The state of wellbeing education across North American medical schools: a scoping review
DOI:
https://doi.org/10.36834/cmej.76095Abstract
Background/Objective: Medical students experience increased rates of burnout and mental illness compared to the general population. Yet, it is unclear to what extent North American medical schools have adopted formal wellbeing curricula. We sought to establish prevailing themes of existing wellbeing educational interventions to identify opportunities for further curricular development.
Methods: We conducted a scoping review of the literature searching for wellbeing education programs implemented for undergraduate medical students across North America. We searched four comprehensive databases and grey literature and only included published original research. Two independent researchers screened all papers with a third to resolve any disagreements. Two researchers conducted the data extraction following a predetermined template that was refined continuously, with a third researcher to resolve any discrepancies.
Results: We identified 3996 articles in the initial search of which 30 met inclusion criteria and were included for further analysis. The most common types of interventions were mindfulness and meditation practices. 27 studies found that their wellbeing sessions contributed to positive wellbeing outcomes of learners.
Conclusions: Our review identified that there are few wellbeing curricular initiatives that have been evaluated and published in the literature. Additionally, the methodology and rigour of wellbeing curriculum evaluation to date leaves significant room for improvement. The existing literature does suggest that the adoption of a wellbeing curriculum has the potential to improve outcomes for medical students. These findings can be used to assist the development of a validated wellbeing curricular framework for wellbeing initiatives.
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References
Maser B, Danilewitz M, Guérin E, Findlay L, Frank E. Medical student psychological distress and mental illness relative to the general population: a Canadian cross-sectional survey. Acad Med. 2019;94(11):1781–91. https://doi.org/10.1097/ACM.0000000000002958
Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73. https://doi.org/10.1097/00001888-200604000-00009
Canadian Federation of Medical Students. CFMS-FMEQ national health and wellbeing survey-student research position. International Conference on Physician Health. Boston; 2016. Available from: https://www.cfms.org/uploads/news-documents/Wellness Survey Research Position 2017.pdf. [Accessed on Aug 25, 2022].
Glauser W. Medical schools addressing student anxiety, burnout and depression. CMAJ. 2017 Dec 18;189(50):E1569–70. https://doi.org/10.1503/cmaj.109-5516
Haglund MEM, Aan Het Rot M, Cooper NS, et al. Resilience in the third year of medical school: a prospective study of the associations between stressful events occurring during clinical rotations and student wellbeing. Acad Med. 2009;84(2):258–68. https://doi.org/10.1097/ACM.0b013e31819381b1
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016 Jan;50(1):132–49. https://doi.org/10.1111/medu.12927
IsHak WW, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009 Dec 1;1(2):236. https://doi.org/10.4300/JGME-D-09-00054.1
Gold JA, Johnson B, Leydon G, Rohrbaugh RM, Wilkins KM. Mental health self-care in medical students: a comprehensive look at help-seeking. Acad Psychiatry. 2015 Feb 5;39(1):37–46. https://doi.org/10.1007/s40596-014-0202-z
Bourcier D, Far R, King LB, et al. Medical student wellness in Canada: time for a national curriculum framework. Can Med Educ J. 2021 Nov 28;12(6):103–7. https://doi.org/10.36834/cmej.73008
Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73(4):403–7. https://doi.org/10.1097/00001888-199804000-00013
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861–71. https://doi.org/10.1097/00001888-199411000-00001
Gaufberg EH, Batalden M, Sands R, Sigall B. The hidden curriculum: what can we learn from third-year medical student narrative reflections? Acad Med. 2010;85(11):1709-1716. https://doi.org/10.1097/ACM.0b013e3181f57899
Fiorillo A, Sartorius N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Ann Gen Psychiatry. 2021 Dec 1;20(1):1–5. https://doi.org/10.1186/s12991-021-00374-y
Latoo J, Mistry M, Dunne FJ. Physical morbidity and mortality in people with mental illness. Br J Med Pract. 2013;6(3). Available from: http://guidance.nice.org.uk/Topic/MentalHealthBehavioural [Accessed on Aug 25, 2022].
