Towards an autonomy-supportive model of wellness in Canadian medical education

Authors

  • Adam Neufeld University of Calgary

DOI:

https://doi.org/10.36834/cmej.75312

Abstract

Purpose: Learner distress is a huge problem in medicine today, and medical institutions have been called upon to help solve this issue. Unfortunately, the majority have responded not by addressing the system and culture that have long plagued the profession, but by creating individual-focused “wellness” interventions (IFWs). As a result, medical learners are routinely being forced to undergo training on resilience, mindfulness, and burnout.

Approach: Grounded in well-supported theory and empirical evidence, my central argument in this commentary is that IFWs are inappropriate, insulting, and psychologically harmful to learners, and that they need to stop.

Contribution: Extending prior work in this area, I first present three fundamental problems with IFWs. I then recommend a paradigm shift in how we are approaching “wellness” in medical education.

Conclusion: Finally, I provide an evidence-based roadmap, in self-determination theory, for how system-level improvements could be made in a timely, sustainable, and socially responsible way, that would benefit everyone in medicine—from leaders, to educators, to learners, to patients.

References

Bourcier D, Far R, King L, et al. Medical student wellness in Canada: time for a national curriculum framework. Can Med Educ J. Published online 2021. https://doi.org/https://doi.org/10.36834/cmej.73008

Tepper J, Champion C, Johnston T, et al. Medical Student Health and Wellbeing.; 2015.

Bourcier D, Far R, King L. CFMS Wellness Curriculum Framework.; 2020. https://www.cfms.org/files/wellness-resources/CFMS-Wellness-Curriculum-Framework_FINAL.pdf

Ryff CD, Singer BH. Know thyself and become what you are: A eudaimonic approach to psychological well-being. J Happiness Stud. 2008;9(1):13-39. https://doi.org/10.1007/s10902-006-9019-0

Neufeld A. A commentary on “Medical student wellness in Canada: time for a national curriculum framework". Can Med Educ J. Published online 2021. https://doi.org/https://doi.org/10.36834/cmej.74143

Dobkin PL, Hutchinson TA. Teaching mindfulness in medical school: Where are we now and where are we going? Med Educ. Published online 2013. https://doi.org/10.1111/medu.12200

Madva A. The Inevitability of Aiming for Virtue. In: Overcoming Epistemic Injustice; 2019.

Sebring JCH. Towards a sociological understanding of medical gaslighting in western health care. Sociol Heal Illn. 2021;43(9). https://doi.org/10.1111/1467-9566.13367

Fraser S. The toxic power dynamics of gaslighting in medicine. Can Fam Physician. 2021;67(5). https://doi.org/10.46747/cfp.6705367

Kunzler AM, Helmreich I, König J, et al. Psychological interventions to foster resilience in healthcare students. Cochrane Database Syst Rev. 2020;2020(7). https://doi.org/10.1002/14651858.cd013684

Ricker M, Brooks AJ, Bodine S, Lebensohn P, Maizes V. Well-being in residency: Impact of an online physician well-being course on resiliency and burnout in incoming residents. Fam Med. 2021;53(2). https://doi.org/10.22454/FamMed.2021.314886

Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. Published online 2016. https://doi.org/10.1111/medu.12927

Naji L, Singh B, Shah A, et al. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. C open. 2021;9(1). https://doi.org/10.9778/cmajo.20200068

West C, Dyrbye L, Sinsky C. Resilience and burnout among physicians and the general US working population. JAMA - J Am Med Assoc. 2020;3(7). https://doi.org/https://doi.org/10.1001/jamanetworkopen.2020.9385

Ryan RM, Deci EL. Self-Determination Theory: Basic Psychological Needs in Motivation Development and Wellness. Guilford Publishing; 2017.

