Association Between Learning Environment Interventions and Medical Student Well-being

Wasson, Lauren; Cusmano, Amberle; Meli, Laura; Louh, Irene; Falzon, Louise; Hampsey, Meghan; Young, Geoffrey H.; Shaffer, Jonathan A.; Davidson, Karina W.

doi:10.1001/jama.2016.17573

Cited by 196 publications

(233 citation statements)

References 84 publications

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“…9,97,98 Modifiable stressors also need to be addressed to improve well-being. As a recent systematic review 99 revealed, there is no satisfactory evidence that learning environment interventions could contribute to improved mental well-being in medical students; additional high-quality research is needed in this area. We observed that signs of lack of motivation (e.g., thoughts of dropping out, dissatisfaction with the course, decreased academic efficacy) and lack of emotional support were associated with MHP, as in medical students from other countries.…”

Section: Discussionmentioning

confidence: 99%

Mental health problems among medical students in Brazil: a systematic review and meta-analysis

Pacheco

Giacomin

Tam

et al. 2017

Rev. Bras. Psiquiatr.

374

214

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Objective: To provide a comprehensive picture of mental health problems (MHPs) in Brazilian medical students by documenting their prevalence and association with co-factors. Methods: We systematically searched the MEDLINE/PubMed, SciELO, LILACS, and PsycINFO databases for cross-sectional studies on the prevalence of MHPs among medical students in Brazil published before September 29, 2016. We pooled prevalences using a random-effects meta-analysis, and summarized factors associated with MHP. Results: We included 59 studies in the analysis. For meta-analyses, we identified the summary prevalence of different MHPs, including depression (25 studies, prevalence 30.6%), common mental disorders (13 studies, prevalence 31.5%), burnout (three studies, prevalence 13.1%), problematic alcohol use (three studies, prevalence 32.9%), stress (six studies, prevalence 49.9%), low sleep quality (four studies, prevalence 51.5%), excessive daytime sleepiness (four studies, prevalence 46.1%), and anxiety (six studies, prevalence 32.9%). Signs of lack of motivation, emotional support, and academic overload correlated with MHPs. Conclusion: Several MHPs are highly prevalent among future physicians in Brazil. Evidence-based interventions and psychosocial support are needed to promote mental health among Brazilian medical students.

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Section: Discussionmentioning

confidence: 99%

Mental health problems among medical students in Brazil: a systematic review and meta-analysis

Pacheco

Giacomin

Tam

et al. 2017

Rev. Bras. Psiquiatr.

374

214

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“…Previous interventions to reduce burnout and promote wellbeing among healthcare workers have targeted the work environment and individual behaviors or cognitions (e.g., coping) (Panagioti et al, 2016; Ruotsalainen et al, 2015; Wasson et al, 2016). In general, the quality of evidence for such interventions is low, and depending on the exact population of healthcare workers and the type of organization being examined, institution-level interventions may be more or less effective (Panagioti et al, 2016; Ruotsalainen et al, 2015; Wasson et al, 2016). Our results could inform development or improvement of future interventions in several ways.…”

Section: Discussionmentioning

confidence: 99%

12-month trajectories of depressive symptoms among nurses—Contribution of personality, job characteristics, coping, and burnout

Duan-Porter

Hatch

Pendergast

et al. 2018

Journal of Affective Disorders

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Background: Job related factors have been associated with higher risk for developing depression, but past studies lacked full consideration of individual factors such as personality and coping. We sought to evaluate associations of personality, coping, job characteristics, and burnout with 12-month trajectories of depressive symptoms among nursing workers. Methods: Cohort of nursing workers (N = 281) in a private hospital system, with baseline assessments of personality, job characteristics, and coping. Burnout and depression were measured at baseline and during monthly follow-ups. Linear mixed modeling was used to examine contributions to between- and within-individual variation in monthly depressive symptoms. Results: Personality trait of negative affectivity accounted for 36% of between-individual variation in depressive symptoms over 12 months, while job characteristics and coping explained an additional 5% and 8% of this variation, respectively. Exhaustion dimension of burnout was associated with between-individual variation in depressive symptoms (fixed effect β coefficient 2.44, p < 0.001), but not with within-individual variation in symptoms. Disengagement dimension of burnout was not associated with between-individual variation in depressive symptoms, but contributed to within-individual variation in depressive symptoms over time (fixed effect β coefficient 0.52, p = 0.01). Limitations: Participants were nursing workers within a single hospital system. Participants who were excluded due to missing baseline data were more likely of non-white race, which may also limit the generalizability of our results. We used latent variables to represent certain job and coping characteristics, which may make our results less comparable with other studies examining the role of these factors in work-associated depression. Conclusions: Future interventions to prevent depression in healthcare workers should consider multiple job and individual factors. Potential components include strategies to manage negative affectivity and reduce avoidant coping, such as cognitive reframing and mindfulness-based techniques, and organizational approaches to address burnout through augmentation of job resources.

