A student-led MD-PhD program wellness initiative

ABSTRACT

Students who are enrolled in MD-PhD training programs face the same stressors and adverse experiences as medical students and graduate students and, additionally, have challenges unique to the dual-degree curriculum. These future physician-scientists can benefit from tailored training to help them manage these challenges. Thus, students in the Medical Scientist Training Program (MSTP) at Virginia Commonwealth University developed and implemented a student-led, administration-supported Wellness Initiative specifically for these trainees. The initiative has four aims designed to improve students’ wellbeing in all major aspects of their lives and to shift the culture of the MSTP to one with a greater focus on holistic wellness. The aims are achieved with four practical components: monthly wellness programming, a peer mentorship program, annual wellness goals for students, and a wellness resource guide. Together, these components help students build their social support network, facilitate vertical transmission of institutional and local knowledge, offer intentional check-ins that encourage students to seek help whenever needed, and encourage wellness and resiliency education that will aid students throughout their careers. Since its inception in 2019, student involvement in the wellness initiative has steadily increased, with promising annual program data suggesting that it has positively impacted our MSTP students and program culture. The success of the initiative is further reinforced by positive messaging and financial support from MSTP leadership. Student leaders within the initiative continue to innovate, ensuring the initiative remains flexible enough to meet new challenges within the MD-PhD training environment as they arise. The VCU MSTP Wellness Initiative, described herein as a framework for other institutions, is the first published model of a comprehensive wellness program specifically designed to address the unique needs of physician-scientist trainees.

MD-PhD dual-degree students constitute approximately 2–3% of enroled medical school students [1]. They face challenges common to medical and graduate students including the academic rigour of each programme, imposter syndrome, and competitive training environments [1]. They also face unique trials including lack of dual professional identity formation, decreased sense of community, reduced support during transitional periods, long duration, and unpredictable completion time [1–3]. Research into MD-PhD students’ wellbeing during prolonged training (averaging 8 years) is minimal. However, MD-only students experience high rates of burnout, anxiety, depression, substance abuse, and suicidal ideation, while at least one-third of US graduate students suffer from moderate to severe anxiety or depression [1,4–8]. Although many MD-only and PhD-only institutions provide wellness programming, the longitudinal nature of MD-PhD curriculum combined with a limited number of students in similar circumstances may exacerbate feelings of isolation which cannot be comprehensively improved through MD- or PhD-only wellness. The vertical structure among MD-PhD cohorts is uniquely positioned to address these barriers through an MD-PhD specific wellness initiative. Thus, it is essential that MD-PhD programmes incorporate more deliberate emphasis on student wellbeing into their training.

Since 2019, Virginia Commonwealth University (VCU) Medical Scientist Training Programme (MSTP) has implemented a student-led, administration-supported Wellness Initiative that provides a holistic wellness infrastructure that addresses eight dimensions of wellbeing: physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental [9]. Four aims were developed to guide the Initiative after conducting a literature review [1–3,10], qualitatively assessing student needs and programme goals, and collecting anecdotal experiences from MD-PhD students. Aims include: 1) Promoting a culture of resiliency, vulnerability, and compassion, 2) Providing comprehensive support beyond academics, 3) Developing wellness skills that address interpersonal challenges during training and beyond, 4) Establishing a student directed, designed, and motivated wellness programme with administrative support. Four Initiative components were employed to accomplish these aims.

The first Initiative component is monthly wellness-related programming. Students volunteer to organise activities based on mutual interests and student suggestions. Average participation at any single monthly event is approximately 20–25% of our 50- to 55-student programme (ranging from 10–80%). Examples include an annual white-water rafting trip, bonfire discussions on therapy, a holiday gift exchange, financial wellness seminars, local tours, and a mental health toolkit event. Monthly events give students an informal chance to become better acquainted and form social support networks within the programme.

The second Initiative component is a peer mentorship programme pairing students with a senior student mentor. Pairs are chosen based on mutual professional interests, extracurriculars, personal characteristics, or connections formed during the programme application process. Mentors and mentees meet at their discretion to share advice and address personal or professional needs. Since the initiation of the mentorship programme in 2022, there are 19 mentor-mentee pairs with a surplus of volunteer mentors. The mentorship programme improves student wellbeing by fostering connection and facilitating vertical transmission of institutional knowledge.

The third Initiative component employs annual wellness goals. VCU MSTP utilises an annual Individualised Development Plan (IDP) which assists in navigating the complex dual-degree curriculum and developing long-term career goals [11]. The Initiative has incorporated a wellness questionnaire into the IDP, encouraging students to evaluate themselves and set wellbeing goals. During the IDP review, students are encouraged, but not required, to share their answers with programme faculty. Thus, the Wellness Initiative has taken advantage of an existing programme evaluation system to promote self-care and provide an avenue for students to seek help.

The final Initiative component is a wellness resource guide available to all students. This guide contains student recommendations for local resources including activities in the Richmond area, home and car services, medical professionals, therapists, and religious organisations. Included is a series of wellness-related tips and suggestions. The resource guide is designed to promote self-care and ease the integration into a new environment while preserving the accumulated local wisdom of students and alumni.

Medical-scientist trainees face the challenges and stressors of both medical and graduate education while also shouldering burdens exclusive to integrated training. Our Wellness Initiative is novel in that it focuses specifically on MD-PhD students and tackles wellness from multiple angles in a manner that is designed by students for students. The individual components are generalisable to other student populations, but we have employed them here to facilitate transmission of knowledge tailored for MD-PhD trainees and community development for MD-PhD students. Some components are directly wellness-focused while others are more subtle, but together they form an extensive and comprehensive approach that improves the wellbeing of all students through every aspect of their MSTP experience. Positive messaging and financial support from programme administration critically reinforce these efforts.

The annual MSTP survey explicitly asks if students are happy with events and know where to seek help when they are concerned about their wellness. Responses demonstrate that students increasingly agree or strongly agree with these statements over the five years the Initiative was implemented. The survey also demonstrates a cultural shift in our MSTP as an increasing percentage of responding students agree or strongly agree that the programme has a culture that promotes health and wellness. Naturally, not every student engages in our wellness events and programming, as mandatory participation would be contrary to our wellness goals. However, all students have benefitted from the Initiative directly or indirectly as we continue to destigmatize mental and physical health issues and promote more holistic approaches to training. Outstandingly, 20–25% of students contributes to the central leadership core.

Adequate funding, strong central student leadership, and administrative support are crucial to the success of wellness programmes, all of which are included in our MSTP Wellness Initiative [12]. Constant feedback and re-evaluation are essential to respond to changing stress points and challenges. We are committed to these elements as we look to the future, continually developing new programming to meet the evolving needs of our students. Just as medicine has transformed care through a more holistic approach to patients, so too must MD-PhD programmes adopt a paradigm of holistic wellness for their trainees, addressing concerns beyond the academic to help students grow and learn as whole humans.

Funding Statement

National Institute of Arthritis and Musculoskeletal and Skin Diseases (1F30AR081102). National Institute of General Medical Sciences (T32GM144294). National Institute on Minority Health and Health Disparities (F30MD018324).

Disclosure statement

No potential conflict of interest was reported by the author(s).