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Canadian Medical Education Journal logoLink to Canadian Medical Education Journal
. 2024 Aug 30;15(4):76–92. doi: 10.36834/cmej.76095

The state of wellbeing education across North American medical schools: a scoping review

L'état de la formation en matière de bien-être dans les facultés de médecine d'Amérique du Nord : un examen de la portée

Noam Raiter 1,, Kiana Yau 2, Alisha Sharma 3, Melanie Lewis 4, Victor Do 5
PMCID: PMC11415736  PMID: 39310320

Abstract

Background/Objective

Medical students experience increased rates of burnout and mental illness compared to the general population. Yet, it is unclear to what extent North American medical schools have adopted formal wellbeing curricula. We sought to establish prevailing themes of existing wellbeing educational interventions to identify opportunities for further curricular development.

Methods

We conducted a scoping review of the literature to identify wellbeing education programs implemented for undergraduate medical students across North America. We searched four comprehensive databases and grey literature and only included published original research. Two independent researchers screened all papers, with a third resolving disagreements. Two researchers conducted the data extraction using a continuously refined template, with a third researcher resolving any discrepancies.

Results

We identified 3996 articles in the initial search of which 30 met inclusion criteria and were included for further analysis. The most common types of interventions were mindfulness and meditation practices. 27 studies found that their wellbeing sessions contributed to positive wellbeing outcomes of learners.

Conclusions

Our review identified that there are few wellbeing curricular initiatives that have been evaluated and published in the literature. Additionally, the methodology and rigour of wellbeing curriculum evaluation to date leaves significant room for improvement. The existing literature does suggest that the adoption of a wellbeing curriculum has the potential to improve outcomes for medical students. These findings can be used to assist the development of a validated wellbeing curricular framework for wellbeing initiatives. However, while such a curriculum may represent an effective tool in enhancing medical trainee wellbeing, it cannot effect change in isolation; lasting and meaningful change will require concurrent shifts within the broader systemic framework and cultural fabric of the medical education system.

Introduction

There has been an increasing focus on enhancing the wellbeing of medical learners to address the endemic issue of burnout within the medical system. Studies have demonstrated that medical students have higher rates of mental illness including mood disorders, anxiety, and suicidal ideation compared to their age-matched counterparts.1,2 Data has shown that at least 37% of Canadian medical students meet the criteria for burnout.3 Despite individuals entering medicine with high levels of mental wellbeing and resilience,4,5 the medical learning environment has a detrimental effect on learner wellbeing. In comparison to age-matched peers, medical learners have a negative wellbeing trajectory upon matriculation into medical school.6 These patterns are not exclusive to medical students; residents and staff physicians also experience higher rates of burnout, mental illness, and suicide than their peers,7 indicating the long-term effects of this health decline along with the ongoing occupational hazards affecting their wellbeing across the continuum of their career. There are several systemic medical cultural factors which have been noted to contribute to the mental health epidemic in healthcare such as the lack of autonomy, perfectionism, and stigmatization of mental illness.8,9 These barriers begin building as early as the first day of medical school, manifesting through the now highly scrutinized “hidden curriculum”10,11 which in part teaches medical students that their success is measured by how hard they work and to wear their burnout as a badge of honor.12

Burnout, mental illness, and lack of self-care negatively impact academic performance, patient care, empathy, and relationships among peers, which overall leads to poor healthcare system sustainability.9,13-16 All of this highlights the irony and stark juxtaposition of medicine’s role of caring for patients and the medical system’s imposed hazardous work conditions for both its staff and trainees. Targeting these issues early in medical school can serve as an important lever to influence longer term change and support high quality health care delivery. At present, many institutions across North America have begun to implement components of education on wellbeing and mental health into their curricula. Systematic reviews have demonstrated some evidence that wellbeing sessions/educational interventions within medical curriculum may be effective in reducing burnout and improving wellbeing, although conclusions thus far are weak and inherently limited by their basis in low quality literature16,17 There is also substantial variation noted between wellbeing curricula in medical schools in Canada, leading to differing content across institutions, a wide variety of delivery methods, and a disparity in comprehensiveness of wellbeing curricula. Robust evaluation data of these wellbeing curricular efforts is lacking and notably many medical schools reportedly remain without a formal wellbeing curriculum, raising the importance of reviewing current curricula.9

Objectives

Our scoping review sought to describe the state of wellbeing curricula within undergraduate medical school programs across North America, many of which have been described in the literature following their implementation. In doing so, we aimed to identify prevailing themes and common components of educational sessions to help guide further curricular development within the Canadian context.

Methods

We conducted a scoping review using guidance from the framework by Arksey and O’Malley18 and further recommendations by Levac et al.19 We did not register the protocol as the International Prospective Register of Systematic Reviews (PROSPERO) does not allow the registration of scoping reviews. Our protocol was developed based on the PRISMA extension for scoping reviews.

Identifying the Research Question

To review the existing literature, we used the following research questions:

  • Which medical schools have established wellbeing curricula and have published research/evaluation data on this curriculum?

  • What methods do medical schools use to deliver their wellbeing education?

  • Which topics and themes are covered in medical school wellbeing education?

  • How were the outcomes and efficacy of these wellbeing education programs determined?

After reviewing the existing literature and analyzing the collected data, our objective was to identify potential gaps in the current literature regarding the state of wellbeing education by comparing and contrasting the findings from different studies to identify inconsistencies, contradictions, and different opinions.

Identifying Relevant Studies

We conducted a literature search using the following databases: Embase, Medline, Cochrane, and CINAHL. Our search used the following terms: “[Medical student OR Medical school] AND [Well* OR resilienc* OR burnout OR mental health] AND [curriculum OR education OR training OR course* OR module*].” Further, we included relevant subject headings were included for each search term. Detailed search strategies used are presented in Appendix A. We then filtered results to the English language and from 2010 onwards in order to keep results relevant to current progression in the field of wellbeing education. In order to fully encompass the state of literature, we conducted a gray literature search with the same terms on Google Scholar (limited to the first 150 results) and MedEdPortal.

Study Selection

We had the following inclusion criteria:

  1. The wellbeing curricula initiative took place at a North American medical school.

  2. The study involved only students enrolled in an undergraduate medicine program.

  3. The paper’s methodology describes and assesses a component of education surrounding the topic of wellbeing.

We excluded papers if they were not published in English; not published in a peer-reviewed publication; and not reporting on original data, such as commentaries and editorials. The initial screening yielded 4439 papers. We performed deduplication via Covidence leaving 3996 papers for initial screening.

