Vital Coach: A Study of Resiliency in Medical Students

Vital Coach: A Study of Resiliency in Medical Students Using Wearable Technology and Personalized Wellness Coaching

Medical students often begin training with psychological and physiological health metrics superior to their age-matched peers. By graduation, however, rates of depression, anxiety, and physiologic dysregulation are markedly higher, reflecting the cumulative strain of long study hours, high-stakes examinations, and the emotional burden of early patient care. Despite this, few medical schools provide structured, evidence-based tools for students to develop resiliency and recovery skills before clinical rotations begin.

Study Overview

• Status: Recruiting
• Conditions: Burnout
• Intervention / Treatment: Behavioral: Arena Strive

Detailed Description

This gap represents both a health crisis and an educational opportunity. Burnout originating in medical school often persists into residency and practice, diminishing empathy and professionalism, and contributing to long-term attrition. Existing wellness offerings are largely reactive, relying on voluntary counseling or broad wellness sessions that fail to provide individualized insight into students' physiological readiness or stress recovery capacity. Moreover, schools lack objective, continuous data to pinpoint when students are physiologically stressed to tailor timely support.

Against this backdrop, this study proposes evaluating a structured performance coaching and biometric feedback approach in the context of scheduled academic stressors. Arena Strive is a digital coaching platform that integrates a virtual human performance coach, wearable-derived biometric data, and a focused skills curriculum adapted from other high-stress domains and tailored to frontline healthcare workers. This novel intervention has proven effective in significantly reducing burnout and enhancing professional fulfillment and self-valuation in a large health-system through an 8-week intervention.

• Study Type: Interventional
• Enrollment (Estimated): 49
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dermot Phelan, MD, PhD; Phone Number: 704 373 0212; Email: Dermot.Phelan@Advocatehealth.org
• Study Contact Backup: Name: Dana Amaro; Phone Number: 704-355-4692; Email: dana.amaro@advocatehealth.org

Study Locations

• United States
  • North Carolina
    • Winston-Salem, North Carolina, United States, 27157
      • Recruiting
      • Wake Forest University Health Sciences
      • Contact: Dermot Phelan, MD, PhD; Phone Number: 704-373-0212; Email: Dermot.Phelan@Advocatehealth.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• active first year Wake Forest School of Medicine medical students
• have an Android or iOS smart phone
• are willing to download the Arena Strive application

Exclusion Criteria:

• under the age of 18; or over the age of 60
• pregnant at enrollment or during course of study
• any self-reported cardiac conditions that may impact heart rate and heart rate variability

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arena Strive; digital coaching platform, which integrates asynchronous coaching, two virtual coaching sessions with a high-performance medicine coach, physiological data from wearable sensors, and a focused curriculum of performance tools tailored to frontline healthcare workers.	Behavioral: Arena Strive; integrates asynchronous coaching, two virtual coaching sessions with a high-performance medicine coach, physiological data from wearable sensors, and a focused curriculum of performance tools tailored to frontline healthcare workers.; Other Names: digital coaching platform

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart Rate Variability	Mean daily nocturnal Heart Rate Variability (HRV): Higher = Better	Weekly through Week 13
Resting Heart Rate (Beats per Minute)	daily nocturnal Resting Heart Rate (RHR): Lower = Better	Weekly through Week 13
Sleep Duration (minutes)	Mean nightly sleep: Higher = Better	Weekly through Week 13
Sleep Consistency (minutes)	SD of mid-sleep time: Lower = Better	Weekly through Week 13

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Perceived Stress (Perceived Stress Scale PSS-4) Scores	To score the Perceived Stress Scale 4 (PSS-4), first, reverse the scores for questions 2 and 3 (0 becomes 4, 1 becomes 3, 2 stays 2, 3 becomes 1, and 4 becomes 0). Then, add up the scores for all four questions. The total score will range from 0 to 16, with higher scores indicating greater perceived stress.	Weekly through Week 13
Change in Burnout (Maslach Burnout Inventory MBI-GSS) Scores	MBI-GSS scoring involves summing responses for each of its three subscales: emotional exhaustion, cynicism, and professional efficacy, which are rated on a 7-point frequency scale from 0 (never) to 6 (daily). To determine burnout, high scores on exhaustion and cynicism indicate higher burnout, while low scores on professional efficacy suggest greater burnout. These subscale scores are then interpreted separately to understand the level of burnout for each dimension. Each item is rated on a frequency scale (e.g., 0 to 6), and higher or lower scores on each subscale indicate different levels of burnout.	Week 13

