Wellness in medical education: definition and five domains for wellness among medical learners during the COVID-19 pandemic and beyond

Figures & data

Table 1. Definitions and example quotations, from semi-structured interviews exploring medical learners’ perceptions and experience of wellness in medical education during the COVID-19 pandemic, University of Calgary, Alberta, July–August 2020.^a

Learner definition for learner wellness in medical education: A general sense of personal well-being – the opportunity to be and to do what is perceived by the learner as most needed and most valued.

General sense of personal well-being ‘I would describe wellness as a general and personal sense of well-being. I think being “well” is a concept is that always changing and evolving, at times good and other times bad, and really something that should be considered on a personal level and supplemented by other levels. So, as a learner, how I might describe wellness now is totally different than how I might describe wellness tomorrow, or even from yesterday, but … generally it’s a sense of personal and holistic well-being.’ (117–84)

The opportunity to be what is most needed and valued ‘A learner who recognizes that wellness is important, perhaps most, takes the time to figure out how to make wellness happen for them in whatever way that means. Asking for flexibility and asking for help so that they can truly be well – reaching out is a big thing. I also think that [a well] learner has a good learning support system, from peers to [supervisors] to [program] coordinators and administrators. Being a learner, we have two homes – our personal home and our academic home. So, if we think about a learner who is well, we can think about being well … in both of our homes.’ (117–13)

The opportunity to do what is most needed and valued ‘Perhaps … I think that … there are two different “facets” of wellness that both fit in to the overall definition of what it means to be well. […] As a medical learner it’s easy to do more – publish more, volunteer extra hours, spend more times on projects you know aren’t going to be fruitful to you. During clerkship, there were times when I didn’t eat for 26 hours, didn’t go to the bathroom. What I’m getting at is that yes, it’s easy to do more, especially in medical education. What’s the difference-maker is whether doing more is determined by the learner as important. Do I feel needed? Are my contributions valuable? Allowing the learner to answer those questions is fundamental in ensuring good wellness for all.’ (117–24)

Five wellness domains for wellness interventions in medical education

Social wellness: Domain of wellness in which medical learners are a part of, and are accepted by their social environment in medical education, and are comfortable expressing their feelings, needs, identities and opinions to colleagues and instructors ‘Social wellness is different to everyone – but it’s the one thing we all have in common because everyone needs social connectivity. Med[ical] students might need it more – demands of medical education can be isolating. Social wellness in medical education … a sense of belonging … having one-to-one connections that are consistent and authentic.’ (117–69)

Mental wellness: Domain of wellness in which medical learners realize their own potential, cope with the normal stressors of life, work productively and fruitfully, and make meaningful contributions to their personal and professional communities ‘I think of mental wellness as a genuine commitment to my communities. Being mentally well means showing up as a contributing, compassionate and empathic member of my personal and professional communities in a way that is meaningful to my mental well-being and stimulating for others. […] I think that if medical students were given the support and flexibility and the time to be committed to our communities in these ways, we could be a great deal more. I know that I would be able to better realize my full potential about if I had this extra space to be mentally well.’ (117–76)

Physical wellness: Expectation of wellness of a leaners’ body, including the active and continuous effort to maintain optimum levels of physical activity and focus on nutrition, as well as self-care and maintenance of a healthy lifestyle ‘Physical wellness is keeping my body physically fit and nourished so that I am able to be the best person that I can be. So, although this sounds like a “doing” thing, it’s more of a “being” thing, for learners … in my opinion. I don’t view exercise as a way to burn calories but rather a means to move my body so that every other domain of wellness can be fulfilled and impacted positively. It’s a way to fill up my cup, so in this sense, it’s really about maintaining good overall health.’ (117–83)

Intellectual wellness: Domain of wellness in which medical learners are enabled to pursue creative, mentally-stimulating activities that expand their knowledge, develop skills, and foster life-long learning and teaching towards self-actualization ‘Intellectual wellness is everything to do with learning – my education. Other activities such as reading a book or taking part in an unrelated seminars would fit here, even if those things are a “break” from my thesis, I think they still contribute to me being intellectually well. Also, having the time to give my brain a break. To make sure I continuously love learning.’ (117–05)

Occupational wellness: Protection and promotion of medical learners, by preventing and controlling occupational diseases and accidents, by elimination of conditions hazardous to health and safety, and by the development and promotion of healthy and safe working environments and organizations ‘Occupational wellness to me is regarding working – doing. I want to know that I am safe, generally, that I am given the conditions and support to work effectively, and there aren’t barriers in the workplace that prevent me from taking care of myself or having time to myself in order to be well. The culture [of healthcare] is not one of self-care, ironically.’ (117–54)

^a‘[…]’ indicates that text has been omitted, while ‘ … ’ indicates a pause in speech.