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“…The model is also thought to combine aspects of various other approaches to medical student mental health, including individual skill-building programs such as mindfulness, mentoring, and curriculum-based programs that target student health and wellbeing. In this way, the model is thought to answer the call for more comprehensive reform of the medical education environment (Wasson et al, 2016) and incorporation of multiple strategies to target student mental health. However, it must be noted that there is a long way to go in furthering the implementation of the model and consequent revisions over time.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review of these various wellbeing-based interventions within the medical student population concluded that some specific learning environment interventions were found to be associated with improved wellbeing amongst students (Wasson et al, 2016). More specifically, the review recommended 'comprehensive reform' within the learning environment, that incorporates a range of targeted interventions, as most likely to be effective.…”

Section: The Medical Student Journeymentioning

confidence: 99%

‘Just What the Doctor Ordered’: Promoting Wellbeing with Medical Students

Sloan¹,

Clayman²

2018

JANZSSA

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The tertiary student experience is not the same for all. Some students navigate the challenges of student life and flourish amidst stresses, whilst others experience considerable distress and disengage (Stallman, 2010;Larcombe et al., 2015). Much research has sought to identify what factors contribute to students' thriving at university and what constitutes a successful student. Medical students have long been thought of as 'successful' students with high academic attainments and abilities, however recent research suggests medical students experience higher rates of mental health distress and suicidal ideation compared to the broader student population (Rotenstein et al., 2016). In recognition of the challenges faced by medical students, in 2017 the Melbourne Medical School (MMS) developed a new proactive approach to student wellbeing through adopting a 'Health Promoting University' strategic model (Okanagan Charter, 2015). The overarching strategic model entails a stage-based process of program endorsement, implementation and evaluation; of which the MMS is currently half way through (Stage 4). The framework has facilitated the development of proactive individual interventions and group based programs, all designed in close consultation with medical students, and seeking to broaden the scope of what constitutes a successful medical student. This innovative approach to medical student health and wellbeing demonstrates a schoolwide, prevention-based approach to promoting student wellbeing. The authors detail the design, beginning stages of delivery, and future plans and aspirations for this evidence-based model of student wellbeing. Keywords Medical Students, Mental Health, WellbeingCommencing university: The big picture Commencing university has long been considered a stressful life transition for young adults, marked by complex changes in social, emotional and academic domains (Gerdes & Mallinckrodt, 1994). This transition represents more than just a discrete or acute life change, but rather a series of life stressors and adjustment difficulties manifesting over the course of university life (Lu, 1994). Some of the stressors associated with this transition include establishing greater levels of independence in the midst of increased levels of social instability, as well as changes in both the quantity and quality of social relationships (Larose & Boivin, 1998;Tanner, 2006). Furthermore the university context involves a range of unique stressors including: increased study load, academic pressures (i.e., pressure to achieve good grades and graduate), studying in a more self-directed manner, and learning in an environment that is largely unfamiliar (Chemers, Hu & Garcia, 2001;Jones & Frydenberg, 1998). Students are often also juggling the broader developmental tasks and responsibilities associated with their age period, such as establishing independence from primary care givers and consolidating a sense of self-identity (Havighurst, 1972;Mattanah, Lopez & Govern, 2011). Given these challenges, commencing u...

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Association Between Learning Environment Interventions and Medical Student Well-being

Cited by 196 publications

References 84 publications

Mental health problems among medical students in Brazil: a systematic review and meta-analysis

Mental health problems among medical students in Brazil: a systematic review and meta-analysis

12-month trajectories of depressive symptoms among nurses—Contribution of personality, job characteristics, coping, and burnout

‘Just What the Doctor Ordered’: Promoting Wellbeing with Medical Students

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