Medical student wellness in Canada: time for a national curriculum framework

There is substantial evidence showing that medical student wellness is a worsening problem in Canada. It is apparent that medical students’ wellness deteriorates throughout their training. Medical schools and their governing bodies are responding by integrating wellness into competency frameworks and accreditation standards through a combination of system- and individual-level approaches. System-level strategies that consider how policies, medical culture, and the “hidden curriculum” impact student wellness, are essential for reducing burnout prevalence and achieving optimal wellness outcomes. Individual-level initiatives such as wellness programming are widespread and more commonly used. These are often didactic, placing the onus on the student without addressing the learning environment. Despite significant progress, there is little programming consistency across schools or training levels. There is no wellness curriculum framework for Canadian undergraduate medical education that aligns with residency competencies. Creating such a framework would help align individual- and system-level initiatives and smooth the transition from medical school to residency. The framework would organize goals within relevant wellness domains, allow for local adaptability, consider basic learner needs, and be learner-informed. Physicians whose wellness has been supported throughout their training will positively contribute to the quality of patient care, work environments, and in sustaining a healthy Canadian population.

A Positive Depression Screen Is Associated with Emergency Medicine Resident Burnout and Is not Affected by the Implementation of a Wellness Curriculum

Introduction: While burnout is occupation-specific, depression affects individuals comprehensively. Research on interventions for depression in emergency medicine (EM) residents is limited. Objectives: We sought to obtain longitudinal data on positive depression screens in EM residents, assess their association with burnout, and determine whether implementation of a wellness curriculum affected the rate of positive screens. Methods: In February 2017, we administered the Maslach Burnout Inventory and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire two-question depression screen at 10 EM residencies. At five intervention sites, a year-long wellness curriculum was then introduced while five control sites agreed not to introduce new wellness initiatives during the study period. Study instruments were re-administered in August 2017 and February 2018. Results: Of 382 residents, 285 participated in February 2017; 40% screened positive for depression. In August 2017, 247/386 residents participated; 27.9% screened positive for depression. In February 2018, 228/386 residents participated; 36.2% screened positive. A positive depression screen was associated with higher burnout. There were similar rates of positive screens at the intervention and control sites. Conclusion: Rates of positive depression screens in EM residents ranged between 27.9% and 40%. Residents with a positive screen reported higher levels of burnout. Rates of a positive screen were unaffected by introduction of a wellness curriculum.

Development of a Wellness Curriculum at a New Regional Campus: A Pilot Study

Background: Burnout is a critical issue that is increasingly prevalent among healthcare professionals. Several studies suggest that the decline in mental health and wellness begins in medical school. As such, medical schools across the United States have started to develop proactive approaches to medical student wellness, often in the form of an organized curriculum focused on resilience, mindfulness, and stress-reduction. There is little research describing the implementation and refinement of a wellness curriculum at a small regional campus of an academic medical center. A regional campus represents a unique opportunity to develop a comprehensive wellness program, because of the flexibility of the curriculum and the small number of students. The Penn State College of Medicine University Park Campus sought to develop a wellness program specific to first year medical students (MS1s) and to create a companion program of inter-professional wellness exercises open to all teaching faculty and learners at our regional campus. Methods: The study was reviewed by the Penn State College of Medicine Institutional Review Board (STUDY00011390) and was granted “Exempt” status. Three components of the wellness curriculum were developed: a mandatory, semester-long curriculum for MS1s focused on professional development, a 10-session Tai Chi class accessible to faculty, staff and students, and a series of watercolor painting workshops accessible to faculty and students. Participants completed pre- and post-surveys to assess these interventions. Results: The participation rate for the optional Tai Chi and watercolor workshops was relatively low, with 20% of students attending. Most participants felt that medical schools should be responsible for offering wellness programs for students. The majority of students wanted optional wellness activities to be available, rather than mandatory sessions. Discussion: The information gathered from this pilot study will be used to develop a formal curriculum that is accessible, helpful, and convenient for all members of the regional campus community. In the future, it will be helpful to conduct a needs assessment to ascertain what kind of wellness offerings will be most successful among students, faculty, and staff of a regional medical campus. Conflicts of Interest: None.