Initial screening of 3996 papers based on the title and abstract were done independently by two researchers (KY, AS), which identified 64 articles for full text review. Any articles that could not be excluded based on information presented in the title and abstract were included for full text review. Additionally, 15 papers were identified from the bibliographies of the initial 64 articles. A total of 79 articles underwent full-text review independently by KY and AS. A third researcher (NR) assisted with the resolution of any discrepancies alongside regular meetings to refine the screening process and reach consensus. Upon further inspection of the full-text articles, we excluded 49 articles for reasons such as describing the wrong target population, being a non-peer-reviewed study, or describe interventions that were held outside of North America. Ultimately, we identified 30 articles to be included in our scoping review.

Charting the data

Data extraction from the studies was performed by two authors (KY, AS) independently following a predetermined data extraction template in Google Sheets (Appendix B). It included each study’s year and country of publication, sample size and year of medical studies of sample population, description of the session (key principles, mode of delivery, activities), study duration and design, and reported quantitative and/or qualitative outcomes. We performed the data extraction in an iterative manner with continuous refinement of the data extraction template. Afterwards, the two authors (KY, AS) compared the collected data to identify any discrepancies (e.g. missing data), which were resolved via discussion among three authors (KY, AS, NR) until a consensus was reached.

Reporting the results

To address our research question concerning which medical schools have implemented and evaluated wellbeing curricula, we summarized study metrics including authors, year, and location of conducted studies. By further classifying studies by curriculum type, duration, themes of the curriculum, delivery method, outcome type(s) and presence of significant findings, where applicable, we were able to generate an understanding of the methods used by medical schools to deliver and evaluate their wellbeing curricula. We coded outcomes as quantitative or qualitative and differentiated between primary and secondary outcomes. After this, we performed descriptive statistics on quantitative data to identify notable patterns and summarized qualitative outcomes. Finally, we completed a content analysis to identify common themes across papers, since raw qualitative data was not available for thematic analysis.

Results

Descriptive statistics

According to our inclusion criteria, we identified 30 studies to include in the final analysis (Figure 1). Articles were generally evenly distributed across the inclusion years. Approximately half of the included articles were published before or during 2015 (n = 14, 47%),20-33 and the remainder between 2016 and 2020 (n = 16, 53%).34-49 The largest number of articles was published in 2020 (n = 7, 23%).35, 37-39, 40, 42, 48

Figure 1.

Figure 1

PRISMA flow diagram depicting study selection process

Types of studies

Study characteristics of included studies are summarized in Table 1. The most common study type was quasi-experimental (n = 13, 43%),20-24,31,35-37,40,42-45,48 with pre-test post-test designs being the most popular among them (n = 7, 23%).20,21,35,36,44,45,48 This was followed by mixed methods (n = 8, 27%).30,34,38-40,44,46,47 Sample sizes ranged from 18 to 450; with most studies having a sample size between 15 and 30 students (n = 5, 16%).21,33,40,43,46 Studies published in the United States comprised the majority of included titles (n = 27, 90%) and three were from Canadian institutions (10%).33,44,48 No studies from other North American countries met inclusion criteria.

Table 1.

Study characteristics and intervention design of included studies.

