Medical students describe their wellness and how to preserve it

(2022) 22:510 Chatterjee et al. BMC Medical Education https://doi.org/10.1186/s12909-022-03552-y Open Access RESEARCH Medical students describe their wellness and how to preserve it Krishanu Chatterjee1,2*, Victoria S. Edmonds1,3, Marlene E. Girardo4, Kristin S. Vickers5, Julie C. Hathaway6 and Cynthia M. Stonnington7 Abstract Background: Despite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students’ perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculumembedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students. Methods: Employing a mixed methods analysis of qualitative and longitudinal quantitative data, first- and secondyear students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018–2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters. Results: Nearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn’t address the medical culture met with skepticism. Conclusions: Interview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students’ identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches. Keywords: Education environment, Qualitative analysis, Undergraduate medical education, Student wellness, Wellness curriculum *Correspondence: 2 Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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BMC Medical Education (2022) 22:510 Background As defined by The World Health Organization, wellbeing is “a positive state experienced by individuals and societies” and wellness is “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” In recent years, student wellness during medical school has garnered much needed attention. The increased awareness of physician burnout and depression [1, 2], which has been shown to begin in medical school, [3] motivated individual medical schools as well as the governing bodies of the American Medical Association and the Association of American Medical Colleges to launch programs to assess levels of distress in medical students [4, 5] and to identify the specific stressors responsible [6–8]. The pressure to score highly on examinations, stigma around help-seeking, and a surrounding culture that prioritizes performance over wellness have been a few of the drivers implicated. [9, 10]. These findings have cumulatively led to curricular changes in medical schools throughout the country such as pass/fail grading and integration of wellness programs [11], as well as the recognition that maintaining wellness ought to be a core physician competency [12]. Despite the paucity in empirically evaluated interventions [13], the promise of fostering students’ resilience and professional development via expanded wellness programs at medical school is compelling [11]. The input of medical students themselves has been recognized as crucial to the development and employment of these changes [14, 15]. Collection of qualitative data from students is one way to gather such insights. In previous studies, medical students were recruited to identify their most salient stressors as well as the selfcare behaviors they use to cope with these stressors [16, 17] in order to build the framework for curricular change [18]. Similarly, in other medical school populations, written responses were gathered to open-ended questions regarding the stressors and barriers to wellness encountered in medical school [18–20]. Another compelling study gathered verbal responses to a wide-ranging set of questions about their entire medical school experience through “life-story interviews” with medical students who had already undergone the National Residents Matching Program match [21]. None of these studies, however, sought a mixed methodology, where the details identified through qualitative means could be correlated with longitudinal quantitative survey measures among the same cohort. Such mixed methodology adds context and nuance to the quanti (...truncated)