Medical students’ perspectives on a longitudinal wellness curriculum: a qualitative investigation
DOI:
https://doi.org/10.36834/cmej.77833Abstract
Introduction: There is growing concern about the mental health status of medical students. Medical students are at a higher risk for depression, anxiety, and burnout than non-medical students. The Undergraduate Medical Education (UGME) Office of Medical Learner Affairs at McGill University developed a Longitudinal Wellness Curriculum (LWC) to foment medical students’ well-being, self-care, and adaptability.
Methods: We conducted a qualitative descriptive study to explore students’ experiences with the LWC. We conducted three semi-structured focus groups involving a total of 11 medical students. We used thematic framework analysis for data analysis.
Results: We found four main themes related to participants’ engagement with the curriculum: 1) diverse perceptions on curriculum relevance and helpfulness; 2) the benefits of experiential sessions, role model speakers, and supportive staff; 3) insights on student-friendly curriculum scheduling; and 4) the importance of wellness education and systemic interventions in medical education.
Conclusions: Most participants found the curriculum valuable and supported its integration into the academic curriculum. Experiential and active learning, diverse approaches to wellness, small group sessions, role modeling, and student-centered approaches were preferred methods. Inconvenient curriculum scheduling and skepticism over system-level support were seen as barriers to curriculum engagement and uptake. The findings of our study contribute to the development and implementation of wellness curriculum efforts in medical education.
References
Bourcier D, Far R, King LB, et al. Medical student wellness in Canada: time for a national curriculum framework. Can Med Ed J. 2021;12(6):103-7. https://doi.org/10.36834/cmej.73008 DOI: https://doi.org/10.36834/cmej.73008
Tian-Ci Quek T, Wai-San Tam WX, Tran B, et al. The global prevalence of anxiety among medical students: a meta-analysis. Int. J. Environ. Res. Public Health 2019;16, 2735. https://doi.org/10.3390/ijerph16152735 DOI: https://doi.org/10.3390/ijerph16152735
Tam W, Lo K, Pacheco J. Prevalence of depressive symptoms among medical students: overview of systematic reviews. Med Educ. 2019;53(4):345–354. https://doi.org/10.1111/medu.13770 DOI: https://doi.org/10.1111/medu.13770
Hope V, Henderson M. Medical student depression, anxiety and distress outside north America: a systematic review. Med Educ. 2014;48(10):963–79. https://doi.org/10.1111/medu.12512 DOI: https://doi.org/10.1111/medu.12512
Heinen I, Bullinger M, Kocalevent RD. Perceived stress in first year medical students - associations with personal resources and emotional distress. BMC Med Educ. 2017;17(4). https://doi.org/10.1186/s12909-016-0841-8
Brazeau C, Shanafelt T, Durning S, 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 DOI: https://doi.org/10.1097/ACM.0000000000000482
Kötter T, Tautphäus Y, Scherer M, Voltmer E. Health-promoting factors in medical students and students of science, technology, engineering, and mathematics: design and baseline results of a comparative longitudinal study. BMC Med Educ. 2014;14:134. https://doi.org/10.1186/1472-6920-14-134 DOI: https://doi.org/10.1186/1472-6920-14-134
Dyrbye L, Thomas M, Shanafelt T. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med. 2006;81(4):354-73. https://doi.org/10.1097/00001888-200604000-00009 DOI: https://doi.org/10.1097/00001888-200604000-00009
Heinen I, Bullinger M, Kocalevent RD. Perceived stress in first year medical students - associations with personal resources and emotional distress. BMC Med Educ. 2017;17(4),1-14. https://doi.org/10.1186/s12909-016-0841-8 DOI: https://doi.org/10.1186/s12909-016-0841-8
Rotenstein L, Ramos M, 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):2214-36. https://doi.org/10.1001/jama.2016.17324 DOI: https://doi.org/10.1001/jama.2016.17324
Bellini L, Shea J. Mood change and empathy decline persist during three years of internal medicine training. Acad Med. 2005; 80(2):164-7. https://doi.org/10.1097/00001888-200502000-00013 DOI: https://doi.org/10.1097/00001888-200502000-00013
Hojat M, Gonnella J, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36(6):522-7. https://doi.org/10.1046/j.1365-2923.2002.01234.x DOI: https://doi.org/10.1046/j.1365-2923.2002.01234.x
Kreitzer M J, Klatt M. Educational innovations to foster resilience in the health professions. Med Teach. 2017;39(2):153-9. https://doi.org/10.1080/0142159X.2016.1248917 DOI: https://doi.org/10.1080/0142159X.2016.1248917
