|Year : 2021 | Volume
| Issue : 2 | Page : 157-161
Promotion of wellness and prevention of illness among medical students
Naresh Nebhinani, Anish Shouan, Swati Choudhary
Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
|Date of Submission||28-Feb-2021|
|Date of Decision||07-Jun-2021|
|Date of Acceptance||14-Jun-2021|
|Date of Web Publication||30-Jun-2021|
Dr. Naresh Nebhinani
Department of Psychiatry, All India Institute of Medical Science, Jodhpur - 342 005, Rajasthan
Source of Support: None, Conflict of Interest: None
Wellness is a concept of optimal well-being, an essential component for medical students at the personal and professional level. While medical education and healthcare service demand an efficient coping reservoir and resilience, but greater burnout and psychological morbidity is being reported among medical students. Responsibility to address the concerns about well-being lies in medical schools, but there is a lack of awareness and nonavailability of such adaptive resources. In this article, we highlight the concept of wellness and its relevance in the context of medical students, models described in the literature for this purpose, and recommendations for wellness of medical students.
Keywords: Medical students, promotion, wellbeing, wellness
|How to cite this article:|
Nebhinani N, Shouan A, Choudhary S. Promotion of wellness and prevention of illness among medical students. Indian J Soc Psychiatry 2021;37:157-61
|How to cite this URL:|
Nebhinani N, Shouan A, Choudhary S. Promotion of wellness and prevention of illness among medical students. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Aug 2];37:157-61. Available from: https://www.indjsp.org/text.asp?2021/37/2/157/320209
| Introduction|| |
Medical education is perceived more stressful than other nonmedical branches of education, as it involves an extensive syllabus of theory and clinical teaching for five and half years in the Indian curriculum (including internship), multiple theory and viva examinations, staying away from home for prolonged durations, competing with multiple intelligent peers daily, and repeated exposure to severe illnesses and mortality of patients. Therefore, it also affects medical students in many ways. Due to biological and psychosocial factors, three-fourth of all lifetime cases of psychiatric disorders evolve by the age of 24 years. In line with the above-mentioned concerns, medical students are at an increased risk of suffering from a mental illness compared to other graduate students (21.2% vs. 8%–15%), but only a smaller proportion of them (7%) are receiving treatment for the same. All in all, medical students are at a higher risk of burnout, have a lower quality of life and are at greater risk of getting suicidal ideations along with suicidal attempt and suicide compared to age-matched populations. This poor mental state appears to deteriorate with the passage of each year of medical training., A recent systematic review and meta-analysis involving medical students from 47 countries demonstrated that 27.2% of the students screened positive for depression and that 11.1% reported suicidal ideation during medical school. However, only 15.7% of students who screened positive for depression reportedly sought treatment. Although the odds of receiving quality mental health care may appear higher than the general population, the reality appears to be the contrary, i.e., medical students are at a lesser chance to receive evidence-based treatment despite the proximity of care. Reasons may range from perceived stigma towards mental illnesses, worry regarding potential consequences, lack of awareness and other personal, family, or service-related issues., The mental health of medical students needs to be discussed and taken care of as it directly impacts the students and the care provided by them to the patients. Therefore, adaptive and promotive strategies are vitally important to improve well-being as in life course several factors and adversities increase the vulnerability of mental illness.
| Conceptual Model of Medical Student Well-Being|| |
As conceptualized in the model of medical Student's well-being by Dunn et al., typically, a medical student has dynamic but finite resources to cope with a stressful situation. The size of this “coping reserve” depends upon the interplay of intrinsic factors (personality and temperamental factors) and extrinsic factors (positive and negative inputs from the environment). Negative inputs are in the form of different pressures, worries, stress, conflicts, deadlines, or other demands. While positive inputs are different support systems such as family, peers, mentors, and their involvements in different social activities.
Some individuals have a better coping reserve and resilience, while others have an insufficient reserve, making them susceptible to mental health issues. The latter group of students may experience even small stressors as major threats or crises.
These are the factors that either diminish the existing reservoir for handling the challenges or replenish it.
Stress due to curriculum, hectic schedules, adjusting to the fact of not being the best one/high self-expectations, psychosocial stressors (family crisis, break ups, family's expectations), physical and mental fatigue and sleep deprivation in exams, self-doubt (about career choice) may act as negative factors leading to depletion of the coping reservoir.
Psychosocial support coming from family members, friends, peers, seniors, the medical school administration and counselors boosts the ability to face academic as well as personal challenges. Intellectual stimulation also helps as a positive input as many students find a great sense of pleasure upon seeing the practical application of the accumulated theoretical knowledge. Constant support from the mentors (including student counselors, research mentors, assigned faculty mentors, and senior student mentors) can help in strengthening the coping reservoir.
