Flourishing as a Measure of Global Well-being in First Year Residents: A Pilot Longitudinal Cohort Study

Abstract

Background: Physician well-being is critical to optimal learning and performance, yet we remain without validated measures to gauge the efficacy of well-being curricula for trainees. This study evaluates initial evidence of flourishing as a valid measure of global well-being in postgraduate-year-1 residents (PGY-1s), providing a means of assessing well-being intervention efficacy. Study design: In this single-site study of PGY-1s participating in Enhanced Stress Resilience Training (ESRT), an online questionnaire of published measures was administered at baseline (T1, just before PGY-1), post-ESRT (T2, 7 weeks later), and at PGY-1 end (T3, 11 months later). The Mental Health Continuum (MHC) was used to assess our primary outcome variable, flourishing, a well-established metric of psychosocial thriving in non-physicians that can be treated continuously or categorically. Correlation between flourishing and both resilience (mindfulness and workplace support) and risk (emotional exhaustion, depersonalization, stress, depressive symptoms, anxiety, and workplace demand) factors was assessed at each time-point and longitudinally. Results: Forty-five interns completed the survey at T1, 37 at T2, and 21 at T3; 21 responded at all time points. MHC score was significantly positively correlated with mindfulness (β = 1.47, SE = 0.35, P < .001) and workplace support (β = 2.02, SE = 1.01, P = .05) longitudinally, and at all time points. Flourishing was significantly negatively correlated with depressive symptoms (β = −7.48, SE = 1.68, P < .001), stress (β = −1.28, SE = 0.29, P < .001), and anxiety (β = −1.74, SE = 0.38, P < .001) longitudinally and at all time points, and significantly negatively correlated with emotional exhaustion (β = −2.65, SE = 0.89, P = .003) longitudinally and at T1 (β = −3.36, SE = 1.06, P = .003). Conclusion: Flourishing showed appropriate correlation with established resilience and risk factors, thus supporting its concurrent validity as a measure of global well-being in this population. As such, the MHC may provide a simple, meaningful assay of well-being and an effective tool for evaluating the efficacy of well-being interventions. Further validation requires a larger, multi-center study.

Flourishing in Healthcare Trainees: Psychological Well-Being and the Conserved Transcriptional Response to Adversity

“…Interestingly, to our knowledge, the only other study to examine flourishing using an alternative measure found results that are discrepant with those found here and with the other studies that used the MHC-SF. Specifically, this study and the previous two that used the MHC-SF found higher rates of flourishing among residents than has been found in a general adult population [ 73 , 85 ]. However, the study that used VanderWeele’s flourishing measure found lower flourishing scores, prompting the interpretation that medical residents have lower rates of flourishing than community samples [ 112 ].…”

“…For example, an early study of over 3000 adults in the United States between the ages of 25 and 74 revealed that only 17% fit the criteria for flourishing, with 12% of adults meeting the criteria for languishing [ 62 ]. Lebares and colleagues’ longitudinal survey of mixed-specialty first year trainees found rates of flourishing between 76% to almost 86%, depending on when the resident was surveyed [ 73 ]. In combination, the findings from our study and those from the study of Lebares et al indicate that flourishing remains high among resident physicians, even while burnout and depression rates are of concern.…”

“…Loneliness and stress remained independent negative predictors of flourishing when included in the same multi-variate analysis. Previous studies examining flourishing (as measured by the MHC) among residents found that flourishing was positively associated with workplace support, but not with workplace demand [ 73 , 85 ]. Together, these findings further highlight the importance of social connection for well-being among resident physicians.…”

“…Previous research has linked flourishing with more optimal biomarkers of inflammation [ 60 , 65 ], positive health behaviors and outcomes [ 66 , 67 , 68 , 69 ], and job satisfaction [ 70 , 71 , 72 ]; however, few studies have examined healthcare trainees. One recent study of resident physicians found that flourishing as measured by the mental health continuum (MHC) was positively associated with resilience and coping and negatively correlated with emotional exhaustion and negative affect [ 73 ]. Here, we conducted an exploratory study to assess the relationship between flourishing and mental health symptoms, psycho-social characteristics, and CTRA gene regulation among healthcare trainees.…”

Wise Ancestors, Good Ancestors: Why Mindfulness Matters in the Promotion of Planetary Health

“…There are several reasons why mindfulness-attentional focus on the present, momentary, experience, and regulation of emotions in the present moment via a nonjudgmental attitude [68]-emerges as salient in discourse related to wisdom and flourishing. First, correlations between high levels of wisdom and mindfulness [69] have been noted, and mindfulness has been identified as a predictor of wisdom [70,71]; second, mindfulness has also been correlated with human flourishing [72][73][74] and lower allostatic load [75]. Thirdly, in an era where the need for wise leaders is an urgent priority, it is worth noting the emerging research demonstrating that mindfulness among leaders in various workplaces has a positive influence on employee wellbeing [76][77][78][79].…”