom. J Eval Clin Pract. 2022;28(1):86\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jep.13589\u003c/span\u003e\u003cspan address=\"10.1111/jep.13589\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2021 Jun 8. PMID: 34105226.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHindin DI, Mazzei M, Chandragiri S, DuBose L, Threeton D, Lassa J, Azagury DE. A National Study on Training Innovation in US Medical Education. Cureus. 2023;15(10):e46433. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.46433\u003c/span\u003e\u003cspan address=\"10.7759/cureus.46433\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37927762; PMCID: PMC10622174.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatuzzo S, Ciliberti R, Medical, Humanities. Recognition and reorganization within the Italian University. Acta Biomed. 2018;88(4):512\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.23750/abm.v88i4.6407\u003c/span\u003e\u003cspan address=\"10.23750/abm.v88i4.6407\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 29350670; PMCID: PMC6166166.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePintrich PR, De Groot EV. A motivational science perspective on the role of student motivation in learning and teaching contexts. J Educ Psychol. 2003;95(4):667\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0022-0663.95.4.667\u003c/span\u003e\u003cspan address=\"10.1037/0022-0663.95.4.667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBureau JS, Howard JL, Chong JXY, Guay F. Pathways to Student Motivation: A Meta-Analysis of Antecedents of Autonomous and Controlled Motivations. Rev Educ Res. 2022;92(1):46\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3102/00346543211042426\u003c/span\u003e\u003cspan address=\"10.3102/00346543211042426\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2021 Sep 11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrhahne D, Wijnia L. Theories of motivation in education: An integrative framework. Educational Psychol Rev. 2023;35(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10648-023-09767-9\u003c/span\u003e\u003cspan address=\"10.1007/s10648-023-09767-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Article 45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHattie J, Hodis FA, Kang SHK. (2020). Theories of motivation: Integration and ways forward. Contemporary Educational Psychology, 61, 101865. https://doi.org/10. 1016/j. cedps ych. 2020. 101865.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFong CJ. (2022). Academic motivation in a pandemic context: A conceptual review of prominent theories and an integrative model. Educational Psychology. Advance online publication. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/01443 410\u003c/span\u003e\u003cspan address=\"10.1080/01443 410\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2022. 20268 91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiusti L, Mammarella S, Salza A, Del Vecchio S, Ussorio D, Casacchia M, Roncone R. Predictors of academic performance during the covid-19 outbreak: impact of distance education on mental health, social cognition and memory abilities in an Italian university student sample. BMC Psychol. 2021;9(1):142. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40359-021-00649-9\u003c/span\u003e\u003cspan address=\"10.1186/s40359-021-00649-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBmn K. The Role of Meditation on Mental Health of the Students During Covid-19. Int Res J Ayurveda Yoga. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.47223/irjay.2022.5318\u003c/span\u003e\u003cspan address=\"10.47223/irjay.2022.5318\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMetakides C, Pielemeier L, Lytras T, Mytilinaios DG, Themistocleous SC, Pieridi C, Tsioutis C, Johnson EO, Ntourakis D, Nikas IP. Burnout and motivation to study medicine among students during the COVID-19 pandemic. Front Med (Lausanne). 2023;10:1214320. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fmed.2023.1214320\u003c/span\u003e\u003cspan address=\"10.3389/fmed.2023.1214320\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinquart M, Ebeling M. (2020). Students\u0026rsquo; expected and actual academic achievement \u0026ndash; A metaanalysis. International Journal of Educational Research, 100, 101524. https://doi.org/10. 1016/j. ijer. 2019. 101524.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKusurkar RA, Ten Cate TJ, Van Asperen M, Croiset G. Motivation as an independent and a dependent variable in medical education: a review of the literature. Med Teach. 2011;33(5):e242\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetrou L, Mittelman E, Osibona O, Panahi M, Harvey JM, Patrick YAA, Leedham-Green KE. The role of humanities in the medical curriculum: medical students' perspectives. BMC Med Educ. 2021;21(1):179. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-021-02555-5\u003c/span\u003e\u003cspan address=\"10.1186/s12909-021-02555-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 33761941; PMCID: PMC7992827.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakowska M, Dec-Pietrowska J, Szczepek AJ. Expectations of Polish undergraduate medical students for medical humanities classes: a survey-based pilot study. BMC Med Educ. 2023;23(1):775. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-023-04771-7\u003c/span\u003e\u003cspan address=\"10.1186/s12909-023-04771-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37853376; PMCID: PMC10585903.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(07)61602-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(07)61602-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 18064739.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHousen AC. Aesthetic thought, critical thinking and transfer. Arts Learn Res J. 2002;18(1):99\u0026ndash;132.