Table 2 Predominant themes identified from sit-down interviews, with representative quotes

Students place value on wellness and have unique conceptions of wellness

“That could be spiritually, religiously, living a moral life in accordance with your morals. No cognitive dissonance in your life. You're living the life that you feel is right, and you're progressing towards your goals, be they career, family, personal, whatever”

“For me, still a large part of my identity and how I view myself is in my abilities, my academics, and my desire to become a doctor. At the end of the day, I feel like I have multiple views in myself. Centrally, when I introduce myself to someone I say first and foremost I'm a medical student. If I was to focus on all of those other aspects of my wellness that's great, but if I didn't have a chance to actually become a doctor I think that would affect me a lot too.”

“For me wellness honestly means that I get to have a balance in my life between the things I prioritize. It means not doing too much of one thing and letting that overtake my life.”

“For me, a lot of my wellness stems from my interactions with my family and friends. That's the top thing, to maintain those relationships.”

Wellness is viewed as contextual and can’t be separated from medical culture

“You take that type of person who clearly doesn't value wellness. That's one party, and there's that subset that still exists to this day where that's what it takes to be a doctor. That's still trickled down into the idea of medicine…. systematic mentality coming down on us from both physicians and these ideas that have been ingrained in students”

“It's one of those environments that with certain chronic illnesses and with certain external stressors like being in medical school. It's exacerbated environment”

“Burnout has this connotation that it's a shortcoming on the part of the people experiencing burnout, rather than a shortcoming of the construct of the culture that people who are experiencing burnout are working in”

There is skepticism towards wellness efforts without addressing predominant medical culture

“We're gonna push our students really hard. We're gonna have high expectations. This is gonna be a rigorous curriculum. This is gonna stress them out, but it's OK because we have a wellness program… It’s treating the symptoms rather than the problem.”

“The people who value wellness aren't rewarded by the system the way it's set up currently, which is ironic… yes you can incorporate wellness, but until the system rewards it, there's only so far you can take it.”

“In an academic setting, it's [wellness] always an adjunct right? It's like, "We want all our students to perform well academically. Also, here's wellness over here," off to the side. I get frustrated because I feel like it's something that is talked about but not truly addressed.”

“Keeping the exact same system, but also, now there's a yoga class you're supposed to go to, doesn't address the real problem.”

Mandatory wellness activities are discouraged

“I wonder about the efficacy of an institution almost wagging a finger and saying, "You should." Shoulds are a really good way to have people turn their backs on it.’

“I'll say that I don't necessarily find mandatory wellness things I need to go to particularly helpful. Going back to my timing and business issues, it sounds like just another thing on the list. I find more intrinsically motivated wellness activities to be more helpful.”

Individual differences and preferences for wellness activities should be honored

“It's become grouped because that's what's been studied into a specific subset of ideas and activities, such as mindfulness, activities like yoga, tai chi, studying meditation, implicit understandings, and things like that”

“It's the students that defines wellness as physical fitness, socialization and stuff like that that really benefit from the wellness program”

“…there is a little bit of that barrier where I'm not fully convinced that you know where I'm coming from. Perhaps, maybe having student moderators would be a really good way to ease that, as well.”