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Background Over a million adolescents die globally each year from preventable or treatable causes, with injuries (intentional and unintentional) being the leading cause of these deaths. To inform strategies to prevent these injuries, we aimed to assess psychosocial factors associated with serious injury occurrence, type, and mechanism in adolescents. Methods and findings We conducted a secondary analysis of cross-sectional survey data collected from the Global School-based Student Health Survey between 2009 and 2015. We used logistic regression to estimate associations between prevalence of serious injuries, injury type (effects of injury), and injury mechanism (cause of injury) and psychosocial factors (factors that relate to individuals socially, or their thoughts or behaviour, or the interrelation between these variables). Psychosocial factors were categorised, based on review of the literature, author knowledge, and discussion amongst authors. The categories were markers of risky behaviour (smoking, alcohol use, drug use, and physical activity), contextual factors (hunger, bullying, and loneliness), protective factors (number of friends and having a supportive family), and markers of poor mental health (planned or attempted suicide and being too worried to sleep). Models were adjusted for country factors (geographical area and income status, both using World Bank classification), demographic factors (age and sex), and factors to explain the survey design. A total of 87,269 adolescents living in 26 countries were included. The weighted majority were 14–15 years old (45.88%), male (50.70%), from a lower-middle-income country (81.93%), and from East Asia and the Pacific (66.83%). The weighted prevalence of a serious injury in the last 12 months was 36.33%, with the rate being higher in low-income countries compared to other countries (48.74% versus 36.14%) and amongst males compared to females (42.62% versus 29.87%). Psychosocial factors most strongly associated with serious injury were being bullied (odds ratio [OR] 2.45, 95% CI 1.93 to 3.13, p < 0.001), drug use (OR 2.08, 95% CI 1.73 to 2.49, p < 0.001), attempting suicide (OR 1.78, CI 1.55 to 2.04, p < 0.001), being too worried to sleep (OR 1.80, 95% CI 1.54 to 2.10, p < 0.001), feeling lonely (OR 1.61, 95% CI 1.37 to 1.89, p < 0.001), and going hungry (OR 1.61, 95% CI 1.30 to 2.01, p < 0.001). Factors hypothesised to be protective were not associated with reduced odds of serious injury: Number of close friends was associated with an increased odds of injury (OR 1.23, 95% CI 1.06 to 1.43, p = 0.007), as was having understanding parents or guardians (OR 1.13, 95% CI 1.01 to 1.26, p = 0.036). Being bullied, using drugs, and attempting suicide were associated with most types of injury, and being bullied or too worried to sleep were associated with most mechanisms of injury; other psychosocial factors were variably associated with injury type and mechanism. Limitations include the cross-sectional study design, making it not possible to determine the directionality of the associations found, and the survey not capturing children who did not go to school. Conclusions We observed strong associations between serious injury and psychosocial factors, but we note the relationships are likely to be complex and our findings do not inform causality. Nevertheless, our findings suggest that multifactorial programmes to target psychosocial factors might reduce the number of serious injuries in adolescents, in particular programmes concentrating on reducing bullying and drug use and improving mental health., In an analysis of data from the Global Schools-Based Student Health Survey, Samiha Ismail, Maria Odland, and colleagues investigate the relationships between serious injuries and psychosocial factors among adolescents across 26 countries., Author summary Why was this study done? Globally, the leading cause of disability-adjusted life years in adolescents is road traffic injuries (self-harm and interpersonal violence are also in the top 5), and there is an urgent need to reduce this preventable burden of injuries. Poor mental health and challenging psychosocial circumstances are also known to commonly affect adolescents. This study was done to assess the association between adolescents’ mental health and psychosocial circumstances and injury in order to suggest potential points of intervention to improve outcomes. What did the researchers do and find? We quantified the association between psychosocial circumstances and serious injury occurrence, mechanism, and type in adolescents, taking into account country as well as individual factors that could affect the relationship. We found that factors and behaviours such as being bullied and using drugs were strongly associated with an increase in serious injuries, as were indicators of poor mental health such as being too worried to sleep or having attempted suicide. We also found that factors that we hypothesised to be protective, such as having close friends or understanding family members or guardians, were not significantly associated with the occurrence of serious injury, apart from in the highest categories, where they were associated with an increase in serious injuries. The relationships between psychosocial circumstances and injury were similar across world regions and countries with different income status. What do these findings mean? All available evidence points to psychosocial factors such as bullying, drug-taking, and poor mental health being strongly associated with occurrence of injury, and this association is consistent across geographical regions and countries with different income status. Our findings suggest that multifactorial programmes to target psychosocial factors might reduce the number of serious injuries in adolescents across different countries and contexts. In particular, concentrating on reducing bullying and drug use and improving mental health could reduce the number of serious injuries among adolescents in the future.