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exam Performance checklist	Exam performance for the three exams during the study period is self-reported by participants via a typeform in the application at the study conclusion.	Week 13
Weekly mean nocturnal HRV (RMSSD, ms) measured via wearable device during intervention and compared to other phases.	HRV will be assessed using the root mean square of successive differences (RMSSD, ms) to provide a daily individual score derived from nightly photoplethysmography (PPG) wearable-recorded data. All primary endpoints are computed at the individual level and compared by week, using week-level means (averaged from the individual daily scores). Heart Rate Variability (HRV) [RMSSD, ms] Individual Test= Like earlier mentioned tests these will include week-to-week differences for the weeks during the phase (Baseline Week, Study Week, Exam Week, Recovery Week) (ex. HRV_Recovery (during) - HRV_Exam (during) and comparisons with pre/post intervention phases (ex. HRV_Recovery (during) - HRV_Recovery (pre-intervention)). Group Test= A linear mixed model for HRV and PSS-4 with fixed effects for Week, Phase (0=pre, 1=post, 2=during) and a Week x Phase interaction, plus a random intercept for participant. Sensitivity Analyses= Paired t-tests (Wilcoxon as nonparametric alternative).	Weekly through Week 13
Weekly mean nocturnal RHR (bpm) measured via wearable device during intervention and compared to other phases.	Daily mean RHR (bpm) will be derived from nightly PPG wearable-recorded data. All primary endpoints are computed at the individual level and compared by week using week-level means (averaged from the individual daily scores). Resting Heart Rate (RHR) [bpm] Individual Test= Like earlier mentioned tests these will include week-to-week differences for the weeks during the phase (Baseline Week, Study Week, Exam Week, Recovery Week) (ex. RHR_Recovery (during) - RHR_Exam (during) and comparisons with pre/post intervention phases (ex. RHR_Recovery (during) - RHR_Recovery (pre-intervention)). Group Test= A linear mixed model for RHR and PSS-4 with fixed effects for Week, Phase (0=pre, 1=post, 2=during) and a Week x Phase interaction, plus a random intercept for participant. Sensitivity Analyses= Paired t-tests (Wilcoxon as nonparametric alternative).	Weekly through Week 13
Weekly mean Sleep Duration (min) measured via wearable device during intervention and compared to other phases.	Daily Sleep Duration (min) will be derived from nightly PPG wearable-recorded data. All primary endpoints are computed at the individual level and compared by week using week-level means (averaged from the individual daily scores). Sleep Duration [min] Individual Test= Like earlier mentioned tests these will include week-to-week differences for the weeks during the phase (Baseline Week, Study Week, Exam Week, Recovery Week) (ex. SleepDuration_Recovery (during) - Sleep Duration_Exam (during) and comparisons with pre/post intervention phases (ex. SleepDuration_Recovery (during) - SleepDuration_Recovery (pre-intervention)). Group Test= A linear mixed model for Sleep Duration and PSS-4 with fixed effects for Week, Phase (0=pre, 1=post, 2=during) and a Week x Phase interaction, plus a random intercept for participant. Sensitivity Analyses= Paired t-tests (Wilcoxon as nonparametric alternative).	Weekly through Week 13
Weekly Sleep Consistency (SD of mid-sleep time, min) measured via wearable device during intervention and compared to other phases.	Sleep Consistency will be measured as the standard deviation of nightly mid-sleep time derived from wearable-recorded sleep onset and offset times over each 7-day period, aggregated weekly at the individual level and compared across pre-intervention, intervention, and post-intervention phases. Sleep Consistency Individual Test= Like earlier mentioned tests these will include week-to-week differences for the weeks during the phase (Baseline Week, Study Week, Exam Week, Recovery Week) (ex. SleepConsistency_Recovery (during) - SleepConsistency_Exam (during) and comparisons with pre/post intervention phases (ex. SleepConsistency_Recovery (during) - SleepConsitency_Recovery (pre-intervention)). Group Test= A linear mixed model for Sleep Consistency and PSS-4 with fixed effects for Week, Phase (0=pre, 1=post, 2=during) and a Week x Phase interaction, plus a random intercept for participant. Sensitivity Analyses= Paired t-tests (Wilcoxon as nonparametric alternative).	Weekly through Week 13
Heterogeneity of effects (sensitivity only)	Moderation by demographics (age, race, gender) on primary outcomes.	Weekly through Week 13

Collaborators and Investigators

• Sponsor: Wake Forest University Health Sciences
• Investigators: Principal Investigator: Dermot Phelan, MD, PhD, Wake Forest University Health Sciences

Study record dates

Study Major Dates

• Study Start (Actual): January 16, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: December 8, 2025
• First Submitted That Met QC Criteria: January 7, 2026
• First Posted (Actual): January 15, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 26, 2026
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: psychological stress; wellness coaching; performance coaching; biometric feedback
• Additional Relevant MeSH Terms: Behavioral Symptoms; Behavior; Burnout, Psychological; Stress, Psychological
• Other Study ID Numbers: IRB00140462

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No