Table 4 Influences upon self-care education

Student-level

Interested students.

• Older, with a greater level of maturity and appreciation for the need for self-care interventions

• Students with higher stress levels pre-intervention

[78, 84, 129, 143, 174]

Students’ adherence to intervention

[3, 7, 58, 64, 85, 89, 90, 99, 136]

Voluntary participation

[54, 68, 76, 89, 114, 115, 132, 146, 178]

Program-level

Validated program

[123, 139]

Occurred during more conducive periods

[49, 66, 75, 86, 114]

Provision of individualised options

[160]

Provision of incentives (e.g., financial, academic points)

[153, 158, 179]

Safe space

• Small group format

• Open, non-judgmental, collaborative discussion to destigmatize mental health concerns

• Personal sharing of own struggles

• Empathetic facilitators

• Peer/clinician led class

• Inter-professional learning to breakdown traditional hierarchies between professions

[7, 56, 58, 64, 65, 83, 115, 138, 139, 144, 145, 154, 155, 167, 168, 177]

Large group size or single session to stay within resource constraints

[68, 84, 87, 90, 92, 161]

Continuous feedback and improvement processes

[58, 139]

Tangible end product creating a sense of accomplishment

[158]

Readily available online material (e.g., videos, audiotapes, readings) for students to learn at own pace, anonymously and to reach rural areas

[68, 100, 138, 159]

References

Student-level

Low adherence (e.g., due to personal stress)

[5, 6, 49, 63, 64, 67, 80, 85, 87, 90, 100, 115, 118, 121, 123, 126, 131, 149, 158, 179]

Mandatory participation (e.g., leading to resentment for program)

[58, 113, 116, 131, 192]

Lack of anonymity and concern about stigma

[58, 121, 160, 193]

Poor understanding of intervention by students

[5, 82, 91, 126, 129]

Program-level

Did not cater to individual preference of self-care practices

[5,6,7, 116, 192, 193]

Large group size

[75, 136]

Poor scheduling (e.g. Scheduled near or in exam periods)_

[116, 192]

Treating wellness as a skill which in doing so stigmatises medical learners and harm their wellness

[192]

Targeting learners instead of learning environment sending the message that they are the problem and not the system

[192]

Hierarchy between facilitators and students

[90, 138]

Lack of support

• Lack of faculty/trained facilitators

• Lack of time allocated to discuss/practice intervention; intervention too short or infrequent

[5,6,7, 56, 58, 67, 68, 75, 90, 91, 96, 131, 137, 143, 145, 155, 161, 166, 173, 180]