Moir F, Yielder J, Sanson J, Chen Y. Depression in medical students: current insights. Adv Med Educ Pract. 2018;9:323–33. https://doi.org/10.2147/AMEP.S137384 DOI: https://doi.org/10.2147/AMEP.S137384
Bergmann C, Muth T, Loerbroks A. Medical students’ perceptions of stress due to academic studies and its interrelationships with other domains of life: a qualitative study. Med Educ Online. 2019;24(1):1603526. https://doi.org/10.1080/10872981.2019.1603526 DOI: https://doi.org/10.1080/10872981.2019.1603526
Thomas M, Bigatti S. Perfectionism, impostor phenomenon, and mental health in medicine: a literature review. Int J Med Educ. 2020;11:201–13. https://doi.org/10.5116/ijme.5f54.c8f8 DOI: https://doi.org/10.5116/ijme.5f54.c8f8
Dyrbye L, Thomas M, Shanafelt T. Medical student distress: causes, consequences, and proposed solutions. Mayo Cli Proc. 2005;80(12):1613-22. https://doi.org/10.4065/80.12.1613 DOI: https://doi.org/10.4065/80.12.1613
Neufeld A, Malin G. Exploring the relationship between medical student basic psychological need satisfaction, resilience, and well-being: a quantitative study. BMC Med Educ. 2019;19(405). https://doi.org/10.1186/s12909-019-1847-9 DOI: https://doi.org/10.1186/s12909-019-1847-9
Noori S, Blood A, Meleca J, Kennedy V, Sengupta D. Current directions in medical student well-being. Col Med Rev. 2017;1(2):10-19. https://doi.org/10.7916/D8572PZK
Hankir A, Zaman R. Stigma and mental health challenges in medical students. BMJ Case Rep. 2014;(2014):bcr2014205226. https://doi.org/10.1136/bcr-2014-205226 DOI: https://doi.org/10.1136/bcr-2014-205226
Klein HJ, McCarthy S M. Student wellness trends and interventions in medical education: a narrative review. Humanit Soc Sci Commun. 2022;9(92). https://doi.org/10.1057/s41599-022-01105-8 DOI: https://doi.org/10.1057/s41599-022-01105-8
Daya Z, Hearn J. Mindfulness interventions in medical education: a systematic review of their impact on medical student stress, depression, fatigue and burnout. Med Teach. 2018; 40(2):146-53. https://doi.org/10.1080/0142159X.2017.1394999 DOI: https://doi.org/10.1080/0142159X.2017.1394999
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 DOI: https://doi.org/10.1111/medu.12927
Hutchinson TA, Liben S. Mindful medical practice: an innovative core course to prepare medical students for clerkship. Perspect Med Educ. 2020;9(4):256–9. https://doi.org/10.1007/s40037-020-00591-3 DOI: https://doi.org/10.1007/S40037-020-00591-3
Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: a systematic review. Clin Teach. 2013;10(4): 242-5. https://doi.org/10.1111/tct.12014 DOI: https://doi.org/10.1111/tct.12014
Lee J, Graham AV. Students’ perception of medical school stress and their evaluation of a wellness elective. Med Educ. 2001;35(7): 652-9. https://doi.org/10.1046/j.1365-2923.2001.00956.x DOI: https://doi.org/10.1046/j.1365-2923.2001.00956.x
Moutier C, Norcross W, Jong P, et al. The suicide prevention and depression awareness program at the University of California, San Diego school of medicine. Acad Med. 2012;87(3): 320–6. https://doi.org/10.1007/s40596-021-01439-6 DOI: https://doi.org/10.1097/ACM.0b013e31824451ad
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 DOI: https://doi.org/10.1097/ACM.0b013e3181c46963
Slavin SJ, Schindler DL, Chibnall JT. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014;89(4):573–7. https://doi.org/10.1097/ACM.0000000000000166 DOI: https://doi.org/10.1097/ACM.0000000000000166
Edmonds VS, Chatterjee K, Girardo ME, Butterfield R J, Stonnington CM. Evaluation of a novel wellness curriculum on medical student wellbeing and engagement demonstrates a need for student-driven wellness programming. Teach Learn Med. 2022;35(1):52–64. https://doi.org/10.1080/10401334.2021.2004415 DOI: https://doi.org/10.1080/10401334.2021.2004415
Chatterjee K, Edmonds VS, Girardo ME, Vickers KS, Hathaway JC, Stonnington CM. Medical students describe their wellness and how to preserve it. BMC Med Educ. 2022;22(510). https://doi.org/10.1186/s12909-022-03552-y DOI: https://doi.org/10.1186/s12909-022-03552-y
Velez C, Gupta N, Gendreau P. The development and implementation of a longitudinal wellness curriculum for McGill University’s undergraduate medical program. Int J Whole Pers Care. 2019;6(22):6-21. https://doi.org/10.26443/ijwpc.v6i1.188 DOI: https://doi.org/10.26443/ijwpc.v6i1.188
Hettler B. Wellness promotion on a university campus. Fam Community Health. 1980;3(1):77-95. https://doi.org/10.1097/00003727-198005000-00008 DOI: https://doi.org/10.1097/00003727-198005000-00008
Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc. 2016;91(4):422–31. https://doi.org/10.1016/j.mayocp.2016.02.001 DOI: https://doi.org/10.1016/j.mayocp.2016.02.001
Creswell J, Poth C. Qualitative inquiry & research design: choosing among five approaches. 4th ed. Thousand Oaks (CA): Sage; 2018.