Kusurkar RA, Croiset G, Mann K V., Custers E, ten Cate O. Have motivation theories guided the development and reform of medical education curricula? A review of the literature. Acad Med. 2012;87(6):735-743. https://doi.org/10.1097/ACM.0b013e318253cc0e

Kusurkar RA, Ten Cate TJ, Vos CMP, Westers P, Croiset G. How motivation affects academic performance: A structural equation modelling analysis. Adv Heal Sci Educ. 2013;18(1):57-69. https://doi.org/10.1007/s10459-012-9354-3

Kusurkar RA, Croiset G, Galindo-Garré F, Ten Cate O. Motivational profiles of medical students: Association with study effort, academic performance and exhaustion. BMC Med Educ. Published online 2013. https://doi.org/10.1186/1472-6920-13-87

Neufeld A, Malin G. Exploring the relationship between medical student basic psychological need satisfaction, resilience, and well-being: A quantitative study. BMC Med Educ. Published online 2019. https://doi.org/10.1186/s12909-019-1847-9

Neufeld A, Malin G. How medical students’ perceptions of instructor autonomy-support mediate their motivation and psychological well-being. Med Teach. Published online 2020. https://doi.org/10.1080/0142159X.2020.1726308

Neufeld A, Malin G. Need fulfillment and resilience mediate the relationship between mindfulness and coping in medical students. Teach Learn Med. Published online 2021. https://doi.org/10.1080/10401334.2021.1960533

Neufeld A, Malin G. Basic psychological needs, more than mindfulness and resilience, relate to medical student stress: a case for shifting the focus of wellness curricula. Med Teach. Published online 2020. https://doi.org/10.1080/0142159X.2020.1813876

Kusurkar RA, van der Burgt SME, Isik U, et al. Burnout and engagement among PhD students in medicine: the BEeP study. Perspect Med Educ. 2021;10(2). https://doi.org/10.1007/s40037-020-00637-6

Williams GC, Deci EL. The importance of supporting autonomy in medical education. Ann Intern Med. Published online 1998. https://doi.org/10.7326/0003-4819-129-4-199808150-00007

Williams GC, Deci EL. Internalization of biopsychosocial values by medical students: A test of self-determination theory. J Pers Soc Psychol. 1996;70(4):767-779. http://dx.doi.org/10.1037/0022-3514.70.4.767

Patrick H, Williams GC. Self-determination in medical education: encouraging medical educators to be more like blues artists and poets. Theory Res Educ. Published online 2009. https://doi.org/10.1177/1477878509104323

Ten Cate TJ, Kusurkar RA, Williams GC, ten Cate OTJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide No. 59. Med Teach. 2011;33(12):961-973. https://doi.org/10.3109/0142159X.2011.595435

Baldwin CD, Craig MS, Garfunkel LC, et al. Autonomy-supportive medical education: let the force be within you! Acad Med. Published online 2012. https://doi.org/10.1097/ACM.0b013e31826cdc3f

Kusurkar RA, Croiset G. Autonomy support for autonomous motivation in medical education. Med Educ Online. Published online 2015. https://doi.org/10.3402/meo.v20.27951

Hoffman BD. Using Self-Determination Theory to Improve Residency Training. Acad Med. Published online 2015. https://doi.org/10.1097/acm.0000000000000523

Orsini C, Binnie VI, Wilson SL. Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory. J Educ Eval Health Prof. 2016;13:19. https://doi.org/10.3352/jeehp.2016.13.19

Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: A scoping review. Acad Med. Published online 2018. https://doi.org/10.1097/ACM.0000000000002004

Seo C, Corrado M, Fournier K, Bailey T, Haykal KA. Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review. BMC Med Educ. 2021;21(1). https://doi.org/10.1186/s12909-021-02495-0

Chung MP, Thang CK, Vermillion M, Fried JM, Uijtdehaage S. Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study. Med Educ Online. 2018;23(1). https://doi.org/10.1080/10872981.2018.1478170

Bell A, Cavanagh A, Connelly CE, Walsh A, Vanstone M. Why do few medical students report their experiences of mistreatment to administration? Med Educ. 2021;55(4). https://doi.org/10.1111/medu.14395

Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students a systematic review and meta-analysis. JAMA Published online 2016. https://doi.org/10.1001/jama.2016.17324

Neufeld A, Malin G. How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents. BMC Med Educ. 2021;21(1). https://doi.org/10.1186/s12909-021-02734-4

Ryan RM, Weinstein N. Undermining quality teaching and learning: A self-determination theory perspective on high-stakes testing. Theory Res Educ. Published online 2009. https://doi.org/10.1177/1477878509104327

Weinstein N, Brown KW, Ryan RM. A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. J Res Pers. Published online 2009. https://doi.org/10.1016/j.jrp.2008.12.008

Weinstein N, Ryan RM. A self-determination theory approach to understanding stress incursion and responses. Stress Heal. Published online 2011. https://doi.org/10.1002/smi.1368

Colenbrander L, Causer L, Haire B. “If you can’t make it, you’re not tough enough to do medicine”: a qualitative study of Sydney-based medical students’ experiences of bullying and harassment in clinical settings. BMC Med Educ. 2020;20(1). https://doi.org/10.1186/s12909-020-02001-y

Kassebaum DG, Cutler ER. On the culture of student abuse in medical school. Acad Med. 1998;73(11). https://doi.org/10.1097/00001888-199811000-00011

Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: A systematic review of the literature. Postgrad Med. 2012;124(4). https://doi.org/10.3810/pgm.2012.07.2583

Rasche K, Orth M. Shift work in health-care system: Consequences for nurses, doctors, and patients. Atemwegs- und Lungenkrankheiten. 2019;45(10). https://doi.org/10.5414/ATX02455

Li-Sauerwine S, Rebillot K, Chung AS, Coates WC, Shah S, Yarris LM. Moving beyond personal factors: A national study of wellness interventions in emergency medicine residency programs. AEM Educ Train. 2021;5(4). https://doi.org/10.1002/aet2.10690

Neufeld A. Autonomy-Supportive Teaching in Medicine: From Motivational Theory to Educational Practice. MedEdPublish. 2021;10(1). https://doi.org/10.15694/mep.2021.000117.1

Deci EL, Ryan RM, Vallerand RJ, Pelletier LG. Motivation and Education: The Self-Determination Perspective. Educ Psychol. Published online 1991. https://doi.org/10.1080/00461520.1991.9653137

Teixeira PJ, Marques MM, Silva MN, et al. A classification of motivation and behavior change techniques used in self-determination theory-based interventions in health contexts. Motiv Sci. Published online 2020. https://doi.org/10.1037/mot0000172

Reeve J. Self-Determination Theory Applied to Educational Settings. In: Handbook of Self-Determination Research. ; 2002.

Earl S. Building autonomous learners: perspectives from research and practice using self-determination theory. Br J Educ Stud. 2019;67(2). https://doi.org/10.1080/00071005.2019.1577592

Tepper J, Champion C, Johnston T, et al. Medical Student Health and Wellbeing.; 2015. https://www.cfms.org/files/position-papers/Wellness Position Paper_Aug19.pdf

King L, Yuan JH, Li H, Do V. Canadian Federation of Medical Students response to “The alarming situation of medical student mental health.” Can Med Educ J. Published online 2021. https://doi.org/10.36834/cmej.71777

Smith C. The Ultimate Change Management Process Flow. The Change Blog. Published 2018. https://change.walkme.com/change-management-process-flow/ [Accessed Mar 3, 2022].

Paul S. 5 Advice that actually will help take charge of life. Published 2022. https://suvadeeppaul.medium.com/5-laws-to-help-you-charge-of-your-life-f30477f63628 [Accessed Apr 20, 2022].

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Published

2022-11-14

How to Cite

1.
Neufeld A. Towards an autonomy-supportive model of wellness in Canadian medical education. Can. Med. Ed. J [Internet]. 2022 Nov. 14 [cited 2024 Dec. 19];14(3):143-51. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/75312

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Commentary and Opinions

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