A high degree of resilience can be fostered by strengthening the replenishing factors, helping the student tackle the conditions leading to depletion of the coping reservoir, along with focusing on each Student's internal structure (coping style, personality traits, and temperament). A recent qualitative analysis supports the validity of this model by putting additional emphasis on connectedness (human connected factor) as one of the important components. The above-mentioned state can be achieved by following the concept of wellness.
| The Concept of Wellness|| |
Wellness is a concept of optimal well-being involving not merely the presence of complete physical, mental and social health but at the same time, merging the abstract concept of living life to its subjective fullest. As the medical profession involves helping a patient meet optimal health, wellness becomes our responsibility, both personally as well as professionally. Wellness comprises the following eight distinct dimensions. All these dimensions play an important role in determining the “wellness status” of an individual.
Taking care of own physical health.
Focusing on intellectual growth, expanding knowledge and skills, developing and maintaining curiosity.
Identifying and appreciating feelings, values, and attitudes of oneself as well as others and also learning to handle emotions in an adaptive way.
Forming and maintaining healthy relationships, enjoying the company of others, developing empathy for others, and contributing to the community.
Finding purpose and meaning in life and participating in religious activities.
Participating in work that provides personal satisfaction and life enrichment that is consistent with an individual's values, goals, and lifestyle and contributing one's skills and talents for meaningful work.
Managing resources well by making timely investments and preparing for short-term and long-term needs or emergencies.
Understanding how social, natural, and built environments affect health and well-being and being aware of the effects of own daily habits on the physical environment and individual's commitment to the healthy planet.
| Wellness Program for Medical Student|| |
With the existing hassles during medical training, there is a need to design wellness programs to enhance coping and prevent the development of mental illnesses. When started early in medical training, these programs can ingrain better capabilities for facing challenges and prevent a decline in health.
A program designed for the purpose of wellness must include preventive and promotive strategies to handle unforeseen situations and demands. Recent systematic reviews have shown the effectiveness of these wellness programs focused on mindfulness-based stress reduction to improve psychological functioning, including feelings of stress, anxiety, and depression.,
Wellness programs in various medical schools
Various medical student wellness programs are being operated in various universities in developed countries such as the USA, European countries, and Australia. For example, Vanderbilt Medical Student (VMS) Wellness Program-Vanderbilt School of Medicine, Medical Student Wellness Program-University of Utah School of Medicine and Student Wellness Program-Sanford School of Medicine, to name a few. However, there is a paucity of such programs or activities in Indian medical colleges.
Among the existing student wellness programs, VMS Wellness Program is more comprehensive, and this model can also be used to tailor such initiatives/programs as per individual needs, feasibility, and resources.
Vanderbilt medical student wellness program
It is a well-executed program designed for enhancing the wellness of medical trainees at Vanderbilt School of Medicine, USA. Three core principles have been described in this program, i.e., mentoring and advising, student leadership, and personal growth. Understanding and evolving through the process of psychological development as a professional is of utmost importance. It follows a tripartite model comprising of Advisory College system, Student Wellness Committee, and VMS LIVE as follows:
The advisory college program
It involves faculty members and pairing them with students to increase Student's access to the faculty, promote equality in advising, strengthen the faculty organization, and improve administrative support to the students. Senior students were involved and given a mentoring responsibility for their juniors. Therefore, both faculty and student advisors would guide the incoming students regarding wellness and career counseling.
Student wellness committee
It is designed by five principal wellness areas, including intellectual, environmental, physical, interpersonal and emotional, and spiritual wellness. It is a student-operated organization with an aim to pinpoint and solves specific problems related to medical students. Its activities are concrete, addressing specific kind of wellness, such as running a club targeting physical wellness and yoga sessions for emotional wellness.
VMS LIVE is a long-term alternate curriculum aiming to enhance the wellness and self-discovery of abilities of physician trainees by promoting the concept of self-care, open discussion about forming life-giving relations, contemplating about values, skills, and the direction of their life.
How helpful are these programs?
Although nonexistent in campuses of Indian medical colleges, these programs are present in many western medical schools. In a national survey involving 27 medical schools in the US, around 60% reported the presence of a full student well-being curriculum, with all reporting various physical, emotional, spiritual, and social well-being activities. Various studies assessing the effectiveness of these wellness programs have shown a positive response to the well-being of medical students, improving all the domains [Table 1].
|Table 1: Outcome of various wellness programs in various medical schools|
Click here to view
If we compare the components of these various wellness programs, the improvement mentioned by medical students in various domains of wellness, and the various components of the “coping reservoir model,” some commonalities and relations become apparent. These wellness programs, by improving the various wellness domains, in turn, help in enhancing the “replenishing factors” and at the same time subtracting the depleting factors of the coping reservoir of a medical student. Hence, improving the resilience of a medical student helps him/her in tackling the hardships of medical training.
| Issues with Existing Wellness Programs|| |
All is not “sunshine and roses” with wellness programs; the following critiques are mentioned:,,,
- Wellness programs, in general, targets the stress that originates during medical training; however, they don't target the specific causes of the origin of the stress
- The goals of a wellness program may be unclear which may hinder the learning process
- Personal views of the members, for instance, traditional views about medical education in an instructor, may become a problem
- Insecurities among the participants in opening up to the group
- Mandatory participation in the wellness program may do more harm than good.
| Recommendations about Medical Student Well-Being|| |
There are several recommendations for the mental well-being and general wellness of medical students.,, Individual institutions can extrapolate some of those measures in line with their needs and resources [Table 2].
