The feasibility of an innovative online mind-body wellness program for medical students

Christina  Ray; Shankar Jha; Makayla Watt; Ashley Hyde; Kendra McGowan; Sarah Tymchuk; Puneeta Tandon

doi:10.36834/cmej.77658

Authors

Christina Ray University of Calgary
Shankar Jha University of Alberta https://orcid.org/0000-0002-1874-8055
Makayla Watt University of Alberta
Ashley Hyde University of Alberta
Kendra McGowan University of Alberta
Sarah Tymchuk University of Alberta
Puneeta Tandon University of Alberta

DOI:

https://doi.org/10.36834/cmej.77658

Abstract

Purpose: Medical students have higher stress levels than their age-matched peers; however, few online wellness interventions have been trialed in this population. This pilot study examined the feasibility of an online wellness program for medical students.

Method: This was a pilot feasibility, mixed-methods study with a pre-post design. From September to October 2020, medical students from a large Canadian medical school were introduced to a 12-week online program with weekly sessions on yoga, breathwork, meditation, and nutrition. Feasibility measures included adherence, satisfaction, and retention, with secondary outcome measures including stress, anxiety, quality of life, and mindfulness. Post-program qualitative interviews explored participant experience.

Results: Of 74 participants, 64 completed the program. Twenty-one achieved the program goal of participating at least two days per week. While 74.8% of participants found the program accessible and satisfying, some students reported challenges with adherence. Exploratory analysis indicated there are signals for reduced stress (11%, p = 0.005), anxiety (14%, p = 0.001), and improved mindfulness (5.6%, p = 0.001). Qualitative analysis revealed themes of participants experiencing an increased sense of balance and mindfulness.

Conclusion: A 12-week online wellness intervention appears feasible for medical students, showing potential benefits for stress, anxiety, and mindfulness.

Author Biography

Christina Ray, University of Calgary

Dr. Christina Ray is an Internal Medicine Resident at the University of Calgary, Calgary, AB.

References

1. 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.

2. Brazeau CM, Shanafelt T, Durning SJ, et al. Distress among matriculating medical students relative to the general population. Acad Med. 2014;89(11):1520-5. https://doi.org/10.1097/acm.0000000000000482.

3. Stirparo G, Pireddu R, D’Angelo M, Bottignole D, Mazzoli R, Gambolò L. Is mental health worse in medical students than in the general population? a cross-sectional study. Medicina 2024;60(6):863. Available from https://www.mdpi.com/1648-9144/60/6/863

4. 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). https://doi.org/10.1097/ACM.0000000000002958

5. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-51. https://doi.org/10.1097/acm.0000000000000134.

6. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ 2016;50(1):132-49. https://doi.org/10.1111/medu.12927.

7. van der Heijden F, Dillingh G, Bakker A, Prins J. Suicidal thoughts among medical residents with burnout. Arch Suicide Res. 2008;12(4):344-6. https://doi.org/10.1080/13811110802325349.

8. 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 2016;316(21):2214-2236. https://doi.org/10.1001/jama.2016.17324.

9. Quek TT, Tam WW, Tran BX, et al. The global prevalence of anxiety among medical students: a meta-analysis. Int J Environ Res Public Health. 2019;16(15) https://doi.org/10.3390/ijerph16152735.

10. 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;11(3):186-92. https://doi.org/10.1016/j.explore.2015.02.003.

11. Prasad L, Varrey A, Sisti G. medical students' stress levels and sense of well being after six weeks of yoga and meditation. Evid Based Complement Alternat Med 2016;2016:9251849. https://doi.org/10.1155/2016/9251849.

12. Barbosa P, Raymond G, Zlotnick C, Wilk J, Toomey R, 3rd, Mitchell J, 3rd. Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Educ Health (Abingdon) 2013;26(1):9-14. https://doi.org/10.4103/1357-6283.112794.

13. Peterson CT, Bauer SM, Chopra D, Mills PJ, Maturi RK. Effects of Shambhavi Mahamudra Kriya, a multicomponent breath-based yogic practice ( Pranayama), on perceived stress and general well-being. J Evid Based Complementary Altern Med 2017;22(4):788-797. https://doi.org/10.1177/2156587217730934.

14. Noori S, Blood A, Meleca J, Kennedy V, Sengupta D. Current directions in medical student wellbeing: a primer for students. association of American medical colleges: organization of student representatives, 2017. Available from https://www.aamc.org/media/24821/download. [Accessed Jan 10, 2024]

15. Peerani F, Watt M, Ismond KP, et al. A randomized controlled trial of a multicomponent online stress reduction intervention in inflammatory bowel disease. Therap Adv Gastroenterol 2022;15:17562848221127238. https://doi.org/10.1177/17562848221127238.

16. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. journal of health and social behavior 1983;24(4):385-396. https://doi.org/10.2307/2136404.

17. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6):361-70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.

18. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16(9):606-13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.

19. Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Personal Soc Psychol. 1989;57(6):1069-1081. https://doi.org/https://doi.org/10.1037/0022-3514.57.6.1069.

20. Ryff CD, Keyes CLM. The structure of psychological well-being revisited. J Personal Soc Psychol. 1995;69(4):719-727. https://doi.org/https://doi.org/10.1037/0022-3514.69.4.719.

21. de Boer AG, van Lanschot JJ, Stalmeier PF, et al. Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res 2004;13(2):311-20. https://doi.org/10.1023/B:QURE.0000018499.64574.1f.

22. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment 2006;13(1):27-45. https://doi.org/10.1177/1073191105283504.

23. Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health care research. Glob Qual Nurs Res. 2017;4:2333393617742282. https://doi.org/10.1177/2333393617742282.

24. Mayan MJ. Essentials of qualitative inquiry. Second edition. ed: Routledge, 2023. https://doi.org/10.4324/b23331

25. Braun V. Thematic analysis: a practical guide: SAGE Publications Ltd, 2022. https://doi.org/10.53841/bpsqmip.2022.1.33.46

26. Quirkos. Quirkos.

27. Yang E, Schamber E, Meyer RML, Gold JI. Happier healers: randomized controlled trial of mobile mindfulness for stress management. J Altern Complement Med 2018;24(5):505-513. https://doi.org/10.1089/acm.2015.0301.

28. Bansal R, Gupta M, Agarwal B, Sharma S. Impact of short term yoga intervention on mental well being of medical students posted in community medicine: a pilot study. Indian J Community Med. 2013;38(2):105-8. https://doi.org/10.4103/0970-0218.112445.

29. Corp I. SPSS. 27 ed.

30. Boettcher J, Aström V, Påhlsson D, Schenström O, Andersson G, Carlbring P. Internet-based mindfulness treatment for anxiety disorders: a randomized controlled trial. Behav Ther 2014;45(2):241-53. https://doi.org/10.1016/j.beth.2013.11.003.

31. Forbes L, Gutierrez D, Johnson SK. Investigating adherence to an online introductory mindfulness program. Mindfulness 2018;9(1):271-282. https://doi.org/10.1007/s12671-017-0772-4.

32. Michie S, Richardson M, Johnston M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46(1):81-95. https://doi.org/10.1007/s12160-013-9486-6.

33. Lemay V, Hoolahan J, Buchanan A. Impact of a yoga and meditation intervention on students' stress and anxiety levels. Am J Pharm Educ 2019;83(5):7001. https://doi.org/10.5688/ajpe7001.

34. Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med Educ 2011;45(4):381-8. https://doi.org/10.1111/j.1365-2923.2010.03877.x.

35. McGrady A, Brennan J, Lynch D, Whearty K. A wellness program for first year medical students. Appl Psychophysiol Biofeedback 2012;37(4):253-60. https://doi.org/10.1007/s10484-012-9198-x.

36. Sharma VK, Trakroo M, Subramaniam V, Rajajeyakumar M, Bhavanani AB, Sahai A. Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students. Int J Yoga 2013;6(2):104-10. https://doi.org/10.4103/0973-6131.113400.

37. Ireland MJ, Clough B, Gill K, Langan F, O'Connor A, Spencer L. A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners. Med Teach 2017;39(4):409-414. https://doi.org/10.1080/0142159x.2017.1294749.

38. Vinothkumar M, Arathi A, Joseph M, Nayana P, Jishma EJ, Sahana U. Coping, perceived stress, and job satisfaction among medical interns: the mediating effect of mindfulness. Ind Psychiatry J 2016;25(2):195-201. https://doi.org/10.4103/ipj.ipj_98_14.

39. Wen L, Sweeney TE, Welton L, Trockel M, Katznelson L. Encouraging mindfulness in medical house staff via smartphone app: a pilot study. Acad Psychiatry 2017;41(5):646-650. https://doi.org/10.1007/s40596-017-0768-3.

40. Canada. TAoFoMo. Canadian medical education statistics. 2020. Available from https://www.afmc.ca/wp-content/uploads/2022/10/CMES2020-Complete_EN.pdf [Accessed on Jan 10, 2024].