Study Study Design Scales/Instruments Used Sample Intervention
Themes of Curriculum Mode of delivery Activities Duration Mandatory
Agarwal et al.34 2016 USA Mixed methods Likert Scale Questionnaire (researcher developed) n = 140
All years
Not reported Small group sessions Blog writing, group discussion 4 years (1h/week) Yes
Aggarwal et al.20
2013 USA
Quasi-experimental (pre-test/post-test) Social Distance Scale, Mental Illness: Clinicians' Attitudes Scale n = 298
Year 1
Not reported Panel, student-led small groups Not reported 2 hours (2 x 1h sessions) No
Bird et al.35
2020 USA
Quasi-experimental (pre-test/post-test) Connor-Davidson Resilience Scale; curriculum presurvey on resilience (researcher developed) n = 144
Year 3
Resilience Facilitated workshops Reflection on stressors in clinical environment, resilience education 1 year No
Bond et al.21
2013 USA
Quasi-experimental (pre-test/post-test) Jefferson Scale of Physician Empathy, Cohen's Perceived Stress Scale, Self-Regulation Questionnaire, Self-Compassion Scale n = 27
Year 1 and 2
Mind-body practices Elective course Yoga, meditation Not reported No
Bynum et al.42
2020 USA
Quasi-experimental (pre-test/post-test) Survey (researcher developed) n = 113
Year 2
Resilience Seminar Introduction to the psychology of shame, student panel on shame experiences, facilitator sharing of personal shame stories 2h No
Chung et al.43
2018 USA
Quasi-experimental Survey (researcher developed) n = 30 Mindfulness Classroom sessions Reading assignments, meditation, wellness planning, journaling 4 weeks (1h/week) No
Danilewitz et al.44 2018 Canada Mixed methods Maslach Burnout Inventory, Five Facet Mindfulness Questionnaire (FFMQ), Jefferson Scale of Empathy, Self-compassion Scale n = 52 Mindfulness Online modules Videos, meditation practice Not reported No
Dossett et al.26
2013 USA
Cross-sectional Survey (researcher developed) n = 122
Year 4
Humanism, relationship-centered medicine, spirituality, complementary/alternative medicine Didactic, experiential sessions Community chores, reflection, self-care activities 4 weeks No
Drolet and Rodgers27
2010 USA
Qualitative Survey (researcher developed) All years Student Wellbeing Longitudinal program (4 years) Wellness curriculum Not reported No
Dyrbye et al.45
2017 USA
Quasi-experimental Maslach Burnout Inventory, Interpersonal Reactivity Index, Connor-Davidson Resilience Scale, Happiness, and Gratitude Scale N = 95
Year 1
Stress management, resilience training Small group sessions Journaling, reflective exercise, facilitated group discussion 10-12 h Yes
Erogul et al.28
2014 USA
Randomized controlled trial Self-compassion Scale, Resilience Scale, Perceived Stress Scale n = 58
Year 1
Mindfulness In-class sessions, at-home activities Mindfulness-based meditation, weekly handouts, full-day retreat, breathing-based yoga, cognitive curriculum about stress 8 weeks (1.25h/week) No
George et al.29
2013 USA
Mixed methods N/A n = 95
Year 1
Stress management Facebook Facebook-based stress management program 11 weeks No
Gold et al.46
2019 USA
Mixed methods UCLA Loneliness Scale, Emotional Self-Awareness Scale, Interpersonal Fulfillment Index n = 30
Year 1-2
Psychotherapy Reflection groups Not reported 6 months (1.5h/week) No
Greeson et al.30
2015 USA
Mixed methods Cognitive and Affective Mindfulness Scale - Revised (CAMS-R), Perceived Stress Scale n = 44
All years
Mind-body skills Didactic lessons, small group sessions, home activities Group discussion, instructor-led meditation, self-regulated skill instruction and practice 4 weeks (1.5h/week) No
Kraemer et al.47
2016 USA
Mixed methods Distress Tolerance Scale, Cognitive and Affective Mindfulness Scale – Revised (CAMS-R), Positive Affect Negative Affect Schedule (PANAS), Perceived Stress Scale – 10 (PSS-10) n = 52
Year 1 and 2
Mind-body skills Skills training group Mind-body skills, breathing exercises, autogenic training 11 weeks (2h/week) No
Kushner et al.31
2011 USA
Quasi-experimental (one-group posttest-only) Questions using five-point Likert scale (researcher developed) n = 343
Year 2
Healthy living Didactic sessions Behavior change plan 6 weeks (12 hours) Yes
MacLean et al.48
2020 Canada
Quasi-experimental Freiburg Mindfulness Inventory, Jefferson Scale of Empathy, Connor-Davidson Resilience Scale, Perceived Stress Scale n = 316
Year 1 and 2
Mindfulness Longitudinal curriculum Mindfulness exercises 2 years Yes
Mascaro et al.49 2018 USA Randomized controlled trial (waitlist) Depression Anxiety and Stress Scale, Beck Anxiety Inventory, UCLA Loneliness Scale, Compassion Love for Humanity Scale, Pittsburgh Sleep Scale, Substance Use Inventory, self-reported exercise frequency n = 132
Year 2
Cognitively based compassion Didactic sessions Meditation 10 weeks (1.5h/week) No
McGrady et al.32
2012 USA
Randomized controlled trial Beck Depression Inventory, Beck Anxiety Inventory, Social Readjustment Rating Scale n = 449
Year 1
Stress management, mindfulness Structured sessions Deep breathing, progressive relaxation, guided imagery, survival thinking, meditation, nutrition counselling Not reported No
Nagji et al.33
2013 Canada
Qualitative N/A n = 18
Year 1
Theatre-based Theatre-based sessions Not reported 15 hours (6 x 2.5h sessions) No
Pasarica et al.36
2016 USA
Quasi-experimental (pre-test/post-test) Multiple-choice survey (researcher developed) n = 44
Year 1 and 2
Mindfulness Single evidence-based session Active practical mindfulness exercise 1h No
Rockfeld et al.37
2020 USA
Quasi-experimental (pre-test/post-test) 5-point Likert scale survey (researcher developed) n = 183
Year 3
Positive lifestyle choices Workshops, didactic, small-group sessions, reflective practices Reflection 4 weeks (over 1 year) Yes
Seritan et al.22
2015 USA
Qualitative Association of American Medical Colleges Graduation Questionnaire n = 105
(per class)
All years
Access/availability, confidentiality/cultural humility, transparency/ trust Office of student wellness, clinical services, advisory council, mental health education Not reported Not reported No
Sheehy et al.38
2020 USA
Mixed methods Survey (researcher developed) Year 3 Burnout Not reported Workshops, team bonding, leisure 7.5h (5 x 1.5h sessions) Yes
Slavin et al.23
2014 USA
Quasi-experimental Center for Epidemiologic Studies Depression Scale, Spielberger State-Trait Anxiety Inventory n = 175-178 (per class)
All years
Not reported Longitudinal curriculum reform Not reported Not reported Yes
Stumbar et al.39
2020 USA
Mixed methods Likert Scale Questionnaire (researcher developed) n = 112
Year 3
Narrative medicine Group session Reflection, writing activity 1.5h Yes
Thomas et al.24
2011 USA
Quasi-experimental Evaluation survey (researcher developed) 50% of class Year 1 Stress/resilience Extracurricular program Presentations on mental health, help-seeking, and stress resilience 1 year No
Thompson et al.25
2010 USA
Observational Center for Epidemiologic Studies Depression Scale, Primary Care Evaluation of Mental Disorders Patient Health Questionnaire n = 102
Year 3
Not reported Didactic Faculty education, discussion, student handbook Not reported No
Williams et al.40
2020 USA
Quasi-experimental (pre-test/post-test) Perceived Stress Scale, Frieburg Mindfulness Inventory, multiple choice survey (researcher developed) n = 24
Year 1 and 2
Meditation Resilience course Mindfulness, biofeedback, art, journaling 11 weeks No
Yang et al.41
2018 USA
Randomized controlled trial Five Facet Mindfulness Questionnaire (FFMQ), General Wellbeing Schedule, Perceived Stress Scale n = 88
All years
Mindfulness Mobile app Not reported 30 days No

Curricular modalities

Curricular evaluation methods employed in the review studies are summarized in Table 1. There is wide variability in the type of wellbeing curricula that schools implemented and sought to evaluate. The wellbeing curricular methodologies included mindfulness (n = 7, 23.3%),28,32,36,41,43,44,48 resilience (n = 4, 13.3%),24,35,42,45 stress management (n = 3, 10%),29,32,45 and mind-body practices (n = 3, 10%).21,30,47 The delivery formats for sessions included: small group sessions (n = 4, 13.3%),20,30,34,45 didactic sessions (n = 5, 16.7%),26,30,31,37,49 longitudinal curriculum spanning across several years (n = 3, 10%),23,27,48 and at-home activities (n = 2, 6.7%).28,30 The duration of sessions varied significantly between papers but most were between four and 11 weeks (n = 10, 33.3%).26,28-31,37,40,43,47,49 The majority of sessions did not enforce mandatory participation (n = 22,73.3%).20-22,24-30,32,33,35,36,40-44,46,47,49 Overall, 16 (53.3%) sessions demonstrated statistically significant improvements relating to at least one aspect of wellbeing that improved following the session.20, 21, 25, 28, 30, 32, 35, 37, 41-45, 47-49

Quantitative outcomes

Quantitative measures reported in studies are summarized in Table 2. Twenty-eight of the 30 studies included in this review reported quantitative data.20-26,28-47,49 Twenty-three of these studies performed statistical analysis to determine the effect of the curriculum they were delivering. Sixteen of these groups reported at least one outcome that was significantly improved from pre- and post- session measurements.20,21,25,28,30,32,35,37,41-45,47-49 Quantitative measures reported by included studies are summarized in Table 2.

