Background: Medical students have been found to experience considerable stress due to their academic studies. The high demands associated with academic studies may interfere with demands in other domains of life. Conversely, demands in those other domains of life may conflict with academic studies. Objective: We aimed to better understand the potential inter-relationships between the demands related to academic studies and in other domains of life. Design: A total of 68 medical students from a medical school in Germany participate in eight focus groups. Sessions were structured by a topic guide and were recorded, transcribed and content-analyzed. Results: Embarking on one’s medical studies was perceived to be associated with important personal challenges, such as living alone for the first time and finding a new social role in one’s peer group. Permanent stress was perceived to result in emotional exhaustion, which spilled over in other domains of life. Students reported to feel guilty if they did not spend their limited spare time on learning. Consequently, they felt to have little time for leisure time activities and a healthy lifestyle. Feelings of social isolation, especially during exam phases, were reported. Leisure activities were perceived to facilitate recovery from academic stress. Social ties were subjectively able to reduce stress, but also to increase stress due to demands. Side jobs were perceived to increase stress and to be time-consuming and were thus perceived to result in poorer academic performance. Certain personality characteristics seemed to amplify those perceptions. For instance, high levels of conscientiousness were felt to relate to higher expectations regarding one’s academic performance and thus increased stress. Conclusion: The demands associated with medical studies, the demands in private life, lacking resources for recovery and certain personal traits as well as interactions between those domains can contribute to stress among medical students and reduce well-being.

Prior evidence suggests that medical students’ mental health is poor and deteriorates during the course of academic studies. This qualitative study therefore aims to improve our understanding of medical students’ perceptions of i) stressors related to their academic studies, ii) resources that may facilitate coping with those stressors and iii) suggestions to potentially reduce stress. Eight focus groups were conducted with medical students enrolled at a medical school in Germany until thematic saturation was reached. A topic guide was used to facilitate the discussion. Subsequently, focus group discussions were transcribed and content-analyzed using MaxQDA. Organizational factors especially related to inadequate information flow as well as exams (e.g. repeat exams, scheduling, perceived unfair grading), poor theoretical and practical teaching quality, time and performance pressure, social interactions and individual characteristics (e.g. self-expectations, fear of failure) emerged as major contributors to stress. Resources perceived to facilitate coping with those stressors pertained to some other organizational aspects (e.g. flexibility, availability of contact persons), career prospects, practical training, social support, personal characteristics (e.g. knowledge base, past experience) and leisure time. Suggestions for improvement related primarily to organizational measures rather than individual-level measures. Besides well-known stressors (e.g. exams and high performance pressure), some new aspects emerged from our study including stress related to organizational factors and repeat exams. Accordingly, students’ wishes for organizational-level interventions, including better information systems and better interweaving of practical and theoretical education, could be first target areas for improvement.

There is wide international variation regarding food allergy knowledge among restaurant staff. Further, attitudes towards food allergy remain under-researched. Insights into the independent determinants of knowledge and attitudes are limited due to lacking mutual statistical adjustment for determinants/confounders in the vast majority of prior studies. In this study we aimed to contribute novel data on the food allergy knowledge and attitudes among restaurant staff in Germany whilst also examining potential determinants of both outcomes using multivariable approaches. We collected data face-to-face from 295 staff members in restaurants in Düsseldorf, Germany. Knowledge was assessed by asking participants to name three common food allergens and to answer five true/false-statements. Seven items assessed attitudes. A total of 16 potential determinants were examined using logistic regression models with backward selection. Only 30% (n = 89) of the respondents correctly named three food allergens and 41% (n = 120) attained a perfect score on the true/false statements. The vast majority expressed positive attitudes toward the need for cooperation and shared responsibilities for food-allergic customers. However, the expressed attitudes towards serving customers with food allergies and validity of customer-reported food allergies were unfavorable. Determinants of food allergy knowledge (e.g. the type of restaurant, professional roles, or levels of school education) and of unfavorable attitudes (e.g. gender) were identified. Food allergy knowledge was suboptimal among restaurant staff and attitudes towards customers were rather poor. While we identified some determinants, additional studies are needed to systematically examine potential determinants for targetting educational interventions in the future.

Work stress may impair physicians’ ability to provide high quality patient care. Prior research remains however sparse and has insufficiently explored explanations for this relationship. It has been suggested that physicians’ poor mental health is one potential explanatory factor. We drew on a well-established model to measure work stress (the effort-reward imbalance [ERI] model) in order to test this hypothesis. Further, to address another research gap and to potentially inform the development of better-targeted interventions, we aimed to examine associations of individual ERI constructs with the quality of care. We used cross-sectional data, which had been collected in 2014 among 416 physicians in Germany. ERI constructs (i.e. effort, reward, the ERI ratio, and overcommitment) were measured by the established 23-item questionnaire. Physicians’ perceptions of quality of care were assessed by a six-item instrument inquiring after poor care practices or attitudes. Physicians’ mental health was operationalized by the state scale of the Spielberger's State-Trait Depression Scales. We used both continuous and categorized dependent and independent variables in multivariable linear and logistic regression analyses. Both an increasing ERI ratio and increasing effort were associated with poorer quality of care while increasing rewards were related to better care. Physicians’ depressive symptoms did not affect these associations substantially. Associations with overcommitment were weak and attenuated to non-significant levels by correction for depressive symptoms. The level of overcommitment did not modify associations between the ERI ratio and quality of care. Our study suggests that high work-related efforts and low rewards are associated with reports of poorer patient care among physicians, irrespectively of physicians’ depressive symptoms. Quality of patient care may thus be improved by concurrently reducing effort and increasing rewards among physicians.