Walker ER, McGee RE, Druss BG. mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry. 2015 Apr 1;72(4):334. https://doi.org/10.1001/jamapsychiatry.2014.2502
Daya Z, Hearn JH. Mindfulness interventions in medical education: a systematic review of their impact on medical student stress, depression, fatigue and burnout. Med Teach. 2017 Feb 1;40(2):146–53. https://doi.org/10.1080/0142159X.2017.1394999
Wasson LT, Cusmano A, Meli L, et al. Association between learning environment interventions and medical student wellbeing: a systematic review. JAMA. 2016 Dec;316(21):2237–52. https://doi.org/10.1001/jama.2016.17573
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Intern J Soc Res Methodol. 2007 Feb;8(1):19–32. https://doi.org/10.1080/1364557032000119616
Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010 Sep 20 [Accessed on 2022 Aug 7];5(1):1–9. https://doi.org/10.1186/1748-5908-5-69
Aggarwal AK, Thompson M, Falik R, Shaw A, O’Sullivan P, Lowenstein DH. Mental illness among us: a new curriculum to reduce mental illness stigma among medical students. Acad Psychiatry. 2013 Nov [Accessed on 2022 Aug 7];37(6):385–91. https://doi.org/10.1007/BF03340074
Bond AR, Mason HF, Lemaster CM, Shaw SE, Mullin CS, Holick EA, et al. Embodied health: the effects of a mind–body course for medical students. Med Educ Online. 2013 [Accessed on 2022 Aug 7];18(1). https://doi.org/10.3402/meo.v18i0.20699
Seritan AL, Rai G, Servis M, Pomeroy C. The office of student wellness: innovating to improve student mental health. Acad Psychiatry. 2015 Feb 5 [Accessed on 2022 Aug 7];39(1):80–4. https://doi.org/10.1007/s40596-014-0152-5
Slavin SJ, Schindler DL, Chibnall JT. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014 [Accessed on 2022 Aug 7];89(4):573–7. https://doi.org/10.1097/ACM.0000000000000166
Thomas SE, Haney MK, Pelic CM, Shaw D, Wong JG. Developing a program to promote stress resilience and self-care in first-year medical students. Can Med Educ J. 2011 Jun 3 [Accessed on 2022 Aug 29];2(1):e32. https://doi.org/10.36834/cmej.36548
Thompson D, Goebert D, Takeshita J. A program for reducing depressive symptoms and suicidal ideation in medical students. Acad Med. 2010 [Accessed on 2022 Aug 7];85(10):1635–9. https://doi.org/10.1097/ACM.0b013e3181f0b49c
Dossett ML, Kohatsu W, Nunley W, et al. A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self-care: an evaluation of the HEART program. Explore (NY). 2013 Sep [Accessed on 2022 Aug 7];9(5):292–8. https://doi.org/10.1016/j.explore.2013.06.003
Drolet BC, Rodgers S. A comprehensive medical student wellness program--design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85(1):103-10. https://doi.org/10.1097/ACM.0b013e3181c46963
Erogul M, Singer G, McIntyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014 Oct 2;26(4):350-6. https://doi.org/10.1080/10401334.2014.945025
George DR, Dellasega C, Whitehead MM, Bordon A. Facebook-based stress management resources for first-year medical students: a multi-method evaluation. Comput Human Behav. 2013 May 1;29(3):559-62. https://doi.org/10.1016/j.chb.2012.12.008
Greeson JM, Toohey MJ, Pearce MJ. An adapted, four-week mind-body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care. Explore (NY). 2015 May 1;11(3):186-92. https://doi.org/10.1016/j.explore.2015.02.003
Kushner RF, Kessler S, McGaghie WC. Using behavior change plans to improve medical student self-care. Acad Med. 2011;86(7):901-6. https://doi.org/10.1097/ACM.0b013e31821da193
McGrady A, Brennan J, Lynch D, Whearty K. A wellness program for first year medical students. Appl Psychophysiol Biofeedback. 2012 Dec;37(4):253-60. https://doi.org/10.1007/s10484-012-9198-x
Nagji A, Brett-MacLean P, Breault L. Exploring the benefits of an optional theatre module on medical student wellbeing. Teach Learn Med. 2013 Jul;25(3):201-6. https://doi.org/10.1080/10401334.2013.801774