To conclude, wellness is a dynamic concept to promote optimal well-being involving many domains. Although different wellness programs are available in western medical institutions, there is a scarcity of well-being measures in the Indian scenario. These programs are proven effective in promoting wellness along with the mitigation of stress and psychological issues in medical students. It is high time to create awareness, sensitization, and plan these wellness programs in Indian medical colleges for helping our medical students to learn resilience for handling unforeseen situations and to reach their full potential. We should be proactive and work together for larger benefit with timely implementation of wellness initiatives and sincere coordination among all stakeholders.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bhagat V, Haque M, Simbak NB, Husain R. Stress among medical students and advantages of metallisation therapy in general: A review of literatures. Adv Hum Biol 2018;8:59. [Full text]
Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry 2007;20:359-64.
Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, et al.
Preventive strategies for mental health. Lancet Psychiatry 2018;5:591-604.
Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al.
Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 2008;149:334-41.
Dyrbye LN, Thomas MR, Power DV, Durning S, Moutier C, Massie FS Jr., et al.
Burnout and serious thoughts of dropping out of medical school: A multi-institutional study. Acad Med 2010;85:94-102.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39:594-604.
Tyssen R, Vaglum P, Grønvold NT, Ekeberg O. Suicidal ideation among medical students and young physicians: A nationwide and prospective study of prevalence and predictors. J Affect Disord 2001;64:69-79.
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;72:542-6.
Tjia J, Givens JL, Shea JA. Factors associated with undertreatment of medical student depression. J Am Coll Health 2005;53:219-24.
Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Acad Med 2002;77:918-21.
Schwenk TL, Gorenflo DW, Leja LM. A survey on the impact of being depressed on the professional status and mental health care of physicians. J Clin Psychiatry 2008;69:617-20.
Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: Promoting resilience and preventing burnout. Acad Psychiatry 2008;32:44-53.
MacArthur KR, Sikorski J. A qualitative analysis of the coping reservoir model of pre-clinical medical student well-being: Human connection as making it 'worth it'. BMC Med Educ 2020;20:157.
Stoewen DL. Dimensions of wellness: Change your habits, change your life. Can Vet J 2017;58:861-2.
Drolet BC, Rodgers S. A comprehensive medical student wellness program – design and implementation at Vanderbilt School of Medicine. Acad Med 2010;85:103-10.
Kriakous SA, Elliott KA, Lamers C, Owen R. The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness (N Y) 2020;12:1-28.
Conversano C, Ciacchini R, Orrù G, Di Giuseppe M, Gemignani A, Poli A. Mindfulness, compassion, and self-compassion among health care professionals: What's new? A systematic review. Front Psychol 2020;11:1683.
Dyrbye LN, Sciolla AF, Dekhtyar M, Rajasekaran S, Allgood JA, Rea M, et al.
Medical school strategies to address student well-being: A national survey. Acad Med 2019;94:861-8.
Novak BK, Gebhardt A, Pallerla H, McDonald SB, Haramati A, Cotton S. Impact of a university-wide interdisciplinary mind-body skills program on student mental and emotional well-being. Glob Adv Health Med 2020;9:1-10.
Nakashima EN, Sutton CX, Yamamoto LG, Len KA. Wellness curriculum in the pediatric clerkship. Hawaii J Health Soc Welf 2020;79:50-4.
Chung AS, Felber R, Han E, Mathew T, Rebillot K, Likourezos A. A targeted mindfulness curriculum for medical students during their emergency medicine clerkship experience. West J Emerg Med 2018;19:762-6.
McGrady A, Brennan J, Lynch D, Whearty K. A wellness program for first year medical students. Appl Psychophysiol Biofeedback 2012;37:253-60.
Thompson D, Goebert D, Takeshita J. A program for reducing depressive symptoms and suicidal ideation in medical students. Acad Med 2010;85:1635-9.
Gaw CE. Wellness programs in medical school: Reevaluating the current paradigm. Acad Med 2017;92:899.
Byrnes C, Ganapathy VA, Lam M, Mogensen L, Hu W. Medical student perceptions of curricular influences on their wellbeing: A qualitative study. BMC Med Educ 2020;20:288.
Dederichs M, Weber J, Muth T, Angerer P, Loerbroks A. Students' perspectives on interventions to reduce stress in medical school: A qualitative study. PLoS One 2020;15:e0240587.
Lutz G, Pankoke N, Goldblatt H, Hofmann M, Zupanic M. Enhancing medical students' reflectivity in mentoring groups for professional development – A qualitative analysis. BMC Med Educ 2017;17:122.
Kemp S, Hu W, Bishop J, Forrest K, Hudson JN, Wilson I, et al.
Medical student wellbeing – A consensus statement from Australia and New Zealand. BMC Med Educ 2019;19:69.
[Table 1], [Table 2]