Table 2.

Quantitative measures reported by included studies.

Study Psychological distress Psychological Wellbeing Health Behaviors Attitude change Personal Traits Program/ Process Evaluation
Depression Stress/ Anxiety Loneliness Mindfulness Wellbeing/ wellness Empathy/ Love Quality of life/ Satisfaction Meditation Exercise Sleep Substance Use Nutrition
Agarwal et al.34 2016 USA NS
Aggarwal et al.20
2013 USA
f (p=.01)
Bird et al.35
2020 USA
NSb NS k (p=.019) NS
Bond et al.21
2013 USA
NS NS d,e (p=.003, .04)
Bynum et al.42
2020 USA
' (p<.001)
Chung et al.43
2018 USA
✓ (p=.0001) ✓ (p=.01) ✓ (p=.0001)
Danilewitz et al.44 2018 Canada NSb ✓ (p<.001) NS d (p=.001) NS
Dossett et al.26
2013 USA
NS
Drolet and Rodgers27
2010 USA
Dyrbye et al.45
2017 USA
NSb ✓ (increased, P<.0001, 0.03) ✓ (decreased, P<.01) ✓ (decreased, P<.001, .015) NSk
Erogul et al.28
2014 USA
✓ (p=.03) NSl
George et al.29
2013 USA
NS
Gold et al.46
2019 USA
NS NS NS NS
Greeson et al.30
2015 USA
✓ (P<.001) ✓ (P<.001)
Kraemer et al.47
2016 USA
✓ (p=.01-.03) NS
Kushner et al.31
2011 USA
NS NS NS NS
MacLean et al.48
2020 Canada
NS ✓ (p=.008) ✓ (p<.001) k (p=.003)
Mascaro et al.49 2018 USA ✓ (p=.008) NS ✓ (p=.002) ✓ (p=.005) ✓ (p=.007) NS NS
McGrady et al.32
2012 USA
✓ (p=.045) NS NSc
Nagji et al.33
2013 Canada
Pasarica et al.36
2016 USA
NS
Rockfeld et al.37
2020 USA
g,h (p<.001, p<.003) NS
Seritan et al.22
2015 USA
NS
Sheehy et al.38
2020 USA
NSk NS
Slavin et al.23
2014 USA
NS NS
Stumbar et al.39
2020 USA
NS
Thomas et al.24
2011 USA
NS
Thompson et al.25
2010 USA
✓ (p<.01)
a (P<.001)
Williams et al.40
2020 USA
NS NS
Yang et al.41
2018 USA
✓ (p<.05) NS ✓ (p<.05)

✓ = significant; NS = not significant; a = suicide ideation; b = burnout; c = illness frequency; d = self-compassion; e = self-regulation; f = mental illness perception; g = understanding relationship between lifestyle factors and patients' wellness

h = confidence in ability to counsel patients about behavioral changes; ' = attitudes, confidence, and willingness to reach out for help; j = utility and burden; k = resilience; l = adaptability

Measures of psychological distress (e.g. depression, suicide ideation, stress, loneliness, anxiety, and burnout) were the most frequently reported variables, appearing in 15 studies,23-25,30 Psychological distress was measured using a variety of scales and questionnaires. Seven of 15 studies reported statistically significant decreases in distress levels after participation in the wellbeing curricular initiative being studied. 25, 28, 30, 32, 41, 47, 49

Measures of psychological wellbeing (e.g. general wellbeing, mindfulness, empathy, compassion, love, quality of life, wellbeing, and student satisfaction) were reported in 15 studies,20-22,25-48,30-37 with six reporting multiple measures of psychological wellbeing.226-28,30,33,35 Seven of the 15 studies reported significant improvements in at least one aspect of wellbeing.26-28,31,33,34,37 Mindfulness was the most common measure being investigated in eight studies,25-27,31-33,35,36 of which four showed significant improvement in mindfulness upon curricular program completion.

Measures of healthy behaviors (e.g. meditation, exercise, sleep, nutrition, and substance use) of participants were reported in three studies,24,34,38 of which two showed significant results in increasing frequency of meditation practice24 and exercise.33 Outcomes related to participants' perspective of wellbeing was measured in four studies,38-41 in which three found significant post-session changes in views towards mental health,39 patient counseling,40 and shame. 41 Four of seven studies that measured participants subjective assessment of their personal traits reported statistically significant results, including increasing levels of self-compassion21,27 and resilience,20,33 as assessed by the Self-compassion Scale and the Connor-Davidson Resilience Scale, respectively,

Of the 28 studies reporting quantitative data, 10 studies specifically reported data on students’ perceptions and opinions surrounding the session’s educational effectiveness.5,20,27,30,38,40,42-46 Evaluation was completed through self-reported data on measures of session’s educational effectiveness,42-44,46,47 perceived impact on student’s wellbeing (e.g. burnout and mindfulness measures pre- and post-session),42,44 quality of the content presented,45 retention rate,27 and self-perceived feasibility of the session.27

Qualitative data

Qualitative findings and methods are summarized in Table 3. Of the 15 studies that adopted a qualitative experimental approach, two studies were strictly observational and only presented qualitative data,47,48 while others presented a mixture of both quantitative and qualitative results.20,22,23,25-27,36,38,39,41-43,49 Methods of qualitative data extraction include via open-ended responses with30-32,41-43 or without27,28,39,49 thematic analysis, focus groups,47 mix of written and verbal responses in an informal manner,48 and case reports.38

Table 3.

Qualitative measures reported by included studies.

