How are Medical Institutions Supporting the Well-being of Undergraduate Students? A Scoping Review

Abstract

Introduction: Medical students experience significant stress and impacts on mood due to multiple factors. Unmitigated stress impacts both physical and mental health while increasing the risk of unethical behavior. It is important for medical institutions to identify strategies that effectively reduce perceived stress and improve the well-being of their students.

Methods: The authors undertook a scoping review of the literature to identify strategies implemented by medical educational programs to improve the well-being of medical students.

Results: Of 1068 articles identified, 19 studies met the inclusion criteria. Interventions were categorized as mindfulness-based programs, reflection groups, curriculum changes, and 'miscellaneous.' All studies assessed outcomes of student stress/resilience, as well as additional domains including academic performance, mental health, and interpersonal skills. Some also assessed the acceptability of the intervention to students.

Conclusions: Despite the heterogeneity of interventions and outcome measures, a clear theme emerged that institutionally-provided strategies to promote student well-being tend to be effective when students opt into the program. It was noted that adding mandatory content or activities to a medical program without creating adequate space or support for it can have the opposite effect. Further high quality intervention studies involving randomization, blinding and rigorous controls are warranted.

Keywords: Burnout; medical education; medical institution; medical students; resilience; stress; well-being; wellness strategies.

Figure 1.

A ‘bucket’ conceptual framework for medical student resilience (courtesy of authors, with acknowledgement to Dunn et al). A conceptual framework for the review, building on the ‘coping reservoir’ model proposed by Dunn et al. Internal and external factors – including the program offered by the educational institution – can contribute to the resilience of medical students, or can cause draining of the coping reservoir. This leads to burnout, poor mental and physical health, and potentially poorer patient care.

Figure 2.

Selection of studies included in the scoping review PRISMA diagram illustrating the identification and selection of articles.

Figure 3.

A mapping of studies reviewed by outcomes (yellow], intervention (purple/green/dark blue), and study design [light blue). A mapping of reviewed studies, describing categories of interventions, study design, and outcomes assessed.