DIGITAL WELLBEINGIN MEDICAL STUDENTSSTEVE GALLAGHER, ANDREW GRAY AND DAVID PEREZDUNEDIN SCHOOL OF MEDICINE

UNIVERSITY OF OTAGO, NEW ZEALAND

@STEVEGALLAGHERSTEVE.GALLAGHER@OTAGO.AC.NZ

WHAT IS DIGITAL WELLBEING?Impact of digital omnipresence on life and learning

Beetham (2015)a - JISC Building Digital Capabilities Challenge:

“…learners' fears range from exposure, to loss of face-to-face contact with teaching staff, as well as issues of distraction and concentration.”

Reinecke et al (2016)b - Digital Stress over the Lifespan“…stress reactions elicited by environmental demands of ICT use...as a function of communication load... and Internet multitasking.” (abridged, p 3)

a https://www.jisc.ac.uk/blog/thriving-in-a-connected-age-digital-capability-and-digital-wellbeing-25-jun-2015b Reinecke, L. et al (2016). Digital stress over the life span: The effects of communication load and internet multitasking on perceived stress and psychological health impairments in a German probability sample. Media Psychology, 1-26.

DIGITAL MEANS “ALL THE THINGS”

MEDICAL STUDENT WELLBEING AT OTAGOLongitudinal survey of medical student wellbeing at Otago Medical SchoolInitiated by David Perez in 2012Followed cohort from 2nd – 5th year- Maslach Burnout Inventory (MBI)- Patient Health Questionnaire – 9 (PHQ-9)- RAND-36 Shortform Health Survey- Bespoke questions on curriculum and teaching

environment, and personal factors relating to wellbeing – “Student Wellbeing”

- What’s changed since 2012?

WHAT’S CHANGED SINCE 2012? EVERYTHING

YikYak – launched 2013, prominent in NZ by 2015

Snapchat – launched in 2012, prominent in NZ by 2014

Not to mention and dozens of messaging apps

POSITIVES AND NEGATIVES

The Guardian, May 2016a

a https://www.theguardian.com/lifeandstyle/2016/may/19/tumblr-mental-health-information-community-disorders-healthcare

The Guardian, Sept 2015b

b https://www.theguardian.com/commentisfree/2015/sep/16/social-media-mental-health-teenagers-government-pshe-lessons

BACK TO OUR STUDENTSData from two timepoints:• 2012 (T2 – 60% RR) and 2015 (T5 67% RR).Maslach Burnout Inventory Subscales• Emotional Exhaustion (EE), De-personalisation (DP), Personal

Accomplishment (PA)

EE T1 EE T2 DP T2 DP T5 PA T2 PA T5Overall 21.1

(8.3)25.3(9.8)

3.9(4.2)

7.3(5.1)

24.2(10.5)

32.0(7.02)

Mean Scores and Standard Deviations

Moderate changes in Emotional Exhaustion, De-personalisation, and Personal Accomplishment

PHQ-9PHQ-9 – Patient Health Questionnaire- Primarily a screening instrument for depression- Range = 0-27

T2 T5Overall 5.4 (4.0)

Mild depression6.08 (4.5)Mild depression

No difference

RAND-36Shortform 36 item Health SurveyDeveloped in Medical Outcomes Study.8 subscales, two reported here:• Physical Role Functioning (PR)• Mental Health (MH)

Reasonably stable, a suggestion of decreasing scores in Mental Health over time.

PR T2 PR T5 MH T2 MH T5Male 79.2 (35.1) 82.4 (31.2) 70.3 (17.8) 64.9 (21.5)Female 67.2 (36.9) 72.1 (36.1) 69.0 (14.5) 62.6 (17.6)

ASKING ABOUT WELLBEINGStudent Wellbeing Questions targeted two broad areas:1 – Curriculum and Teaching (e.g., I generally cope well with course workload, I find it difficult to cope with the assessment programme)2 – Personal Issues (e.g., I have sufficient time for outside interests, I have problematic personal or social issues outside of medicine)

23 items total, answered on a 5-pt Likert-type scaleStrongly Disagree

Disagree Undecided Agree Strongly Agree

0 1 2 3 4

DIGITAL WELLBEINGAt T5, introduced 5 additional items targeting digital wellbeing

The following questions relate to your digital and online activity, which includes using the web and online services for social networking, education, information gathering, and entertainment. Think about your use of specific sites, apps, and devices (e.g., tablets, phones), and discriminate between the use of digital technology for your study vs other uses.= BROAD DEFINITION OF DIGITAL, NOT JUST LEARNING

50.8% Agree or Strongly Agree

18.72% Agree or Strongly Agree

49.2% Agree or Strongly Agree

60.97% Disagree or Strongly Disagree

5.88% Agree or Strongly Agree

MEASURING DIGITAL WELLBEING• The five items, when summed show moderate internal

consistency (α= 0.52)• Sufficiently consistent to look at relationships between

scores on these items and other measures

EE PA DP PHQ RP MH SWDW 0.27 -.219 0.166 0.279 -0.145 -0.213 0.116

(p) 0.00 0.003 0.24 0.00 0.048 0.003 0.115

Digital wellbeing items correlated with all measures except other student wellbeing questions (marginal correlation with RAND-36 Role Physical Subscale)

IS THERE A PROBLEM?When more than 50% of your students are describing the amount of online learning material as overwhelming….

… I think we might have a problem.

WHAT CAN WE DO?1. Build capability in our students• E.g., JISC’s Digital Capability Model

https://www.jisc.ac.uk/guides/developing-digital-literacies

WHAT ELSE CAN WE DO?2. Digital Learning Design• Build staff capability to contextualise digital learning• Move staff from “read the thing” to “do the thing with the

thing” – promote active learning

http://emilysdiaryofficial.tumblr.com/

MORE?3. Increase student participation in shaping their digital learning environment• Course feedback is great, but it’s not enough,

especially if you don’t act on it• Engage students in solving problems in learning

environment• Students who are engaged in co-design report greater

cohesion, more motivation, engagement, confidence and autonomy. Staff find it “nerve wracking”! (Bovill, 2014)a

• Curriculum hack? Ideas welcome!

a Bovill, C. (2014). An investigation of co-created curricula within higher education in the UK, Ireland and the USA. Innovations in Education and Teaching International, 51(1), 15-25.

THANKSDavid Perez for having the foresight to begin the studyAndrew Gray for incredibly helpful biostatistics supportOur students!

And you all, for listening.