To address the above findings, and the documented risk of increased depression during the course of medical school, we created WellMed, a coordinated wellness program that incorporates multiple dimensions of wellness into one cohesive program. Inspired by similar programs at Vanderbilt and elsewhere [8], the components included in the program are physical health; mental health; spiritual wellness; physical fitness; nutrition; intellectual wellness; social wellness; and financial wellness. Under the leadership of the Assistant Dean for Student Affairs, a task force was organized to expand and effectively “market” the program on campus. The group included additional faculty members, the Director of Student Activities and the Director of Student Affairs, the Director of Fitness Services, Director of Food Services and representative students from all four years of the medical school curriculum. This program was not meant to replace the existing services available for students, but rather to complement and enhance the existing infrastructure. For example, prior to the program’s implementation, students in psychological distress received referrals for counseling through the Office of Academic Support and Counseling. While this is still a way for students to receive acute counseling and referrals, students can also access psychiatric services directly through a partnership developed between WellMed and the Department of Psychiatry that allows students direct access to expedited psychiatric services.
Since the introduction of the program in the 2013–2014 academic year there have been multiple WellMed sponsored events around campus. Based on our needs assessment findings, a mindfulness training program has been integrated into the established and required “transition to third year” program which is administered just before the students begin their first clerkship. Additionally, there has been an emphasis on teaching stress reduction strategies to the Einstein Peer Mentors, a group of second, third and fourth year students dedicated to supporting members of the community throughout their tenure at Einstein. Sessions have included simple massage techniques and meditation.
Future directions
In the coming year we plan to incorporate mindfulness interventions into the programming in ways to reach the entire class. Mindfulness interventions have been shown to lead to reduction in depression and anxiety in first and second year medical students [15, 16], but their impact on the clerkship years has not been examined. Our goal in this effort will be to develop a model for mindfulness training compact enough to be offered to the entire class as part of the required curriculum, and yet effective enough to make a meaningful difference. The intervention will start during second year and then continue into and through the third year and will be based on models successfully developed and implemented for smaller groups of students elsewhere [17]. Although we recognize that specific mental health and counseling interventions will still be necessary for many students to address the increased stress and depression documented here, we hope to reduce the proportion of the class in need of these interventions through this class-wide strategy.
We will continue to administer the wellness survey as a curricular element to the first and third year classes. We plan to compare the above baseline results to subsequent classes who have been offered the WellMed program since matriculating at Einstein. We will supplement this quantitative data with a qualitative inquiry using focus groups with third year students from the classes of 2017–2018. The purpose of the qualitative inquiry will be to glean a more nuanced view of the challenges to student wellness, to solicit feedback on the elements of the program that students felt were helpful and to gain insight into future directions.
Limitations
Although our comprehensive needs assessment and evaluation strategy for our wellness program has distinct advantages, some limitations must be noted. First, the fact that the wellness survey is required may affect the honesty of reporting due to students’ concerns regarding whether their answers are in fact entirely confidential. Second, to protect this anonymity, we were unable to include specific identifiers to track the impact of our program on individual students. Therefore, we can only evaluate the data for the class as a whole, possibly leading to an underestimate of the actual changes that happen during medical school for selected students more at risk and of the potential impact of our program on those same students. Finally, as multiple components to the program may be implemented over the same time period, it is difficult to discern the impact of any one intervention on the overall wellbeing of the class.