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYenawine P. Visual Thinking Strategies: Using Art to Deepen Learning Across School Disciplines. Cambridge, MA: Harvard Education; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrara V, De Santis S, Melchiori FM. Art for improving skills in medical education: the validation of a scale for measuring the Visual Thinking Strategies method. Clin Ter. 2020 May-Jun;171(3):e252-e259. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7417/CT.2020.2223\u003c/span\u003e\u003cspan address=\"10.7417/CT.2020.2223\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 32323715.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharon R, Hermann N, Devlin MJ. Close Reading and Creative Writing in Clinical Education: Teaching Attention, Representation, and Affiliation. Acad Med. 2016;91(3):345\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ACM.0000000000000827\u003c/span\u003e\u003cspan address=\"10.1097/ACM.0000000000000827\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 26200577; PMCID: PMC4721945.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCentro Nazionale Malattie Rare, Istituto Superiore di Sanit\u0026agrave;. (2015) Linee di indirizzo per l\u0026rsquo;utilizzo della Medicina Narrativa in ambito clinic-assistenziale, per le malattie rare e cronico-degenerative. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.iss.it/-/medicina-narrativa-1\u003c/span\u003e\u003cspan address=\"https://www.iss.it/-/medicina-narrativa-1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSch\u0026ouml;n D. The reflective practitioner. San Francisco: Jossey-Bass; 1983.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971 Nov-Dec;12(6):371-9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0033-3182(71)71479-0\u003c/span\u003e\u003cspan address=\"10.1016/S0033-3182(71)71479-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 5172928.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVillani L, Pastorino R, Molinari E, Anelli F, Ricciardi W, Graffigna G, Boccia S. Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: a web-based cross-sectional survey. Global Health. 2021;17(1):39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12992-021-00680-w\u003c/span\u003e\u003cspan address=\"10.1186/s12992-021-00680-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 33823897; PMCID: PMC8022300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck AT, Steer RA, Brown GK. Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corp; 1996.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBert F, Lo Moro G, Corradi A, Acampora A, Agodi A, Brunelli L, Chironna M, Cocchio S, Cofini V, D'Errico MM, Marzuillo C, Pasquarella C, Pavia M, Restivo V, Gualano MR, Leombruni P, Siliquini R, Collaborating Group. Prevalence of depressive symptoms among Italian medical students: The multicentre cross-sectional PRIMES study. PLoS ONE. 2020;15(4):e0231845. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0231845\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0231845\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 32302354; PMCID: PMC7164645.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCasacchia M, Cifone MG, Giusti L, Fabiani L, Gatto R, Lancia L, Cinque B, Petrucci C, Giannoni M, Ippoliti R, Frattaroli AR, Macchiarelli G, Roncone R. Distance education during COVID 19: an Italian survey on the university teachers' perspectives and their emotional conditions. BMC Med Educ. 2021;21(1):335. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-021-02780-y\u003c/span\u003e\u003cspan address=\"10.1186/s12909-021-02780-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 34107926; PMCID: PMC8187887.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385\u0026ndash;96. PMID: 6668417.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuintiliani L, Sisto A, Vicinanza F, Curcio G, Tambone V. Resilience and psychological impact on Italian university students during COVID-19 pandemic. Distance learning and health. Psychol Health Med. 2022;27(1):69\u0026ndash;80. Epub 2021 Feb 18. PMID: 33602027.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeombruni P, Corradi A, Lo Moro G, Acampora A, Agodi A, Celotto D, Chironna M, Cocchio S, Cofini V, D'Errico MM, Marzuillo C, Pavia M, Restivo V, Veronesi L, Gualano MR, Bert F, Siliquini R, On Behalf Of The Primes Collaborating Group. Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(9):5010. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19095010\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19095010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35564409; PMCID: PMC9100187.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakowska M, Szczepek AJ, Nowosad I, Weissbrot-Koziarska A, Dec-Pietrowska J. Perception of Medical Humanities among Polish Medical Students: Qualitative Analysis. Int J Environ Res Public Health. 2022;20(1):270. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph20010270\u003c/span\u003e\u003cspan address=\"10.3390/ijerph20010270\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 36612590; PMCID: PMC9819447.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, Ho RC. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(15):2735. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph16152735\u003c/span\u003e\u003cspan address=\"10.3390/ijerph16152735\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31370266; PMCID: PMC6696211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePukas L, Rabkow N, Keuch L, Ehring E, Fuchs S, Stoevesandt D, Sapalidis A, Pelzer A, Rehnisch C, Watzke S. Prevalence and predictive factors for depressive symptoms among medical students in Germany - a cross-sectional study. GMS J Med Educ. 2022;39(1): Doc13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3205/zma001534\u003c/span\u003e\u003cspan address=\"10.3205/zma001534\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35368844; PMCID: PMC8953191.