Imagine you are a first-year medical student and just moved across the country to start your training. It is a stressful time, adjusting to a new city, a school and new people. How do you find your way around campus? Do you need a car? Who should you contact if you need help? Some of these questions are answered during orientation, but the difficult transition to an unfamiliar environment added to the demands of medical training make it a challenge.
The stressfulness of medical training is nothing new. Recently, a systematic review found that a third of medical students have symptoms of depression and a tenth report suicidal ideation. Training is both physically and emotionally demanding. Articles on burnout and its consequences are regularly published. Physician wellness also affects the quality of care we deliver, and burnout has been linked to reduced professionalism and compassion. However, these issues and their impact on patient care haven’t gone unrecognized, and there are resources available, hotlines to call, and other support systems.
A few of us saw our peers struggling with the transition to medical school and looked for ways to help them. Speaking with Student Affairs and other groups, we considered approaches that might be beneficial. We discovered many resources weren’t always easy to find, sometimes hidden on websites. In the early winter of first year, four of us formed the Western Vitals team to start an initiative to better support our peers.
Getting started
How can we best support our peers? After forming, we were welcomed to meetings with Student Affairs, the on-campus Student Development Centre, the head of the Physician Health Program in the province and others. Student Affairs shared results of their annual needs survey of students which helped us in finding where we might contribute.
Early on we had many visions of the project, but each had the formation of a website as a central element. After a few meetings, the project was divided into a website providing specific resources addressing wellness for medical students, targeted workshops and an awareness campaign. With the basic components in place, we needed funding to make the project a reality.
Luckily, a grant opportunity from the Ontario Medical Students Association (OMSA) was available, and we drafted a proposal. We received one of their OMSA Innovator Grants with enough funding to build the website, produce promotional materials and cover food costs at our workshops. With the endorsement of our project by the OMSA and funding in place, it was time to put our ideas into action.
Design
Over several meetings, the design of the project evolved. The workshops would be targeted to specific times of the year, with professional speakers delivering the talks. These ranged from a study skills workshop in October aimed at first-year students to workshops on mindfulness later in the year. The Western Vitals website central to the project was initially intended to have reader contributions and focus on personal narratives to normalize experiences, but as we considered the resources already available, we made the choice not to remake something that was already out there and instead focused on developing an easily accessible and user-friendly resource hub.
After that decision to create a hub, there was the question of how to organize these resources. We chose to divide the resources into major categories. Life, School, Wellness and Crisis, each appended with Matters discussing school life and home life to reduce stigma and show the value of each category. Life would deal with practicalities including parking, transportation, cooking and more, while School would provide information about medical school and its transition points. Wellness focused on self-care and healthy relationships and lastly, Crisis would cover topics such as depression and substance abuse. Within each category, there were many subtopics and for each, a small summary, links to resources and a list of contacts including email addresses and hotlines.
To ensure the resources and contacts we provided were of high quality, we ran them by the Student Development Centre, the head of the Physician Health Program, as well as Student Affairs. This helped to ensure we weren’t just providing everything available, but instead a curated list of what would be most useful to our peers. We also realized that resources and contact information would change with time, therefore making the website easy to update was necessary.
This led to another user experience question. Since users would be interacting with the site, what should be the voice for the content and what would be the right tone? We didn’t want to sound like an authority, more like a peer group that was making suggestions and offering help. Therefore, the voice of a senior medical student was chosen for a consistent and supportive tone throughout the website.
To aid in the user experience, we considered how students would be accessing and browsing such a site. We envisioned different archetypal students with different concerns and mapped how they would interact with the elements of the site. We accordingly tailored the visuals and flow of the site. Some design decisions included the use of non-stigmatizing graphics on the landing page, the visibility of related subtopics while browsing, a social media presence and mobile access, among others.
After we had designed a user experience including the visuals and voice, as well as collected content and tailored the browsing experience, we needed to see how they functioned together. We recruited peers to beta test it along and solicited feedback from established wellness groups. They provided feedback through comments as well as completion of a survey evaluating ease of use and other components. With this feedback, we revised the site and finished working on the rest of the core content.
