Gallagher, S., Gray, A. & Perez, D. (2016). Digital Wellbeing in Medical Students. Paper presented at AMEE 2016 Conference, Barcelona.

1. DIGITAL WELLBEING
IN MEDICAL
STUDENTS
STEVE GALLAGHER, ANDREW GRAY AND DAVID
PEREZ
DUNEDIN SCHOOL OF MEDICINE
UNIVERSITY OF OTAGO, NEW ZEALAND
@STEVEGALLAGHER
STEVE.GALLAGHER@OTAGO.AC.NZ

2. 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-2015
b 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.

3. DIGITAL MEANS “ALL THE
THINGS”

4. MEDICAL STUDENT
WELLBEING AT OTAGO
Longitudinal survey of medical student wellbeing at Otago
Medical School
Initiated by David Perez in 2012
Followed 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?

5. 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

6. 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

7. BACK TO OUR STUDENTS
Data 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 T5
Overall 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

8. PHQ-9
PHQ-9 – Patient Health Questionnaire
- Primarily a screening instrument for depression
- Range = 0-27
T2 T5
Overall 5.4 (4.0)
Mild depression
6.08 (4.5)
Mild depression
No difference

9. RAND-36
Shortform 36 item Health Survey
Developed 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 T5
Male 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)

10. ASKING ABOUT
WELLBEING
Student 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 scale
Strongly
Disagree
Disagree Undecided Agree Strongly
Agree
0 1 2 3 4

11. DIGITAL WELLBEING
At 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

12. 50.8% Agree or Strongly Agree

13. 18.72% Agree or Strongly Agree

14. 49.2% Agree or Strongly Agree

15. 60.97% Disagree or Strongly Disagree

16. 5.88% Agree or Strongly Agree

17. 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 SW
DW 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)

18. 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.

19. 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

20. 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/

21. 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.

22. THANKS
David Perez for having the foresight to begin the study
Andrew Gray for incredibly helpful biostatistics support
Our students!
And you all, for listening.