How are Medical Institutions Supporting the Well-being of Undergraduate Students? A Scoping Review

Figures & data

Figure 1. A ‘bucket’ conceptual framework for medical student resilience (courtesy of authors, with acknowledgement to Dunn et al). A conceptual framework for the review, building on the ‘coping reservoir’ model proposed by Dunn et al. Internal and external factors – including the program offered by the educational institution – can contribute to the resilience of medical students, or can cause draining of the coping reservoir. This leads to burnout, poor mental and physical health, and potentially poorer patient care.

Figure 2. Selection of studies included in the scoping review PRISMA diagram illustrating the identification and selection of articles.

Table 1. Summary of studies reviewed.

Mind-Body or Mindfulness Based Programs
Author [Year)	Country of Origin	Participants	Quality rating
15	USA	n = 27	Fair
27	USA	n = 104	Fair
23	Canada	n = 30	Fair
de Vibe, M et al. [21,22]	Norway	n = 144	Good
25	USA	n = 66	Fair
17	USA	n = 28	Fair
16	USA	n = 24	Good
24	UK	n = 57	Fair
26	Israel	n = 3	Fair
18	USA	n = 24	Fair
19	China	n = 50	Fair
20	USA	n = 45	Good
Miscellaneous Elective Courses
28	USA	n = 28	Fair
29	Canada	n = 18	Good
30	Ireland	n = 74	Fair
Reflection Groups
32,	UK	n = 1827	Fair
31	USA	n = 30	Fair
Curriculum Changes
33	Kuwait	n = 345	Fair
34	USA	n = 350–353	Fair

Abbreviation: RCT, randomized control trial.

Table 2. Studies included in review.