A National Curriculum to Address Professional Fulfillment and Burnout in OB-GYN Residents

ABSTRACT Background Physician well-being is a priority in graduate medical education as residents suffer high rates of burnout. With complex stressors affecting the clinical environment, conflicting evidence exists as to whether a formal curriculum improves resident well-being. Objective We assessed the feasibility and impact of a national pilot of a yearlong wellness curriculum for obstetrics and gynecology (OB-GYN) residents. Methods The Council on Resident Education in Obstetrics and Gynecology Wellness Task Force developed a national multicenter pilot group of 25 OB-GYN programs to participate in a prospective cohort study. The curriculum included 6 interactive wellness workshops using uniform teaching materials delivered during didactic time. Prior to and following their participation in the curriculum, residents completed a survey containing demographic information and the Professional Fulfillment Index. Results Among 592 eligible participants, 429 (72%) responded to the pretest and 387 (65%) to the posttest. Average age of respondents was 29.1 years (range = 24–52 years) and included 350 (82%) women and 79 (18%) men. At baseline, 254 of 540 (47%) respondents met criteria for burnout, and 101 (23%) met criteria for robust professional fulfillment. Residents participated in an average of 3.9 workshops. While aggregate posttest scores did not differ from baseline, residents attending 4 to 6 workshops had improved rates of burnout (40% vs 50%, P = .017) and robust professional fulfillment (28% vs 20%, P < .001) compared with those with lower attendance. Conclusions A wellness curriculum was a feasible addition to OB-GYN residency program curricula in programs across the country. Residents with higher attendance experienced improved professional fulfillment and less burnout.

Mindfulness Education for Otolaryngology Residents: A Pilot Study

This pilot project was designed to (1) implement a mindfulness-based wellness curriculum for otolaryngology residents, (2) determine the impact of a mindfulness-based curriculum on resident mood, and (3) examine the use of mindfulness among otolaryngology residents. Otolaryngology residents participated in a 6-week course guided by the Headspace mindfulness mobile application. Resident use of mindfulness was measured by the validated Mindful Attention Awareness Scale (MAAS). Changes in mood before and after each session were assessed using the validated Positive and Negative Affect Schedule (PNAS). Residents reported a statistically significant decrease in postsession negative affect scores ( P < .001). A moderate positive correlation was noted between mindfulness scores and presession positive mood (Pearson r = 0.597, P < .001). This pilot study supports the feasibility and impact of including mindfulness training as part of a resident wellness curriculum.

Building resilient oncologists: A feasibility study of a resiliency curriculum for hematology oncology fellows.

TPS11043 Background: Rates of burnout and career dissatisfaction have declined slightly, but remain high among oncologists (Berg, AMA 2020). As hematology oncology fellows prepare to join this workforce, the ACGME now mandates wellness be a part of their training curriculum. Yet, there are few, if any, structured and effective programs specifically for these trainees. Based on feedback from our prior mindfulness-based wellness curriculum, we created a more varied and comprehensive resiliency program with the use of our institutional resources to incorporate and evaluate as part of our fellowship curriculum (ASCO, Abstract 10508), and potentially expand to other fellowships. Methods: This is a single-center, non-randomized, pilot project to assess the feasibility, acceptability, and impact of a resiliency training program. All hematology oncology fellows at our institution were eligible for enrollment, and participation was voluntary. A total of seven monthly, 1 hour sessions were conducted through the academic year. Each session focused on a particular topic - alternative forms of wellness through art and music, self care, mindfulness and stretching, reflective writing, and healthy boundaries and work life integration - which have all been studied individually in wellness and burnout with positive results. Sessions were co-led by a peer and “expert” guest speakers from our training institution. Participants completed questionnaires pre and post-program, and feedback evaluations after each session. Questionnaires included the Perceived Stress Scale (PSS), Five Facet Mindfulness Questionnaire (FFMQ), Connor Davidson Resiliency Scale (CDRS-10), and modified Maslach Burnout Inventory (MBI), as well as demographics and open response questions. The primary aim was feasibility (enrollment, completion, and compliance rates), and the secondary aim was acceptability (usefulness of the intervention). Examination of stress, mindfulness, resiliency, and burnout were exploratory. Enrollment and data collection are complete, with 18 of 29 (62%) eligible participants consented. Data analysis is in process.