Table 2.

Study methodology

Study	Number of Sites	Overall Sample Size	Women, No. (%)	Intervention	Evaluation	MERSQ I	Aim
Pass/Fail Grading Systems
Bloodgood et al,14 2009	Single site	n = 281	5-interval (A/B/C/D/F ): (62%) Pass/fail: (46%)	Changed first- and second-year grading system from 5-interval letter grades (A/B/C/D/F) to pass/fail grading system in first 2 preclinical years	Self- assessment	11.5	Measure the association of change in grading systems on medical student satisfaction and psychologic well- being
Rohe et al,15 2006	Single site	n = 81	5-interval (A/B/C/D/F ): 26/41 (63%) Pass/fail: 20/40 (50%)	Replaced 5-interval grading system (A/B/C/D/F) or first preclinical year with a modified pass/fail system (grading included pass/marginal pass requiring student action for remediation/fail) during first preclinical year	Self- assessment	12	Measure the sustained and immediate effects of a pass/fail grading system on stress, mood, group cohesion, and test anxiety
Reed et al,19 2011	Multisite	n = 2056 n = 1192 (responded)	550/1192 (47%)	Multisite survey of 2 different grading scales: 1) pass/fail and 2) 3+- interval (eg, honors/pass/fail, honors/high pass/pass/marginal pass/fail)	Self- assessment	12.5	Examine the relationship among curriculum structure, grading scales, and student well- being
Mental Health Programs
Thompson et al,20 2010	Single site	n = 120	---	Multipronged intervention for third- year students aimed at 1) reducing barriers to mental health treatment by reducing stigma via faculty education, mental health curriculum, including lectures and a student handbook; and 2) fully confidential and reduced/no-cost counseling services	Self- assessment	11.5	Test the effectiveness of an intervention meant to reduce depressive symptoms and suicidal ideation
Seritan et al,21 2013	Single site	---	---	Multipronged mental health/wellness program offering prevention, support, and enhanced clinical services (ie, hiring a psychiatrist to offer medication management) through development of a new Office of Student Wellness with evening hours and strict confidentiality	Survey	11.5	Presentation of a model for effective preventative student wellness
Downs et al,22 2014	Single site	n = 1008 (program) n = 343 (program and screen)	Year 1: 93/148 (63%) Year 2: 34/65 (52%) Year 3: 27/49 (55%) Year 4: 49/79 (62%)	4-year intervention including an educational group program (lectures, workshops, trainings) and a web- based mental health screening survey	Self- assessment and survey	13	Educate, destigmatize, identify, refer, and treat individuals with depression and increased suicide risk
Moutier et al,23 2012	Single site	n = 498 n = 132 (screened)	---	Two-pronged intervention consisting of Grand Rounds lecture on mental health and a web-based mental health screening survey	Self- assessment	11.5	Develop a mental health program to address physician and medical student depression and suicide
Mind-Body Skills Education/Training Programs
Erogul et al,24 2014	Single site	n = 58	26/58 (45.6%)	8-week mindfulness- based stress reduction intervention for first- year medical students	Self- assessment	12	Assess whether an abridged mindfulness based stress reduction intervention can improve wellness
Holtzworth -Munroe et al,26 1985	Single site	n = 40	---	6 weekly meetings focused on teaching skills to reduce stress levels (progressive muscle relaxation, skills to help recognize and change maladaptive thoughts, and meditation techniques)	Self- assessment	10	Help students acquire and develop skills to cope with stress
Kraemer et al,27 2016	Single site	n = 52	(62.7%)	Mind-body program consisting of 11 weekly skill training groups focusing on mind-body skills (biofeedback, guided imagery, relaxation, breathing exercises, autogenic training, and meditation)	Self- assessment and survey	12	Describe changes in distress tolerance after completing a mind-body skills training group
Rosenzweig et al,29 2003	Single site	n = 302	---	Mindfulness-based stress reduction including 10 weekly 90- minute sessions teaching mindfulness meditation practices and daily, independent meditation	Self- assessment	11	Examine the effectiveness of Mindfulness Based Stress Reduction seminar
Finkelstein et al,31 2007	Single site	n = 72	Time 1: Intervention 17/26 (77.3%) Control 22/46 (61.1%) Time 2: Intervention 17/26 (77.3%) Control 16/25 (80%) Time 3: Intervention 15/23 (75%) Control 20/40 (62.5%)	Mind-Body Medicine: An Experiential Elective including 10 sessions of didactic and small group instruction	Self- assessment	11	Assess the effectiveness of a stress reduction elective on second year medical students
Greeson et al,32 2015	Single site	n = 44	29/44 (65%)	4 weekly 1.5-hour small-group sessions and home practice of mind-body skills in addition to monitoring a weekly self-care goal	Self- assessment and semistructured interview	11.5	Evaluate the feasibility, acceptability, and effectiveness of a stress- management and self-case workshop
Bond et al,33 2013	Single site	n = 27	---	11-week Embodied Health course combining yoga meditation and neuroscience didactics	Self- assessment and semistructured interview	11.5	Evaluate the psychologic effects of an 11- week mind-body elective course
Curriculum Structure
Reed et al,19 2011	See above in Grading Systems section
Camp et al,35 1994	Single site	n = 275	93/275 (33.8%)	Student-directed, project-based learning approach featuring small-group, problem- based sessions in which both basic and clinical science learning issues are generated; lecture- based learning is an instructor-directed, didactic approach	Self- assessment	12	Assess changes in depression among medical students enrolled in a lecture-based learning or problem-based learning program