Study Qualitative Findings Qualitative Methods
Agarwal et al.34
2016 USA
Qualitative feedback varied, though no formal analysis was conducted to identify major themes. Qualitative comments were informally collected from students and small group leaders.
Aggarwal et al.20
2013 USA
Five major themes were identified from student responses which most commonly indicated that the curriculum changed participants' views on mental illness and taught them compassion for the patient. An optional open-ended question was included in the curriculum's final exam
Bynum et al.42
2020 USA
Qualitative results suggest that the seminar successfully strengthened students' resilience. Inductive thematic analysis was conducted for two free-response questions
Danilewitz et al.44
2018 Canada
Thorough analysis was not presented. Open-ended qualitative feedback was eliAccessed on to support quantitative findings.
Dossett et al.26
2013 USA
Qualitative analysis found twelve key themes regarding the HEART program's professional and personal impact on students, with self-discovery identified as the most common theme. The retrospective cross-sectional program survey included qualitative questions which were developed by study authors through an iterative process guided by the program goals. A codebook was developed for qualitative analysis by the study authors based on grounded theory and the program's goals.
Drolet and Rodgers27
2010 USA
No formal analysis conducted, though qualitative feedback was predominantly positive. Informal written and verbal feedback was collected.
Dyrbye et al.45
2017 USA
Qualitative feedback was mixed. Qualitative comments were collected on the end-of course evaluation, though no formal analysis was conducted.
Gold et al.46
2019 USA
Thematic analysis demonstrated that the reflection groups may be a feasible and effective intervention for mitigating loneliness in medical school. The baseline survey contained one open-ended qualitative question assessing expectations and goals, and the post-group survey included four qualitative questions assessing the intervention's impact on students. Thematic analysis was performed by two authors.
Greeson et al.30
2015 USA
The qualitative findings were predominantly positive, suggesting that the workshop series is an effective and feasible intervention for stress reduction, stress management and relaxation, and increasing self-awareness among medical students. The pre-workshop evaluation included a qualitative question regarding student goals for workshop participation and the post-workshop evaluation collected open-ended feedback about the workshops' perceived value. Thematic analysis of qualitative feedback was conducted through inductive grouping of student responses based on prevalent themes.
Kraemer et al.47
2016 USA
Qualitative results supported the overall efficacy and success of the mind-body group. A questionnaire including five open-ended questions was distributed following completion of the mind-body skills group to assess students' perceived efficacy and overall perception of the group. Three study authors analyzed the qualitative data to identify common themes.
Kushner et al.31
2011 USA
Qualitative case reports provided insight about both successful and unsuccessful behavior change plans, as well as associated goals and obstacles to change. Case reports were created to present and analyse qualitative examples of two students' behavior change plans.
Nagji et al.33
2013 Canada
Qualitative data suggested that novel, humanities-based curriculum offerings may help foster personal development and wellbeing in medical students. Participants were invited to participate in a focus group, in which open-ended questions were used to stimulate discussion. Transcripts of the focus groups were analyzed to identify key themes.
Stumbar et al.39
2020 USA
Qualitative responses provided insight into strategies that students felt would help them in future patient care and in maintaining personal wellbeing. An optional online survey was distributed to participants following session completion which included open-ended questions. Inductive coding was used for thematic analysis of all open-ended responses.

Overall, key messages that were identified through implementation of these wellbeing curriculum sessions were; strengthened social connection,20,30,32,42,47 shifting perspectives on becoming a physician30,39,42,43 and personal growth,39,47 including increased self-discovery42 and self-awareness.30 Participants across various studies pointed to increased tolerance to distress,32 resilience,47 coping skills,42 overcoming imposter syndrome,30 and willingness to express emotions.43 Studies also described curricular participant perspective changes,30 such as changing views on mental illness.39 A collection of studies described increasing healthy behavior adoption among its participants. The promotion of social connection with peers also emerged as a key benefit of the sessions,20,30,47 with participants reporting an increased sense of community42 and feeling supported32 and less alone.20

Some studies described participants’ changing their perspectives on becoming a physician because of the curricular sessions. Examples include increased understanding of humanism,43 the importance of whole patient care,39 increased empathy43 and compassion.39 Participants also reported that sessions equipped them with professional tools42 that are useful for their future careers and better prepared them for the transition to residency.42

Nine of the 15 studies that reported qualitative data described participant feedback on curricular program design and delivery.20,27,28,31,36,38,41,48,49 Overall, most studies reported positive feedback on program design and delivery.3,1,38,40,41,48 In two studies, participants expressed lack of comfort in sharing personal matters with peers, which was a part of the curricular activity20,49 Two studies collected qualitative feedback on program feasibility (e.g. recruitment, program completion rate, compliance, optional vs. mandatory).27,28 Danilewitz et al. successfully met their recruitment goal, though program completion rate was variable and adherence to regular meditation practice, the primary intervention of this study, was low.27 Similarly, Dyrbye et al. received mixed feedback regarding the feasibility of their mandatory longitudinal stress management program, with many students citing the mandatory nature of the program as an added source of stress.28

Discussion

The aim of this study was to identify and describe the state of wellbeing education across North American medical schools which have been evaluated as part of their implementation. Since 2010, though the discourse around medical student wellbeing has continued to increase, the number of studies evaluating wellness related curricular sessions have not increased greatly and there remain relatively few studies in this area, given the number of medical schools in North America.

Curriculum characteristics

Regarding our aim to better understand the methods used by medical schools to deliver their wellbeing education, we identified that most wellbeing curriculum sessions focused on building skills in mindfulness and resilience. Sessions were most frequently delivered via large group information sessions. However, we identified that students prefer wellbeing education to be delivered via small group format27,34, highlighting the potential benefit of altering the modality in which the majority of curricula are currently being delivered. The length of the interventions also had noticeable variation across papers searched, ranging from 1.5 hours to 4 years.

Population demographics and sizes varied between studies as some included only pre-clerkship students, while others included only clerkship students. The largest sample size was 343 and the smallest was 18. This was indicative of the wide variation in methods of education. The smaller sample sizes across studies highlights an opportunity for increased rigor when conducting future research on wellbeing education within medical school.

Of 30 included studies, only eight wellbeing curricula required mandatory participation. This is a highly debated topic as the importance of wellbeing education is evidently critical but the nature of making wellbeing education mandatory may lead to an undermining intrinsic motivation and ultimately increase burnout by increasing workload of students.50

Evaluation

Outcomes and efficacy of the wellbeing education programs described in the studies included in this review were determined through a variety of scales and surveys, with measures of psychological distress and wellbeing used most. Throughout 28 studies that used such scales, 27 different validated scales were used, with 15 studies using more than one scale for evaluation. The scales most commonly used were Center for Epidemiologic Studies Depression Scale,23,24 Maslach Burnout Inventory,27,28 the Five Facet Mindfulness Questionnaire,26,27 and the Connor-Davidson Resilience Scale.20,28,33 Ten studies only used scales that were developed by those researchers, making conclusions difficult to draw due to lack of previous evaluation of scale validity. Regarding the effectiveness of these interventions, 16 studies were deemed “successful” based on having at least one statistically significant outcome among quantitative measures. Qualitative data were collected in 15 studies and were predominantly positive in all of these where participants reported strengthened social connections, shifting perspectives on becoming a physician, and personal growth. This wide variation in types of scales used to evaluate the curricular sessions reflect more broadly the non-standardized way wellbeing is measured amongst medical learners and increases the difficulty of objectively comparing session effectiveness.

