Medical student mental health 3.0: improving student wellness through curricular changes

Stuart J Slavin, Debra L Schindler, John T Chibnall, Stuart J Slavin, Debra L Schindler, John T Chibnall

Abstract

Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009-2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health.

Conflict of interest statement

Other disclosures: None reported.

References

    1. Strecker EA, Appel KE, Palmer HD, Braceland FJ. Psychiatric studies in medical education. Am J Psychiatry. 1936;92:937–957.
    1. Hutchins EB. The AAMC longitudinal study: Implications for medical education. J Med Educ. 1964;39:265–277.
    1. McGuire FL. Psycho-social studies of medical students: A critical review. J Med Educ. 1966;41:424–445.
    1. Adsett CA. Psychological health of medical students in relation to the medical education process. J Med Educ. 1968;43:728–734.
    1. Stress in medical students. Lancet. 1980;1:129–130.
    1. Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: A five-year prospective longitudinal study. J R Soc Med. 1998;91:237–243.
    1. Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260:2521–2528.
    1. Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students’ depression at one medical school. Acad Med. 1997;72:542–546.
    1. Zoccolillo M, Murphy GE, Wetzel RD. Depression among medical students. J Affect Disord. 1986;11:91–96.
    1. Rosenthal JM, Okie S. White coat, mood indigo—depression in medical school. N Engl J Med. 2005;353:1085–1088.
    1. Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: A multischool study. Acad Med. 2009;84:236–241.
    1. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334–341.
    1. Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. Compr Psychiatry. 1984;25:552–565.
    1. Vitaliano PP, Maiuro RD, Russo J, Mitchell ES. Medical student distress. A longitudinal study. J Nerv Ment Dis. 1989;177:70–76.
    1. Hojat M, Glaser K, Xu G, Veloski JJ, Christian EB. Gender comparisons of medical students’ psychosocial profiles. Med Educ. 1999;33:342–349.
    1. Dyrbye LN, Thomas MR, Power DV, et al. Burnout and serious thoughts of dropping out of medical school: A multi-institutional study. Acad Med. 2010;85:94–102.
    1. Dyrbye LN, Massie FS, Jr, Eacker A, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304:1173–1180.
    1. Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: A consensus statement. JAMA. 2003;289:3161–3166.
    1. Schernhammer ES, Colditz GA. Suicide rates among physicians: A quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161:2295–2302.
    1. Schernhammer E. Taking their own lives—the high rate of physician suicide. N Engl J Med. 2005;352:2473–2476.
    1. Thompson D, Goebert D, Takeshita J. A program for reducing depressive symptoms and suicidal ideation in medical students. Acad Med. 2010;85:1635–1639.
    1. 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;87:320–326.
    1. Drolet BC, Rodgers S. A comprehensive medical student wellness program—design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85:103–110.
    1. Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998;21:581–599.
    1. Saunders PA, Tractenberg RE, Chaterji R, et al. Promoting self-awareness and reflection through an experiential mind–body skills course for first year medical students. Med Teach. 2007;29:778–784.
    1. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302:1284–1293.
    1. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15:88–92.
    1. Bloodgood RA, Short JG, Jackson JM, Martindale JR. A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Acad Med. 2009;84:655–662.
    1. Rohe DE, Barrier PA, Clark MM, Cook DA, Vickers KS, Decker PA. The benefits of pass–fail grading on stress, mood, and group cohesion in medical students. Mayo Clin Proc. 2006;81:1443–1448.
    1. Robins LS, Fantone JC, Oh MS, Alexander GL, Shlafer M, Davis WK. The effect of pass/fail grading and weekly quizzes on first-year students’ performances and satisfaction. Acad Med. 1995;70:327–329.
    1. Reed DA, Shanafelt TD, Satele DW, et al. Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: A multi-institutional study. Acad Med. 2011;86:1367–1373.
    1. Moore-West M, Harrington DL, Mennin SP, Kaufman A. Distress and attitudes toward the learning environment: Effects of a curriculum innovation. Res Med Educ. 1986;25:293–300.
    1. Camp DL, Hollingsworth MA, Zaccaro DJ, Cariaga-Lo LD, Richards BF. Does a problem-based learning curriculum affect depression in medical students? Acad Med. 1994;69(10 suppl):S25–S27.
    1. Seligman MEP. Flourish: A Visionary New Understanding of Happiness and Well-Being. New York, NY: Free Press; 2011.
    1. Slavin SJ, Hatchett L, Chibnall JT, Schindler D, Fendell G. Helping medical students and residents flourish: A path to transform medical education. Acad Med. 2011;86:e15.
    1. Slavin SJ, Schindler D, Chibnall JT, Fendell G, Shoss M. PERMA: A model for institutional leadership and culture change. Acad Med. 2012;87:1481.
    1. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
    1. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory (Form Y) Palo Alto, Calif: Consulting Psychologists Press; 1983.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396.
    1. Chin WW, Salisbury WD, Pearson AW, Stollak MJ. Perceived cohesion in small groups: Adapting and testing the perceived cohesion scale in a small-group setting. Small Gr Res. 1999;30:751–766.
    1. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: Prospective cohort study. BMJ. 2008;336:488–491.
    1. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: A missing quality indicator. Lancet. 2009;374:1714–1721.
    1. Williams ES, Manwell LB, Konrad TR, Linzer M. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: Results from the MEMO study. Health Care Manage Rev. 2007;32:203–212.

Source: PubMed

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