Mind-Body or Mindfulness Based Programs
Author [Year)	Design	Participants	Intervention	Control	Outcome Measures	Results
15	NRNCT	1st and 2nd year medical students n = 27	11 weekly elective “embodied health” course	N/A	Jefferson Scale of Physician Empathy Cohen’s Perceived Stress Scale Self-Regulation Questionnaire Self-Compassion Scale	Increase in self-regulation and self-compassion Increase in empathy
27	NRNCT	3rd and 4th year medical students n = 104	Mandatory Brief Behavioral Intervention Program [BBIP]	N/A	General Well-Being Scale	Decreased stress; decreased anxiety; improved positive well-being.
23	RCT	1st and 2nd year medical students n = 30	Eight-week elective mindfulness meditation program	Waitlist n = 270	Self-reported psychological distress, empathy, self-compassion, mindfulness, altruism, professionalism, and program satisfaction	High level of satisfaction; positive impact on academic performance; positive impact on clinical performance.
de Vibe, M et al. [21,22]	RCT	n = 144	Seven week elective mindfulness‐based stress reduction program	Control n = 144	General Health Questionnaire Maslach Burnout Inventory Perceived Medical institution Stress Scale Subjective Well‐being Scale Five Facet Mindfulness Questionnaire	Moderate reduction in mental distress; small improvement in subjective well‐being and ‘non‐judging;’ significant reduction in study stress for female students
25	NRNCT	2 cohorts of 1st year medical students n = 66	Curricular [mandatory] mindfulness-based stress management course	N/A	Maslach Burnout Inventory Medical Outcomes Study Short Form Perceived Stress Scale Connor Davidson Resilience Scale Happiness and Gratitude Scale	Decrease in mean mental QOL and happiness declined; increased stress; decline in cognitive and emotive empathy; no statistically significant changes in burnout or resilience.
17	NRCT	1st and 2nd year medical students n = 28	Eleven weekly elective mind-body sessions	Control n = 24	Distress tolerance scale Cognitive and affective mindfulness scale revised Perceived stress scale positive affect and negative affect schedule	Improved tolerance of affective distress; improvement in psychological symptoms associated with improvements in distress tolerance; positive satisfaction with program
16	NRCT	1st year medical students n = 24	Eleven weekly elective mind-body skills sessions	Control n = 22	Blood cortisol, DHEA-S, testosterone, and secretory immunoglobulin	Significant reduction in mean morning salivary cortisol, DHEA-S and testosterone; no change in sIgA levels; stability of hormonal levels throughout the semester compared to increases in controls
24	Qualitative	1st-3rd year medical students n = 57	Eight-week elective mindfulness training program	N/A	Open- ended text survey and qualitative interviews regarding well- being, coping reserve and professional development	Themes: greater awareness of thoughts and feelings; greater sense of control and resilience; improved ability to manage workload; greater acceptance of limitations as learners; improved empathy; improved communication skills
26	NRNCT	6th year medical students n = 3	2- hr workshop Mind-Body Medicine Skills combined with interactive reflective writing Reflection 1-month post-workshop	N/A	Professional Quality of Life measure Questionnaire evaluating understanding of professional burnout, resilience and perception on preparation for applying workshop techniques	Participants reported a better understanding of professional burnout/ resilience and felt better able to use meditation and reflective writing as coping tools
18	Mixed	1st and 2nd year medical students n = 24	Eleven week elective mind–body medicine course	N/A	Freiburg Mindfulness Inventory [FMI] Perceived Stress Scale Open text survey items Satisfaction	Improved average mindfulness scores No changes to perceived stress scale Positive satisfaction. Improvements in mindfulness, relationships with peers, and having a safe place to receive support.
19	RCT	1st year medical students n = 50	Five weekly elective well-being therapy sessions	Control n = 51	Psychological well-being, adaptation, anxiety and depression	Improvements in psychological well-being and adaptation; alleviation in symptoms of anxiety and depression
20	RCT	1st- 4th year medical students n = 45	Elective daily use [10–20 min] of audio-guided mindfulness meditation program	Waitlist n = 43	Perceived Stress Scale Five-Facet Mindfulness Questionnaire General Well-Being Schedule	Significant decrease in perceived stress; significant increase in general well-being
Miscellaneous Elective Courses
28	NRNCT	1st and 2nd year medical students n = 28	Equine- assisted course; seven sessions over 2 months	N/A	Beck Depression Inventory-II Stress Factors adapted scale Perceived Stress Scale	Significantly reduced perceived stress, depression, stress severity, and stress frequency
29	Qualitative	1st year medical students n = 18	Six theater based special study modules	N/A	Semi-structured focus groups	3 thematic areas identified: 1] fun/enjoyment/relaxation 2) enhanced relationship connections 3) personal growth/resilience
30	Mixed	1st and 2nd year medical students n = 74	Six weekly elective exercise-based workshops	No control	Beliefs about exercise as medicine; level of physical activity; state of health and well-being; concentration WHO-5 Well-Being Index Sleep scale Loneliness scale Satisfaction with program	Increased well-being, improved sleep, decreased loneliness, increased physical activity; improvement in perception of the importance of exercise as a treatment modality; strong satisfaction
Reflection Groups
32	mixed	3rd year medical students n = 1827	12 weekly mandatory small group clinical debrief discussions	N/A	Online surveys	Positive satisfaction Students appreciated safe environments, the session structure, facilitator role modeling, transitional support and processing of emotional experiences.
31	Mixed	1st and 2nd year medical students n = 30	Biweekly elective reflection groups	N/A	Modified Emotional Self-Awareness Scale, modified Interpersonal Fulfillment Index, and Revised UCLA Loneliness Scale	Improved well-being, enhanced self-awareness, improved ability to empathize, increased sense of connection
Curriculum Changes
33	NRNCT	5th and 6th year dental students n = 345	Subject-based curriculum vs. case-based integrated curriculum	N/A	A modified Dental Environment Stress questionnaire	Increased stress levels
34	NRCT	1st year medical students n = 350–353	Changes to curriculum (Pass/ fail for preclinical courses; reduction of contact hours in first two years of study; longitudinal electives; creation of learning communities; addition of a mandatory resilience and mindfulness program	Students in Class of 2011 and 2012, preceding curricular changes	Center for Epidemiological Studies Depression Scale, Spielberger State-Trait Anxiety Inventory, Perceived Stress Scale, Perceived Cohesion Scale Association of American Medical Colleges’ Graduation Questionnaire	Increased satisfaction with the program For the classes of 2011 and 2012, the mean Step 1 score was 224.5; for the class of 2013, 227; and for the class of 2014, 230. The mean score for the class of 2014 was significantly higher (p = 0.002) than that for the classes of 2011 and 2012.

Abbreviations: RCT: randomized control trial; NRCT: non-randomized control trial; NRNCT: non-randomized non-controlled trial

Figure 3. A mapping of studies reviewed by outcomes (yellow], intervention (purple/green/dark blue), and study design [light blue). A mapping of reviewed studies, describing categories of interventions, study design, and outcomes assessed.

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