Implications for wellbeing curriculum in medical schools

Importantly, this scoping review found a lack of published research and evaluation on wellbeing curricula in North American medical schools with only 30 studies identified through our search. The data for Canadian schools is further limited with only three studies conducted at Canadian institutions. Beyond the limited number of published studies, the existing research often lacked rigor and varied widely in its methodology including in design and populations. For instance, the majority of studies were quasi-experimental, a study design.50

Additionally, we found a wide variety of reported outcomes, making it difficult to compare the effectiveness of different curricula. Validated tools for quantitative assessment of wellbeing outcomes were used inconsistently, with many studies relying on novel or unvalidated scales. Many studies also only utilised either a quantitative or qualitative method rather than both that may have provided a more comprehensive evaluation. The importance of curriculum evaluation is a critical step to ensure effective educational interventions.51 Furthermore, only two studies collected data on feasibility of their intervention, which is an important factor for meaningful translation of research in this field. This highlights the opportunity of developing standardized measures to evaluate the effectiveness of wellbeing curricula in medical education.

Medical education leaders may use our study findings to consider opportunities for medical school wellbeing education reform. The limited evidence base behind curricular interventions being utilized makes it difficult for schools to identify whether their sessions are helping students. With the overwhelming evidence that the medical learning environment contributes to poorer wellbeing amongst medical students, it is incumbent on all faculties to make meaningful efforts to address these threats. Effective wellbeing curricula can be part of the toolbox as we work to change the culture of medicine and thwart systemic occupational hazards.

Limitations

Our study has several limitations. Firstly, as this is a scoping review, we did not conduct an explicit risk of bias assessment to assess the quality of the studies and thus we cannot comment on the level of evidence. Secondly, our study could only evaluate wellbeing curricula in medical schools on which formal evaluative research has been conducted. We know other schools have implemented wellbeing education programs and may have even collected data on their effectiveness but have not published their findings. As such, our work presents an incomplete picture of the field of wellbeing curricula in medical education. While many terms could have been used, our search was limited to the following terms related to wellbeing: Well*, resilienc*, burnout and mental health. Therefore, there may be studies that were not captured within our search that did not use these specific words. However, it is very likely that curriculum aimed at improving wellbeing would include these terms.

Conclusions

Our scoping review found that many of the wellbeing curricula in North America were associated with positive impacts of varying degrees on student participants. However, these conclusions are limited by the wide variety of study methodologies and low rigor of the eligible studies. Ultimately, although wellbeing curricula are becoming more common in medical schools, relatively few of these curricula have been developed, implemented, evaluated, and reported using a curriculum development framework. The present work highlights the potential for wellbeing curricula to positively influence medical trainee wellbeing, as well as the need for standardization and evidence-based practice to identify optimal content and learning strategies to inform these curricula, many of which currently lack structure and may in fact be better characterized as individual intervention sessions.

Future directions

To address these gaps and enhance our understanding of the state of wellbeing curricula within North American undergraduate medical schools, as discussed in our limitations, we propose the development of a standardized wellbeing curriculum framework using an evidence based approach, such as the updated 2022 curriculum guide by Thomas et al.51 Specifically, given the complexity and diversity of these gaps, a collaborative effort may be the most effective in creating a framework that not only addresses identified gaps in a comprehensive manner, but also allows for the gathering of valuable data on outcomes and effectiveness of the curricula. This framework, while standardized, should allow for localized adaptations to accommodate the unique contexts of different institutions. Furthermore, the evaluation of such a wellbeing curriculum should be conducted using evidence-based methodology to yield meaningful findings. Moving forward, integration of validated, standardized outcomes in wellbeing education research will provide higher quality evidence to guide decision making, which in combination with qualitative data, will ultimately contribute to more effective wellbeing education interventions for medical students in North America.

Appendix A. Database search strategies

Embase <1974 to 2021 July 06>

(Medical student or Medical school).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

AND

(Well* or resilienc* or burnout or mental health).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

AND

(curriculum or education or training or course* or module*).mp. [mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword, floating subheading word, candidate term word]

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions(R) <1946 to July 06, 2021>

(Medical student or Medical school).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

AND

(Well* or resilienc* or burnout or mental health).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

AND

(curriculum or education or training or course* or module*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

EBM Reviews - Cochrane Database of Systematic Reviews <2005 to June 30, 2021>

EBM Reviews - ACP Journal Club <1991 to June 2021>

EBM Reviews - Database of Abstracts of Reviews of Effects <1st Quarter 2016>

EBM Reviews - Cochrane Clinical Answers <June 2021>

EBM Reviews - Cochrane Central Register of Controlled Trials <May 2021>

EBM Reviews - Cochrane Methodology Register <3rd Quarter 2012>

EBM Reviews - Health Technology Assessment <4th Quarter 2016>

EBM Reviews - NHS Economic Evaluation Database <1st Quarter 2016>

(Medical student or Medical school).mp. [mp=ti, ot, ab, tx, kw, ct, sh, hw]

AND

(Well* or resilienc* or burnout or mental health).mp. [mp=ti, ot, ab, tx, kw, ct, sh, hw]

AND

(curriculum or education or training or course* or module*).mp. [mp=ti, ot, ab, tx, kw, ct, sh, hw]

Interface - EBSCOhost Research Databases

Search Screen - Advanced Search

Database - CINAHL Complete

(Medical student OR Medical school ) AND ( Well* OR resilienc* OR burnout OR mental health ) AND (curriculum OR education OR training OR course* OR module* )

Limiters - Published Date: 20100101-20211231

Search modes - Boolean/Phrase

MedEdPortal, Google Scholar, CMEJ:

Medical school OR medical student AND Well* OR resilienc* OR burnout OR mental health AND curriculum OR education OR training OR course* OR module*

Publication Date: 2010-2021

Appendix B. Data extraction template

Study Details
Title
Author (s)
Year
Country
Study Characteristics
Study design
Sample size
Intervention design
  • Themes of curriculum

  • Mode of delivery

  • Included activities

  • Duration

  • Scales/instruments used for outcome measures (if applicable)

  • Qualitative methods (if applicable)

Results
Outcome measures (quantitative)
  • Psychological distress: depression, stress/anxiety, loneliness
  • Psychological wellbeing: mindfulness, wellbeing/wellness, empathy, love, quality of life, satisfaction
  • Health behaviors: meditation, exercise, sleep, substance use, nutrition
  • Change in attitude
  • Personal traits
  • Program/process evaluation

Qualitative findings

Funding Statement

Funding:

No funding was provided to any of the authors in association with this study.

