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Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program

Abstract

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.

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Notes

  1. 1.

    Internal consistency reliability is satisfactory, ranging from α = 0.77 for Psychoticism to α = 0.90 for Depression. Test–retest reliability coefficients are appropriate, ranging from r = 0.78 for Hostility to r = 0.90 for Phobic Anxiety. Validity has been supported by good convergence between similar constructs and good discrimination between dissimilar constructs in other well-established multidimensional measures of psychopathology such as the MMPI, MHQ, GHQ-28, and PSE.

  2. 2.

    Internal consistency is adequate with Cronbach α’s ranging from 0.6 to 0.9, except for social relationships. Test–retest reliability is good, ranging from r = 0.83 to r = 0.86 for each of the subscales. Construct validity is acceptable when compared with SF-36, AQoL, EQ5D, HUI3, and 15D. Discriminant validity is supported with highly significant differences in all four domains found between groups distinguished by health status.

  3. 3.

    The conservative Mauchly’s Test of Sphericity was violated for all analyses and therefore, significance of the tests were examined using Huynh-Feldt Epsilon correction. Evaluation of assumptions was undertaken to reduce skewness, reduce the number of outliers, and improve normality, linearity, and homoscedasticity of residuals. Transformations of variables which violated these assumptions were undertaken. Using Mahalanobis distance with p < 0.001, no cases were identified as multivariate outliers. Inspection of variance inflation factors indicated that multicollinearity was not an issue.

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Acknowledgements

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.

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Correspondence to Craig Hassed.

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Hassed, C., de Lisle, S., Sullivan, G. et al. Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv in Health Sci Educ 14, 387–398 (2009). https://doi.org/10.1007/s10459-008-9125-3

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Keywords

  • Medical students
  • Medical education
  • Stress management
  • Lifestyle
  • Mindfulness