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDamiano RF, de Oliveira IN, Ezequiel ODS, Lucchetti AL, Lucchetti G. The root of the problem: identifying major sources of stress in Brazilian medical students and developing the Medical Student Stress Factor Scale. Braz J Psychiatry. 2021;43(1):35\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/1516-4446-2019-0824\u003c/span\u003e\u003cspan address=\"10.1590/1516-4446-2019-0824\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 32696807; PMCID: PMC7861167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajali S. Positive Anxiety and Its Role in Motivation and Achievements among University Students. Int J Instruction. 2020;13:975\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu CH. The effects of students' learning anxiety and motivation on the learning achievement in the activity theory based gamified learning environment. EURASIA J Math Sci Technol Educ. 2017;13(5):1229\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu H, Li S, Zheng J, Guo J. Medical students' motivation and academic performance: the mediating roles of self-efficacy and learning engagement. Med Educ Online. 2020;25:1742964.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical Humanities, Medical Education, Visual Thinking Strategies, Narrative Medicine, Reflective Practice, Motivation, University Curriculum","lastPublishedDoi":"10.21203/rs.3.rs-4247752/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4247752/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedical humanities can contribute positively to clinical practice and medical education. Therefore, in many countries, medical schools have been progressively incorporating medical humanities into their curriculum. In Italy, only a few medical schools offer a variety of medical humanities courses, often as elective. What induces Italian medical students to take a medical humanities course has not yet been explored. The aim of this study is to fill this gap by investigating whether academic performance, sociodemographic and psychological variables may influence student motivation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study in a medical school and collected data from 260 medical students, from the 3rd to the 6th years of study course. The students who took a course in Medical Humanities were compared with those who took not, analysing numeric variables (age, grade point average, psychometric scores) and categorical variables (gender, nationality, educational level, living conditions). Motivations were investigated by open-ended questions and categorized prior to analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe two subgroups showed no significant differences in sociodemographic characteristics, except for age, which was lower for the students who chose to take a medical humanities course (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Psychological scores were worse for the students taking a Medical Humanities course. However, only anxiety differed significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Regarding academic performance, the number of examinations passed was similar between the groups, while the average grade was lower for the students taking the course (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Interest in the humanities and their educational potential were the main reasons for choosing to take a course in medical humanities (76.2%). Concurrent commitments and lack of time were the major obstacles to this choice (39%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAge, anxiety levels and expectations of academic performance can play a decisive role in the choice of whether to attend a medical humanities course. Considering the workload due to curricular activities when scheduling elective courses could increase student participation.\u003c/p\u003e","manuscriptTitle":"Why do undergraduate medical students choose medical humanities? A cross-sectional study at an Italian university","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-29 07:06:06","doi":"10.21203/rs.3.rs-4247752/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-22T10:38:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-03T05:28:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145028744769931506700282930559048498669","date":"2024-07-24T19:31:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-05T16:37:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177770300165918254594113753381253588677","date":"2024-06-12T19:42:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-11T12:03:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-11T11:55:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-17T09:30:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-17T09:29:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-04-10T13:52:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6e48d3f4-7165-4280-b420-9a9f587993f3","owner":[],"postedDate":"May 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-18T19:15:41+00:00","versionOfRecord":{"articleIdentity":"rs-4247752","link":"https://doi.org/10.1186/s12909-024-06293-2","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-11-13 15:57:51","publishedOnDateReadable":"November 13th, 2024"},"versionCreatedAt":"2024-05-29 07:06:06","video":"","vorDoi":"10.1186/s12909-024-06293-2","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06293-2","workflowStages":[]},"version":"v1","identity":"rs-4247752","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4247752","identity":"rs-4247752","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}