Glatthorn A, Boschee F, Whitehead B. Curriculum leadership: development and implementation. Thousand Oaks (CA): Sage; 2006.
Vaterlaus JM, Higginbotham BJ. Qualitative evaluation methods The Forum for Family and Consumer Issues; 2011. Available from: http://www.ncsu.edu/ffci/publications/2011/v16-n1-2011-spring/vaterlaus-higginbotham.php. [Accessed Mar 20, 2023].
Onwuegbuzie AJ, Dickinson WB, Leech NL, Zoran AG. A qualitative framework for collecting and analyzing data in focus group research. Int J Qual Methods. 2009;8:1-21. https://doi.org/10.1177/160940690900800301 DOI: https://doi.org/10.1177/160940690900800301
Nestel D, Ivkovic A, Hill R, et al. Benefits and challenges of focus groups in the evaluation of a new graduate entry medical programme. Assess Eval High Educ. 2012;37(1):1-17. https://doi.org/10.1080/02602938.2010.494232 DOI: https://doi.org/10.1080/02602938.2010.494232
Hill-Mey PE, Merrill RM, Kumpfer KL, Reel J, Hyatt-Neville B. A focus group assessment to determine motivations, barriers and effectiveness of a university-based worksite wellness program. Health Promot Perspect. 2013;3(2):154-164. https://doi.org/10.5681%2Fhpp.2013.019
Lie D, Shapiro J, Pardee S, Najm W. A focus group study of medical students’ views of an integrated complementary and alternative medicine (CAM) curriculum: students teaching teachers. Med Educ Online. 2008;13(3):1-13. https://doi:10.3885/meo.2008.Res00252.
Walling A, Istas K, Bonaminio G, et al. Medical student perspectives of active learning: a focus group study. Teach Learn Med. 2017;29(2):173-180. https://doi:10.1080/10401334.2016.1247708 DOI: https://doi.org/10.1080/10401334.2016.1247708
Rudestam KE, Newton RR. Surviving your dissertation: a comprehensive guide to content and process. 3rd ed. Thousand Oaks (CA): Sage; 2007.
Krueger RA. Focus groups: a practical guide for applied research. 2nd ed. Thousand Oaks (CA): Sage; 1994.
Frasier P, Slatt L, Kowlowitz V, Kollisch D, Mintzer M. Focus groups: a useful tool for curriculum evaluation. Fam Med. 1997; 29(7): 500-7.
Hull S, DiLalla L, Dorsey J. Student attitudes toward wellness, empathy, and spirituality in the curriculum. Acad Med. 2001;76(5):520. https://doi.org/10.1097/00001888-200105000-00053 DOI: https://doi.org/10.1097/00001888-200105000-00053
Lie D, Shapiro J, Pardee S, Najm W. A focus group study of medical students’ views of an integrated complementary and alternative medicine (CAM) curriculum: students teaching teachers. Med Educ Online. 2008;13(3):1-13. https://doi.org/10.3885/meo.2008.Res00252 DOI: https://doi.org/10.3402/meo.v13i.4473
Rabiee F. Focus-group interview and data analysis. Proc Nutr Soc. 2004;63(4):655–60. https://doi.org/10.1079/pns2004399 DOI: https://doi.org/10.1079/PNS2004399
Guba EG, Lincoln YS. Fourth generation evaluation. Newbury Park (CA): Sage; 1989.
Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004; 22, 63-75. https://doi.org/10.3233/EFI-2004-22201 DOI: https://doi.org/10.3233/EFI-2004-22201
Smith S, Kassam A, Griggs L, Rizzuti F, Horton J, Brown A. Teaching mindfulness-based stress management techniques to medical learners through simulation. Can Med Educ J. 2021;12(1):e95–e97. https://doi.org/10.36834/cmej.69821 DOI: https://doi.org/10.36834/cmej.69821
Hategan A, Riddell T. Bridging the gap: Responding to resident burnout and restoring well-being. Perspect Med Educ. 2020;9(2):117–22. https://doi.org/10.1007/s40037-020-00567-3 DOI: https://doi.org/10.1007/S40037-020-00567-3
Wekam V, Vance-Chalcraft HD. Investigating prior mentoring experiences of medical students and its perceived benefits. J Microbiol Biol Educ. 2022; 23(1):e00209-21. https://doi.org/10.1128/jmbe.00209-21 DOI: https://doi.org/10.1128/jmbe.00209-21
Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual. Health Res. 2016;26(13):1753-1760. https://doi.org/10.1177/1049732315617444 DOI: https://doi.org/10.1177/1049732315617444
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