Build & Belong: A Peer-Based Intervention to Reduce Medical Student Social Isolation

Abstract

Problem

Medical school can be a socially isolating experience, particularly for students underrepresented in medicine. Social isolation and perceptions of not belonging can negatively impact students’ academic performance and well-being. Therefore, interventions are needed to support students and these efforts should be appealing, brief, and low-burden.

Intervention

Guided by evidence-based approaches, we developed the Build & Belong intervention for medical students as a brief peer-to-peer approach that consisted of four components. First, M3 and M4 students wrote reflections on belonging in medical school. Second, M3 and M4 students video recorded messages for M1 and M2 students using their written reflections. Third, M1 and M2 students watched and discussed the videos in small groups. Fourth, the M1 and M2 students wrote letters to future students. Our intervention differs from previous student belonging interventions in the peer delivery of messages.

Context

The Build & Belong intervention aimed to improve medical students’ social belongingness. Using a longitudinal observational study design, the intervention was piloted at a medical school in the Mid-Atlantic United States in 2017-2018. Students completed surveys before and after the intervention. Paired samples tests (t-tests and Wilcoxon) assessed pre- to post-intervention changes in social isolation, social connectedness, and social assurance.

Impact

Among 63 medical students, with 25.9% from backgrounds underrepresented in medicine, we assessed follow-up outcomes in 38 students. Social isolation scores significantly decreased from baseline (M = 54.8, SD = 7.06) to follow-up (M = 51.3, SD = 6.67; p < .001). Social isolation changes were evident regardless of sex, although males reported a greater reduction (M Δ = −5.32, p < .001) than females (M Δ = −2.79, p = .014). Black/African American students had the largest reduction in social isolation (M Δ = −7.24, p = .010). Social assurance and connectedness scores did not change significantly between baseline and follow-up. Medical students appeared to resonate with messages delivered by more experienced peers (M3s and M4s), particularly messages that normalized feelings of not belonging and strategies to reduce those feelings.

Lessons Learned

The Build & Belong intervention appears to reduce social isolation scores among medical students. This pilot test of the Build & Belong intervention provides initial evidence of the effectiveness of a brief, low-cost intervention. Build & Belong may provide a scalable strategy to reduce medical students’ social isolation. Our peer-based approach is distinct from administrator-led strategies; peers were seen as trusted and reliable sources of information about belonging and ways to overcome the challenges experienced during medical school.

Keywords:

• Curriculum development
• diversity and inclusion
• health science education
• instructional materials/methods
• medical education

Acknowledgments

The authors wish to acknowledge Boyang Wei for his contributions to preliminary data analyses; Melanie Vaughn and Preeya Subedi for their assistance with the development of the internal summary report of the Build & Belong Intervention and Natalie Corrilo and John Guzzi, two Georgetown University School of Medicine alumni from the class of 2019, for their work on independent scholarly projects and presentation of earlier results. The authors wish to thank the Office of Admissions at Georgetown School of Medicine for granting us access to historical admissions data. We acknowledge the support of Dean Emeritus for Medical Education and Professor of Medicine and Pediatrics, Stephen Ray Mitchell, MD, MBA, MACP, FRCP, for his support of the research proposal funded by the Georgetown University School of Medicine’s Curricular Innovation, Research, and Creativity in the Learning Environment (CIRCLE) grant program.

Disclosure statement

The authors have no competing interests to report.

Ethical approval

Georgetown University’s Institutional Review Board approved the study.

Additional information

Funding

This work was supported by Georgetown University School of Medicine’s Curricular Innovation, Research, and Creativity in the Learning Environment (CIRCLE) grant program 2017-2018 to S.M.C, D.L.T. and K.D.G. K.D.G was funded by CA51008. A.A.F was funded by CA50633, CA51008 and F30 CA239441.