Mitigating medical student stress and anxiety: Should schools mandate participation in wellness intervention programs?

Abstract

Purpose

Medical students are at increased risk of poor mental health and need to regularly engage in preventive programs to maintain well-being. However, many do not and it remains an open question whether these programs should be mandatory. We implemented a RCT to examine the effectiveness of assigning medical students to a wellness intervention on adherence to engagement in the assigned intervention and on psychological and academic outcomes.

Method

Medical students participated in a 12-week randomized controlled intervention involving one-hour wellness sessions of either (1) yoga; (2) mindfulness; or (3) walking, held twice-weekly. Students completed standardized psychological assessments at baseline and following the intervention.

Results

Students randomized to the wellness intervention group engaged in more minutes of assigned activities than students randomized to the control. There was a significant difference in the change from pre- to post- intervention on measures of state anxiety and perceived stress, with better outcomes for the intervention group.

Conclusions

The assignment of twice-weekly wellness intervention sessions protects medical students from state anxiety and perceived stress with no negative impact on academic performance. Students adhered to the sessions and reported enjoying the sessions once trying them. Actual engagement is more important than wellness activity type.

Keywords:

• Medical student stress
• medical education
• stress and academic success
• psychological distress

Acknowledgements

The authors wish to thank the following individuals for their contribution to the delivery of the interventions or the collection of data: Rebecca Phillip and Lexi Fisher. The authors also gratefully acknowledge all the students who participated.

Ethical approval

All participants provided signed informed consent before participating in the study and ethical approval was granted by the St. George’s University institutional review board, October 18, 2013 (application # 13020).

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The data generated and analyzed during the study are available from the corresponding author on reasonable request.

Additional information

Funding

Funding for this study was provided by St. George’s University Small Research Grants Initiative, which provides up to $5,000 USD for faculty members to carry out research in their fields of expertise. In-kind support for this project was provided by Kaplan Test Prep and The Institute of Medical Boards in the form free tuition for enrollment for one student (each institution) in the United States Medical Licensing Exam (USMLE) Step 1 preparation course. A draw was held for all students who completed the post-intervention assessment to determine which two students would receive the USMLE Step 1 prep course free tuition.

Notes on contributors

Randall Waechter

Randall Waechter, MA, PhD, is Associate Director of Research and Assistant Dean in the School of Graduate Studies and Associate Professor in the School of Medicine at St. George’s University.

Gabriel Stahl

Gabriel Stahl, MPH, MD, is Emergency Medicine Resident Physician PGY3 at the Brookdale University Hospital and Medical Center in Brooklyn, NY.

Sara Rabie

Sara Rabie, MA, PhD, is Chair and Professor, Department of Educational Services at St. George’s University, St. George’s, Grenada.

Bora Colak

Bora Colak, MPH, MD, is a Psychiatry Resident at Westchester Medical Center/New York Medical College program.

Debbi Johnson-Rais

Debbi Johnson-Rais, MA, EdD, is the Director of the Scholars Program, Division of Student Affairs and Enrollment Management, and Adjunct Professor in the College of Science at Florida Atlantic University, Boca Raton, Florida.

Barbara Landon

Barbara Landon, PsyD, is Director of the Psychological Services Center and Professor in the School of Medicine at St. George’s University.

Kristen Petersen

Kristen Petersen, BA, is a Clinical Evaluation Report Specialist at Global Medical Writing and Translation, Kent, Washington.

Shirin Davari

Shirin Davari, MPH, is a student in the School of Medicine at St. George’s University.

Thinn Zaw

Thinn Zaw, MPH, is a student in the School of Medicine at St. George’s University.

Kesava Mandalaneni

Kesava Mandalaneni, MBBS, is Assistant Professor in the School of Medicine at St. George’s University.

Bianca Punch

Bianca Punch, MPH, is a research scientist at the Windward Islands Research and Education Foundation.