Agarwal G, Lake M. Personal transition to the profession: a novel longitudinal professional development and wellness medical student curriculum. Acad Psychiatry. 2016 Feb 1;40(1):105-8. https://doi.org/10.1007/s40596-015-0463-1
Bird A, Tomescu O, Oyola S, Houpy J, Anderson I, Pincavage A. A curriculum to teach resilience skills to medical students during clinical training. MedEdPORTAL. 2020 Sep 30;16:10975. https://doi.org/10.15766/mep_2374-8265.10975
Pasarica M, Lee E, Lee M. Introduction to mindfulness: evidence-based medicine lecture and active session. MedEdPORTAL J Teach Learn Resour. 2016 Sep 28;12. https://doi.org/10.15766/mep_2374-8265.10472
Rockfeld J, Koppel J, Buell A, Zucconi R. An interactive lifestyle medicine curriculum for third-year medical students to promote student and patient wellness. MedEdPORTAL. 2020 Sep 18;16:10972. https://doi.org/10.15766/mep_2374-8265.10972
Sheehy J, Yim E, Hayton A. Third-year resilience days: fortifying students against burnout. Med Educ. 2020 Nov 1;54(11):1051-2. https://doi.org/10.1111/medu.14341
Stumbar SE, Bracho A, Schneider G, Samuels M, Gillis M. Narrative medicine rounds: promoting student wellbeing during the third year of medical school. South Med J. 2020 Aug 1;113(8):378-83. https://doi.org/10.14423/SMJ.0000000000001131
Williams MK, Estores IM, Merlo LJ. Promoting resilience in medicine: the effects of a mind-body medicine elective to improve medical student wellbeing. Glob Adv Heal Med. 2020;9. https://doi.org/10.1177/2164956120927367
Yang E, Schamber E, Meyer RML, Gold JI. Happier healers: randomized controlled trial of mobile mindfulness for stress management. J Altern Complement Med. 2018 May 1;24(5):505-13. https://doi.org/10.1089/acm.2015.0301
Bynum WE, Uijtdehaage S, Artino AR, Fox JW. The psychology of shame: a resilience seminar for medical students. MedEdPORTAL. 2020 Dec 24;16:11052. https://doi.org/10.15766/mep_2374-8265.11052
Chung AS, Felber R, Han E, Mathew T, Rebillot K, Likourezos A. A Targeted mindfulness curriculum for medical students during their emergency medicine clerkship experience. West J Emerg Med. 2018 Jul 1;19(4):762. https://doi.org/10.5811/westjem.2018.4.37018
Danilewitz M, Koszycki D, Maclean H, et al. Feasibility and effectiveness of an online mindfulness meditation program for medical students. Can Med Educ J. 2018 Nov 13;9(4):e15. https://doi.org/10.36834/cmej.43041
Dyrbye LN, Shanafelt TD, Werner L, Sood A, Satele D, Wolanskyj AP. The impact of a required longitudinal stress management and resilience training course for first-year medical students. J Gen Intern Med. 2017 Dec 1;32(12):1309. https://doi.org/10.1007/s11606-017-4171-2
Gold JA, Bentzley JP, Franciscus AM, Forte C, De Golia SG. An intervention in social connection: medical student reflection groups. Acad Psychiatry. 2019 Aug 15;43(4):375-80. https://doi.org/10.1007/s40596-019-01058-2
Kraemer KM, Luberto CM, O'Bryan EM, Mysinger E, Cotton S. Mind-body skills training to improve distress tolerance in medical students: a pilot study. Teach Learn Med. 2016 Apr 2;28(2):219-28. https://doi.org/10.1080/10401334.2016.1146605
MacLean H, Braschi E, Archibald D, et al. A pilot study of a longitudinal mindfulness curriculum in undergraduate medical education. Can Med Educ J. 2020 Feb 27;11(4):e5. https://doi.org/10.36834/cmej.56726
Mascaro JS, Kelley S, Darcher Aet al. Meditation buffers medical student compassion from the deleterious effects of depression. J Posit Psychol. 2018 Mar 4;13(2):133-42. https://doi.org/10.1080/17439760.2016.1233348
Neufeld A. A commentary on “Medical student wellness in Canada: time for a national curriculum framework.” Can Med Ed J. 2022;13(2):2022. https://doi.org/10.36834/cmej.74143
Thomas PA, Kern DE, Hughes MT, Tackett SA, Chen BY. Curricular development for medical education: a six-step approach. Baltimore, Maryland: Johns Hopkins University Press; 2022.
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