Conflicts of Interest

All authors state that there are no conflicts of interest.

Edited by

Marco Zaccagnini (senior section editor); Marcel D’Eon (editor-in-chief)

References

  • 1.Maser B, Danilewitz M, Guérin E, Findlay L, Frank E. Medical student psychological distress and mental illness relative to the general population: a Canadian cross-sectional survey. Acad Med. 2019;94(11):1781–91. 10.1097/ACM.0000000000002958 [DOI] [PubMed] [Google Scholar]
  • 2.Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73. 10.1097/00001888-200604000-00009 [DOI] [PubMed] [Google Scholar]
  • 3.Canadian Federation of Medical Students . CFMS-FMEQ national health and wellbeing survey-student research position. International Conference on Physician Health. Boston; 2016. Available from: https://www.cfms.org/uploads/news-documents/Wellness_Survey_Research_Position_2017.pdf. [Accessed on Aug 25, 2022]. [Google Scholar]
  • 4.Glauser W. Medical schools addressing student anxiety, burnout and depression. CMAJ. 2017. Dec 18;189(50):E1569–70. 10.1503/cmaj.109-5516 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Haglund MEM, Aan Het Rot M, Cooper NS, et al. Resilience in the third year of medical school: a prospective study of the associations between stressful events occurring during clinical rotations and student wellbeing. Acad Med. 2009;84(2):258–68. 10.1097/ACM.0b013e31819381b1 [DOI] [PubMed] [Google Scholar]
  • 6.Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016. Jan;50(1):132–49. 10.1111/medu.12927 [DOI] [PubMed] [Google Scholar]
  • 7.IsHak WW, Lederer S, Mandili C, et al. Burnout during residency training: a literature review. J Grad Med Educ. 2009. Dec 1;1(2):236. 10.4300/JGME-D-09-00054.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Gold JA, Johnson B, Leydon G, Rohrbaugh RM, Wilkins KM. Mental health self-care in medical students: a comprehensive look at help-seeking. Acad Psychiatry. 2015. Feb 5;39(1):37–46. 10.1007/s40596-014-0202-z [DOI] [PubMed] [Google Scholar]
  • 9.Bourcier D, Far R, King LB, et al. Medical student wellness in Canada: time for a national curriculum framework. Can Med Educ J. 2021. Nov 28;12(6):103–7. 10.36834/cmej.73008 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73(4):403–7. 10.1097/00001888-199804000-00013 [DOI] [PubMed] [Google Scholar]
  • 11.Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861–71. 10.1097/00001888-199411000-00001 [DOI] [PubMed] [Google Scholar]
  • 12.Gaufberg EH, Batalden M, Sands R, Sigall B. The hidden curriculum: what can we learn from third-year medical student narrative reflections? Acad Med. 2010;85(11):1709-1716. 10.1097/ACM.0b013e3181f57899 [DOI] [PubMed] [Google Scholar]
  • 13.Fiorillo A, Sartorius N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Ann Gen Psychiatry. 2021. Dec 1;20(1):1–5. 10.1186/s12991-021-00374-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Latoo J, Mistry M, Dunne FJ. Physical morbidity and mortality in people with mental illness. Br J Med Pract. 2013;6(3). Available from: http://guidance.nice.org.uk/Topic/MentalHealthBehavioural [Accessed on Aug 25, 2022]. [Google Scholar]
  • 15.Walker ER, McGee RE, Druss BG. mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry. 2015. Apr 1;72(4):334. 10.1001/jamapsychiatry.2014.2502 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Daya Z, Hearn JH. Mindfulness interventions in medical education: a systematic review of their impact on medical student stress, depression, fatigue and burnout. Med Teach. 2017. Feb 1;40(2):146–53. 10.1080/0142159X.2017.1394999 [DOI] [PubMed] [Google Scholar]
  • 17.Wasson LT, Cusmano A, Meli L, et al. Association between learning environment interventions and medical student wellbeing: a systematic review. JAMA. 2016. Dec;316(21):2237–52. 10.1001/jama.2016.17573 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Intern J Soc Res Methodol. 2007. Feb;8(1):19–32. 10.1080/1364557032000119616 [DOI] [Google Scholar]
  • 19.Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010. Sep 20 [Accessed on 2022 Aug 7];5(1):1–9. 10.1186/1748-5908-5-69 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Aggarwal AK, Thompson M, Falik R, Shaw A, O’Sullivan P, Lowenstein DH. Mental illness among us: a new curriculum to reduce mental illness stigma among medical students. Acad Psychiatry. 2013. Nov [Accessed on 2022 Aug 7];37(6):385–91. 10.1007/BF03340074 [DOI] [PubMed] [Google Scholar]
  • 21.Bond AR, Mason HF, Lemaster CM, Shaw SE, Mullin CS, Holick EA, et al. Embodied health: the effects of a mind–body course for medical students. Med Educ Online. 2013. [Accessed on 2022 Aug 7];18(1). 10.3402/meo.v18i0.20699 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Seritan AL, Rai G, Servis M, Pomeroy C. The office of student wellness: innovating to improve student mental health. Acad Psychiatry. 2015. Feb 5 [Accessed on 2022 Aug 7];39(1):80–4. 10.1007/s40596-014-0152-5 [DOI] [PubMed] [Google Scholar]
  • 23.Slavin SJ, Schindler DL, Chibnall JT. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014. [Accessed on 2022 Aug 7];89(4):573–7. 10.1097/ACM.0000000000000166 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Thomas SE, Haney MK, Pelic CM, Shaw D, Wong JG. Developing a program to promote stress resilience and self-care in first-year medical students. Can Med Educ J. 2011. Jun 3 [Accessed on 2022 Aug 29];2(1):e32. 10.36834/cmej.36548 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Thompson D, Goebert D, Takeshita J. A program for reducing depressive symptoms and suicidal ideation in medical students. Acad Med. 2010. [Accessed on 2022 Aug 7];85(10):1635–9. 10.1097/ACM.0b013e3181f0b49c [DOI] [PubMed] [Google Scholar]