Student representatives, termed ‘Academic Representatives’ (AR), at the University of Birmingham act as intermediaries for their respective year group by relaying feedback to, and working with, medical school staff (MSS) to resolve any academic issues that arise, as well as wellbeing concerns. Owing to large cohort sizes (405 students in Year 3 2019/20), various feedback methods have historically been employed to effectively gather cohort feedback to ensure student concerns can be relayed in a method which is accessible to all, but also manageable for the sole year group AR. As students enter different hospital placements in their third year, the task of gathering feedback becomes more challenging. A novel method was devised where Hospital Representatives (HR) would be assigned to each hospital to assist the Year 3 AR in gathering and assimilating feedback to present to MSS responsible for Year 3 medical students. Thus, we aimed to assess whether HRs are indeed a feasible and effective method in gathering feedback in the clinical years. We based our analysis on qualitative responses as reported by medical students, HRs, AR and MSS. As reported by students, the personal interaction with HRs was more encouraging and welcoming compared to previous methods, increasing the yield in feedback garnered. Meanwhile, MSS reported the feedback to be more in-depth and practical. They were able to focus on individual hospitals and tailor resources where needed, owing to different clinical experiences students experienced across different hospital trusts. The AR reported the benefits of not having to physically travel to each hospital; more time could be spent addressing individual issues raised, or on their own medical studies. To conclude, deploying HRs across different placements has proved to be efficacious, fruitful and resourceful. Thus, we recommend this strategy be implemented on a larger scale at other medical schools and institutions.

At the University of Birmingham, cohorts’ student representatives (‘Academic Representatives’) are viewed as the intermediaries between staff and students; they represent views of the cohort, express concerns and work closely with the staff to tackle issues across all aspects of the medicine programme, academic and wellbeing. The collective body of medicine student representatives make the Curriculum and Wellbeing Committee (CAWC). CAWC is made up of student reps from all year groups ensuring the views of all students are conveyed to the appropriate staff groups. The COVID-19 pandemic presented an unprecedented problem for medical education. At Birmingham, the pandemic was close to the main examination period and had consequences for delivery of teaching, placements and for final year students which needed to have met the GMC’s Outcome for Graduates. The pandemic caused great distress for students due to the uncertainty regarding their medical education. CAWC collated all the thoughts of the student body and provided clear and constructive student feedback to the staff ensures that contingency plans can work in the favour of the students. A staff-student meeting was held to present all the feedback we had gathered from the entire medicine cohort (2000+ students). The approach taken by CAWC was greatly welcomed by staff and student alike. Students appreciated the continual dialogue with the medical school but also being as transparent with the student cohort. Regularly informing students both on a general and year specific basis, so they were aware (within the bounds of confidentiality) as soon as we were rather than waiting for official university communication, who were under immense pressure. The CAWC committee’s response to the crisis demonstrated that medical students have the tenacity and resilience to deal with challenging times, thus indicating that they can make remarkable leaders.

Background At the University of Birmingham, cohorts’ student representatives (‘Academic Representatives’ - AR) are viewed as the intermediaries between staff and students; they represent views of the cohort, express concerns and work closely with the staff to tackle issues across all aspects of the medicine programme, academic and wellbeing. Obtaining feedback is therefore instrumental in identifying student concerns and views and relaying them to the staff. While this is simpler in pre-clinical years where students are primarily at the university, obtaining feedback becomes difficult in the clinical years due to students being placed at various hospital sites across the West Midlands. In the academic year 19/20, students in Year 4 had their feedback collected using feedback forms distributed electronically by the Year 4 AR. In contrast, the Year 3 cohort had their views represented in the form of designated hospital representatives which fed back to the Year 3 AR. Aim To assess the effectiveness of using hospital representatives in representing feedback compared with feedback forms. Method For Year 4, we used the number of feedback responses registered throughout the academic year. For Year 3, we relied on the qualitative responses gained from hospital representatives, alongside feedback from senior medical school staff. Results For feedback forms, there were 65 responses (cohort of 340) in the 19/20 academic year. This is markedly lower than the 185 responses recorded in 15/16 academic year. For hospital representatives, the senior staff found the feedback provided to be more in-depth, practical and purposeful. Also, students found engagement with the hospital representatives more welcoming than using feedback forms. Conclusion Deployment of hospital representatives across different placement sites has proved to be more efficacious and practical. We recommend this to be implemented on a larger scale across other avenues.