Medical student wellness: Blueprints for the curriculum of the future
The focus on wellness in medical education is growing, and it’s motivating students and faculty to search for the path to the wellness-centered learning environment of the future.
Several submissions to the AMA Medical Education Innovation Challenge, which encouraged students around the nation to upend the traditional medical school curriculum with outside-the-box ideas, and projects within the AMA Accelerating Change in Medical Education Consortium emphasize student wellness.
The goal is to create physicians who are better equipped to take care of themselves and therefore able to serve patients throughout the course of their medical careers.
Building health for the healer
A team of students from the University of Louisville School of Medicine, which placed third in the Innovation Challenge, set out an ambitious goal to forge “an ideal version of medical education.”
In their proposal, “Happy healers, healthy humans: A wellness curricular model as a means of effecting cultural change, reducing burnout and improving patient outcomes,” the four team members said the current environment is stressful and self-awareness, empathy and communication skills suffer.
Their vision is of a medical school curriculum with an emphasis on student wellness comprised of physical, mental and spiritual health. Under their curriculum, students build coping and self-care skills with goal-setting groups, reflection and cognitive behavioral therapy.
This vision even includes redesigning the medical school buildings. If the library is next to a gym, if the school provides stationary bikes, treadmill desks and meditation zones, the school promotes student wellness.
“The healthiest choices also become the easiest choices,” said student Matthew Neal, an author of the proposal. “You make it so the path of least resistance leads to wellness, and folks will take care of the rest.”
A team of Eastern Virginia Medical School (EVMS) students submitted a proposal to the challenge titled, “The medical education manifesto: Training the physician change agent of tomorrow,” and said the current system fails to preserve student idealism and the vision of “changing the world for the better.” Students tend to become more cynical and less idealistic as they move through their education, said Heath Patel, an author of the proposal.
“Our work promotes wellness by preventing this phenomenon,” he said.
Patel and three other students propose fostering wellness with a curriculum that preserves idealism and humanism, and makes time for what they call gratitude, mindfulness and reflection. The result is a student driven by his or her core values and beliefs and more resistant to burnout.
“Intrinsic motivation is armor that protects from the difficulties of life,” Patel said.
The medical school administration already has taken steps toward those values. In the fall of 2016 EVMS will debut the school’s CareForward Curriculum, which integrates student wellness as a guiding principal. EVMS is a member of the AMA’s Accelerating Change in Medical Education Consortium.
The four-year longitudinal curriculum promotes student well-being, academic success and resilience, said Allison Knight, PhD, who leads the wellness element of CareForward. Senthil Kumar Rajasekaran, MD, assistant dean for academic affairs, is leading the curriculum reform at EVMS.
CareForward builds first-year students’ emotional skills to help deal with the transition to medical school and encourages students to monitor their sleep, nutrition and exercise routines. Throughout the curriculum, there is an emphasis on asking for help when needed and cultivating supportive relationships.
The curriculum also features periodic, confidential mental health screenings and weekly protected time for health maintenance and well-being activities.
Supporting medicine’s social mission
The Innovation Challenge proposal, “Reaffirming medicine’s social mission,” from a team based at Yale School of Medicine, called for greater emphasis on social responsibility as a way to wellness.
“Reinforcing social responsibility as a crucial part of medicine through curricular reform and cultural changes is necessary to promote wellness,” said Tehreem Rehman, an author.
Many who go into medicine with the goal of helping underserved populations face obstacles that challenge their own well-being. Those on the front lines of coping with health inequities suffer the most the proposal said.
The proposal called for a curriculum that values contemplative practices that can lower burnout, improve joy and foster social responsibility. Rehman said contemplation allows those in the medical community to “process all of the chaos and trauma that medical training and practice inevitably entails.”
Preparing students for the business side of practice
A team of students from Ohio University Heritage College of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine and Rowan University School of Osteopathic Medicine in their Innovation Challenge proposal tied burnout and stress to a common lack understanding of the business side of medicine among physicians.
According to their proposal, “Training students to be prepared for the modern challenges of health care: Lessons learned in business school,” that lack of understanding has grown in importance as business issues play an ever-larger role in decisions that affect physicians.
“Being able to have a say [in] your practice can give you a sense of ownership and lead to less burnout,” said Dan Krajcik, a dual DO and MBA student at Ohio University and lead author of the proposal.
A greater understanding of mental health issues among students inspired him to take part in the Medical Education Innovation Challenge, Krajcik said—he helped carry out a survey of 10,000 osteopathic students and found more depression, anxiety and suicide than in the general population.
Addressing the hazards of education
These and other proposals are part of ongoing work to foster medical student wellness. Some efforts are as simple as retreats to the mountains or low rates for gym membership, while others are more comprehensive.
Mayo Medical School researchers have studied wellness among students for more than 14 years. Lotte Dyrbye, MD, professor of medicine at Mayo, has studied burnout since 2004, and the school is a founding member of the AMA’s Accelerating Change in Medical Education Consortium. Close to one-half of medical students in the United States experience burnout, she has said.
“Trying to become a doctor shouldn’t be a hazard,” Dr. Dyrbye said in a recent tweet chat convened by the AMA.
She has identified six important ways to prevent future physicians from experiencing what she calls “student distress”—these actions recognize the need for broad changes and involvement by both students and the broader medical community in making them happen.