  • 26.Dossett ML, Kohatsu W, Nunley W, et al. A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self-care: an evaluation of the HEART program. Explore (NY). 2013. Sep [Accessed on 2022 Aug 7];9(5):292–8. 10.1016/j.explore.2013.06.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Drolet BC, Rodgers S. A comprehensive medical student wellness program--design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85(1):103-10. 10.1097/ACM.0b013e3181c46963 [DOI] [PubMed] [Google Scholar]
  • 28.Erogul M, Singer G, McIntyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014. Oct 2;26(4):350-6. 10.1080/10401334.2014.945025 [DOI] [PubMed] [Google Scholar]
  • 29.George DR, Dellasega C, Whitehead MM, Bordon A. Facebook-based stress management resources for first-year medical students: a multi-method evaluation. Comput Human Behav. 2013. May 1;29(3):559-62. 10.1016/j.chb.2012.12.008 [DOI] [Google Scholar]
  • 30.Greeson JM, Toohey MJ, Pearce MJ. An adapted, four-week mind-body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care. Explore (NY). 2015. May 1;11(3):186-92. 10.1016/j.explore.2015.02.003 [DOI] [PubMed] [Google Scholar]
  • 31.Kushner RF, Kessler S, McGaghie WC. Using behavior change plans to improve medical student self-care. Acad Med. 2011;86(7):901-6. 10.1097/ACM.0b013e31821da193 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.McGrady A, Brennan J, Lynch D, Whearty K. A wellness program for first year medical students. Appl Psychophysiol Biofeedback. 2012. Dec;37(4):253-60. 10.1007/s10484-012-9198-x [DOI] [PubMed] [Google Scholar]
  • 33.Nagji A, Brett-MacLean P, Breault L. Exploring the benefits of an optional theatre module on medical student wellbeing. Teach Learn Med. 2013. Jul;25(3):201-6. 10.1080/10401334.2013.801774 [DOI] [PubMed] [Google Scholar]
  • 34.Agarwal G, Lake M. Personal transition to the profession: a novel longitudinal professional development and wellness medical student curriculum. Acad Psychiatry. 2016. Feb 1;40(1):105-8. 10.1007/s40596-015-0463-1 [DOI] [PubMed] [Google Scholar]
  • 35.Bird A, Tomescu O, Oyola S, Houpy J, Anderson I, Pincavage A. A curriculum to teach resilience skills to medical students during clinical training. MedEdPORTAL. 2020. Sep 30;16:10975. 10.15766/mep_2374-8265.10975 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Pasarica M, Lee E, Lee M. Introduction to mindfulness: evidence-based medicine lecture and active session. MedEdPORTAL J Teach Learn Resour. 2016. Sep 28;12. 10.15766/mep_2374-8265.10472 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Rockfeld J, Koppel J, Buell A, Zucconi R. An interactive lifestyle medicine curriculum for third-year medical students to promote student and patient wellness. MedEdPORTAL. 2020. Sep 18;16:10972. 10.15766/mep_2374-8265.10972 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Sheehy J, Yim E, Hayton A. Third-year resilience days: fortifying students against burnout. Med Educ. 2020. Nov 1;54(11):1051-2. 10.1111/medu.14341 [DOI] [PubMed] [Google Scholar]
  • 39.Stumbar SE, Bracho A, Schneider G, Samuels M, Gillis M. Narrative medicine rounds: promoting student wellbeing during the third year of medical school. South Med J. 2020. Aug 1;113(8):378-83. 10.14423/SMJ.0000000000001131 [DOI] [PubMed] [Google Scholar]
  • 40.Williams MK, Estores IM, Merlo LJ. Promoting resilience in medicine: the effects of a mind-body medicine elective to improve medical student wellbeing. Glob Adv Heal Med. 2020;9. 10.1177/2164956120927367 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Yang E, Schamber E, Meyer RML, Gold JI. Happier healers: randomized controlled trial of mobile mindfulness for stress management. J Altern Complement Med. 2018. May 1;24(5):505-13. 10.1089/acm.2015.0301 [DOI] [PubMed] [Google Scholar]
  • 42.Bynum WE, Uijtdehaage S, Artino AR, Fox JW. The psychology of shame: a resilience seminar for medical students. MedEdPORTAL. 2020. Dec 24;16:11052. 10.15766/mep_2374-8265.11052 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.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. Jul 1;19(4):762. 10.5811/westjem.2018.4.37018 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Danilewitz M, Koszycki D, Maclean H, et al. Feasibility and effectiveness of an online mindfulness meditation program for medical students. Can Med Educ J. 2018. Nov 13;9(4):e15. 10.36834/cmej.43041 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Dyrbye LN, Shanafelt TD, Werner L, Sood A, Satele D, Wolanskyj AP. The impact of a required longitudinal stress management and resilience training course for first-year medical students. J Gen Intern Med. 2017. Dec 1;32(12):1309. 10.1007/s11606-017-4171-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Gold JA, Bentzley JP, Franciscus AM, Forte C, De Golia SG. An intervention in social connection: medical student reflection groups. Acad Psychiatry. 2019. Aug 15;43(4):375-80. 10.1007/s40596-019-01058-2 [DOI] [PubMed] [Google Scholar]
  • 47.Kraemer KM, Luberto CM, O'Bryan EM, Mysinger E, Cotton S. Mind-body skills training to improve distress tolerance in medical students: a pilot study. Teach Learn Med. 2016. Apr 2;28(2):219-28. 10.1080/10401334.2016.1146605 [DOI] [PubMed] [Google Scholar]
  • 48.MacLean H, Braschi E, Archibald D, et al. A pilot study of a longitudinal mindfulness curriculum in undergraduate medical education. Can Med Educ J. 2020. Feb 27;11(4):e5. 10.36834/cmej.56726 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Mascaro JS, Kelley S, Darcher Aet al. Meditation buffers medical student compassion from the deleterious effects of depression. J Posit Psychol. 2018. Mar 4;13(2):133-42. 10.1080/17439760.2016.1233348 [DOI] [Google Scholar]
  • 50.Neufeld A. A commentary on “Medical student wellness in Canada: time for a national curriculum framework.” Can Med Ed J. 2022;13(2):2022. 10.36834/cmej.74143 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Thomas PA, Kern DE, Hughes MT, Tackett SA, Chen BY. Curricular development for medical education: a six-step approach. Baltimore, Maryland: Johns Hopkins University Press; 2022. [Google Scholar]

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