Kornitzer et al,36 2005	Single site	n = 92	---	6-week prematriculation enrichment program targeting educationally disadvantaged students (didactic sessions and laboratory component)	Survey	7	Determine whether educationally disadvantaged students participating in a summer enrichment program were reported to have had an easier time adjusting to medical school
Multi-component Program Reform
Drolet and Rodgers,37 2010	Single site	n = 116	---	Vanderbilt Medical Student Wellness Program to promote student health and well- being through changes, including faculty mentoring (Advisory College Program and Vanderbilt Medical Student Careers in Medicine), curriculum (VMS Live Program), and student well-being (Student Wellness Committee)	Survey	6.5	Evaluate a multicomponent wellness program
Fleming et al,38 2013	Single site	n = 245	---	Initiatives, activities, and resources including: 1) the Advisory College Program for student well-being and career mentoring/advising with an additional aim of establishing relationships between students and faculty serving as both teachers and role models; 2) the student-led Student Wellness Committee focused on peer mentoring, social community, and mind/body wellness programming; 3) Vanderbilt Medical Students Careers in Medicine for career exploration, advising and planning, as well as residency application preparation; 4) VMS Live Program focused on the personal development of physicians-in-training; and 5) the 4-year College Colloquium Course focused on medical humanities and formally addressing professionalism, ethics, and leadership skills	Survey	6	Reflect on and describe learning community system and effect on student satisfaction
Real et al,39 2015	Single site	n = 450	(55%)	Vanderbilt Wellness Program including a faculty-led mentoring system, annual retreat series, and student-led programming committee, all organized around a college system which divides students into 1 of 4 colleges	Self- assessment and survey	10.5	The association of a wellness initiative on distress
Slavin et al,40 2014	Single site	n = 875– 890	---	Phase 1: pass/fail replaced 4-interval (honors/near honors/pass/fail) grading system, reduction in contact hours by approximately 10%, longitudinal electives, established 5 learning communities of medical students and faculty with common interests beyond the classroom Phase 2: refined pass/fail grading system by eliminating norm referenced performance data, resilience/mindfulness program spanning 6 hours Phase 3: modified human anatomy course to occur later in the first year and to have examinations with mean scores consist with other courses	Self- assessment and survey	12	Discuss the utility and relevance of curricular changes and association with student mental health
Strayhorn,41 1989	Single site	n = 478 (responders , original sample size not provided)	---	Major curriculum revision, including seminar- and small group-based learning, analytical and problem- solving skill building, increased free time for student learning, formal instruction in social and behavioral sciences, increased mentoring, and development of a new student/faculty/curriculum evaluation system	Self- assessment	12	Assess student well-being and perceptions on medical school learning environment after curriculum change
Miscellaneous Wellness Programs
Whitehouse et al,42 1996	Single site	n = 35	(60%)	Daily practice of self- hypnosis and diary records of sleep, mood, physical symptoms, and frequency of relaxation practice	Self- assessment	12	Determine the effectiveness of a self- hypnosis/relaxation intervention to relieve symptoms of psychologic distress and immune system reactivity to examination stress
Goetzel et al,44 1984	Single site	n = 26	(45%)	Human Dimensions Program: biweekly, self-help support group	Survey	9	Assess the quality of support groups at Albert Einstein College of Medicine
Lee and Graham,45 2001	Single site	n = 66	40/60 (66%)	6-week wellness elective consisting of 1- hour lectures by physician presenters, discussions, and writing exercises	Survey	7	Explore students’ perceptions of medical school stress and to assess their perspective on the wellness elective
Kushner et al,46 2011	Single site	n = 343	171/343 (49.8%)	Behavior change plan in which students attempt to change one of their own health behaviors, including a mental/emotional health personal goal	Self- assessment	8	Teach medical students the principles and practice of behavior change using a behavior change plan
Group-based Faculty Advisor/Mentor Programs
Sastre et al,47 2010	Single site	n = 318	---	Faculty advisory program, Advisory College Program, consisting of 4 advisory colleges each co-led by 2 faculty members nominated and competitively selected by a student committee; Advisory College Program faculty focus on advising by promoting wellness and providing career counseling	Survey	9.5	Determine if Advisory College Program is more effective than 1- on-1 mentoring
Coates et al,48 2008	Single site	n = 100	---	Group-based mentoring program (the College Program) exclusively for fourth-year medical students, which divided students into academic interest-based groups led by a faculty chair and included a team of both faculty and student mentors/advisors/role models; the College Program provided mentoring, career advising, and curricular support	Survey	8	Change in fourth- year curriculum to include more mentors
Ficklin et al,49 1983	Single site	n = 151	---	Small group-based faculty advisor program exclusively advising first-year medical students with goals of increased student/faculty communication, informal student/faculty activities, increased student-to-student communication and support, and decreased anonymity; advisory groups were maintained as sections of larger courses	Survey	6	Provide advice and support in areas of documented stress

MERSQI, Medical Education Research Study Quality Instrument.