Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program
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Medical students experience various stresses and many poor health behaviours. Previous studies consistently show that student wellbeing is at its lowest pre-exam. Little core-curriculum is traditionally dedicated to providing self-care skills for medical students. This paper describes the development, implementation and outcomes of the Health Enhancement Program (HEP) at Monash University. It comprises mindfulness and ESSENCE lifestyle programs, is experientially-based, and integrates with biomedical sciences, clinical skills and assessment. This study measured the program’s impact on medical student psychological distress and quality of life. A cohort study performed on the 2006 first-year intake measured effects of the HEP on various markers of wellbeing. Instruments used were the depression, anxiety and hostility subscales of the Symptom Checklist-90-R incorporating the Global Severity Index (GSI) and the WHO Quality of Life (WHOQOL) questionnaire. Pre-course data (T1) was gathered mid-semester and post-course data (T2) corresponded with pre-exam week. To examine differences between T1 and T2 repeated measures ANOVA was used for the GSI and two separate repeated measures MANOVAs were used to examine changes in the subscales of the SCL-90-R and the WHOQOL-BREF. Follow-up t-tests were conducted to examine differences between individual subscales. A total of 148 of an eligible 270 students returned data at T1 and T2 giving a response rate of 55%. 90.5% of students reported personally applying the mindfulness practices. Improved student wellbeing was noted on all measures and reached statistical significance for the depression (mean T1 = 0.91, T2 = 0.78; p = 0.01) and hostility (0.62, 0.49; 0.03) subscales and the GSI (0.73, 0.64; 0.02) of the SCL-90, but not the anxiety subscale (0.62, 0.54; 0.11). Statistically significant results were also found for the psychological domain (62.42, 65.62; p < 0.001) but not the physical domain (69.11, 70.90; p = 0.07) of the WHOQOL. This study is the first to demonstrate an overall improvement in medical student wellbeing during the pre-exam period suggesting that the common decline in wellbeing is avoidable. Although the findings of this study indicate the potential for improving student wellbeing at the same time as meeting important learning objectives, the limitations in study design due to the current duration of follow-up and lack of a control group means that the data should be interpreted with caution. Future research should be directed at determining the contribution of individual program components, long-term outcomes, and impacts on future attitudes and clinical practice.
KeywordsMedical students Medical education Stress management Lifestyle Mindfulness
This study was performed by Steven de Lisle as the primary researcher as a partial fulfillment of the requirements of the degree of Bachelor of Arts (Hons) in the School of Psychology, Psychiatry and Psychological Medicine, Monash University.
The authors would like to thank the Theme 1 working group for personal and professional development and the wider faculty at Monash University for their commitment over many years to the wellbeing of the student body and the Health Enhancement Program. Ethics. The study was approved by the Monash University Standing Committee for Ethics on Research on Humans.
- Baldwin, D. C., Jr., & Daugherty, S. R. (2004). Sleep deprivation and fatigue in residency training: Results of a national survey of first- and second-year residents. Sleep, 27(2), 217–223.Google Scholar
- Derogatis, L. R. (1994). SCL-90-R: Administration, scoring, and procedures manual (3rd ed.). Minneapolis: National Computer Systems.Google Scholar
- Epstein, R. M., & Hassed C. S. (2008). Mindfulness training: From student care to clinical practice. In 13th Ottawa International Conference on Clinical Competence. http://www.ozzawa.com.
- Fahrenkopf, A. M., Sectish, T. C., Barger, L. K., Sharek, P. J., Lewin, D., Chiang, V. W., et al. (2008). Rates of medication errors among depressed and burnt out residents: Prospective cohort study. British Medical Journal, 336(7642), 488–491. doi: 10.1136/bmj.39469.763218.BE.CrossRefGoogle Scholar
- Hassed, C. (2002). Know thyself: The stress release program. Melbourne: Michelle Anderson Publishing.Google Scholar
- Kabat-Zinn, J. (2005). Full catastrophe living—using the wisdom of your body and mind to face stress, pain, and illness (3rd ed.). New York: Bantam Dell.Google Scholar
- Moss, S. B., & Smith P. O. (2006). Wellness and impairment content in schools of medicine curriculum in the United States and Canada. Medical Education Online [serial online], 12, 3. Available from http://www.med-ed-online.org.
- Murphy, B., Herrman, H., Hawthorne, G., Pinzone, T., & Evert, H. (2000). Australian WHOQOL instruments: User’s manual and interpretation guide. Melbourne: Australian WHOQOL Field Study Centre.Google Scholar
- Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.Google Scholar
- Toneatto, T., & Nguyen, L. (2007). Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research. Canadian Journal of Psychiatry, 52(4), 260–266.Google Scholar
- Willcock, S. M., Daly, M. G., Tennant, C. C., & Allard, B. J. (2004). Burnout and psychiatric morbidity in new medical graduates. Medical Journal of Australia, 181(7), 357–360.Google Scholar