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Table 5 Recommendations for future iterations of SeRenE

From: Can stoic training develop medical student empathy and resilience? A mixed-methods study

Issue Recommendation
The term ‘judgments’ within exercise 2 was confusing for some students. This led to misinterpretation of what this exercise was asking for amongst some, and lessened the potential impact of this exercise, which was intended to promote Stoic mindfulness regarding what can, and cannot, be controlled. Reconsider use of the term ‘judgments’. Although this is a technical term associated with Stoic Philosophy, it was widely misunderstood. We suggest that the alternative term ‘interpretations’ is trialled to encourage students to consider the negative or positive labels they assign to emotions or experiences. Be open to re-evaluating the effectiveness of this exercise following modifications to the language used.
Some students found it difficult to consider possible solutions to the practice of negative visualisation in regard to empathy, given limited clinical exposure. Integrate SeRenE alongside established communication skills/clinical skills modules within health professions training or ensure delivery of an appropriate in-person follow up, where students have a chance to discuss possible solutions with peers and senior clinicians. This may also increase engagement.
It could be difficult to remember exactly how to complete each exercise each day, as the worked examples were only visible on day 1 of the training. Provide access to the worked examples on each day of training.
For students who were shielding, or did not volunteer clinically, a lack of patient contact made considering patient cases to reflect on more difficult. This training is most appropriate for students experiencing regular patient contact. If it is used in situations where patient contact is limited in the future, a bank of clinical examples should be offered for students to reflect on.
There was no consensus regarding whether training should repeat within an academic year, and how frequently this should be done. A flexible approach following initial training may be most suitable, where students can, and are encouraged to, re-engage at their own leisure.
Having to access training through a web browser was off-putting for some. An app could be developed to host SeRenE, which would increase the accessibility of, and possibly the engagement, with such training in future.