Achievements
In the fall of 2013 we launched the project, our promotional material was distributed during orientation week and we ran workshops throughout the fall term. That winter the website went live and we had a launch party that filled most of the computer lab leading to great discussions of the project and future directions. New students are introduced to the project at orientation and since 2013 we have continued to run workshops each year, all being well attended, with particularly positive feedback for study skills and identifying peers in crisis. Since the launch of the website, it has experienced consistent traffic, ranging from a dozen to a few hundred visitors a day.
The project has been a great success. In addition to the well-attended workshops and traffic, it has inspired another group of medical students at Schulich to start a project called Clerkship Confidential, hosting debriefing sessions for clinical clerkships. We have also had the chance to present our work at both the OMSA Wellness Retreat in 2015 and at the Canadian Conference on Medical Education in 2016. It was entered in the province-wide Mental Health 2.0 competition for use of technology on campuses to support mental health, placing 3rd overall and winning the People’s Choice Award. The feedback from these events was complimentary to the user-centered design of the website and well-curated resources. It has been wonderful to see the positive response to our idea in support of our peers.
Lessons
As medical students, we were surprised with how willing people were to listen to our ideas and try to support this project. That we were doing a project in support of our trainees may have helped, but doors opened easily and people were happy to set up meetings. It was a lesson in the platform we have in medicine and the ability we have to make connections to drive change.
Part of what made the project work was having a common aim, but differing perspectives on how to achieve it. We had open communication and discussed our ideas, always with the goal helping our peers. There was tension between the members’ visions that was beneficial, allowing us to find a balance between the ideal approach and larger systemic issues related to wellness and what we could feasibly do with our funding, skills and time. Inevitably, such tensions lead to conflict — it would have been beneficial to have established early on were ground rules for discussion and means to deal with disagreement among members.
Since the project involved multiple elements from website content, to graphic design, and arranging workshops, being organized was exceedingly important. We used a Facebook group and Google Docs to collaborate, in addition to our in-person meetings. During each meeting, someone would take notes that were later typed or scanned and sent to all members. In addition, to keep forward momentum at the end of each meeting, we would summarize what we talked about and make a to-do list for each member of specific, achievable items.
A common challenge of such projects had to do with limited funding. Certain design elements for the website or promotional ideas simply weren’t possible. Another challenge was the physical transition of team members to clinical sites, which made it more difficult to meet and work on the project. That the majority of the work was completed before clinical rotations minimized this issue; when it was time for clerkships the website required minimal maintenance.
Another challenge was finding our niche and not encroaching on other groups supporting students. There were professional development groups, with a group establishing a positive campus environment as well as others active at the school. Knowing the other groups’ values and collaborating on events when possible helped prevent conflict. After all, student life is busy, and too many similar events can be overwhelming.
Another lesson was the need for program evaluation. What would count as a success? How would we know if our project was making a difference? We knew people were using the site and attending our workshops, but determining the impact of our work was not easy. This was an element that, if we were to do it all over again, would have been incorporated into the project to better understand and serve the needs of students.
A final challenge was year-to-year transitions upon the departure of team members. This was something that we have come to realize needed to be planned from the beginning. When so much time and effort has been invested in creating something, to have it disappear when core members leave is a shame, especially on a project so beneficial to trainees. To have defined roles that can be transitioned and a portfolio to pass along is a must. In mid-2016 Western Vitals was transitioned to a portfolio under a member of the student council, ensuring its continuation.
Going Forward
Western Vitals will continue to support students at Schulich School of Medicine & Dentistry, but as time passes and student needs change, it will evolve with them. With the simple interface and ease of making changes to the website, we feel it or something like it could serve as a template for other schools to adopt to organize resources for their students. Our hope is that we have made the transition to medical training smoother for those at our school, helped trainees take better care of themselves and thereby improved the care provided to patients.
Acknowledgements
Western Vitals was created through the support of an OMSA Innovator Grant. Team members Julian Surujballi, Daniela Kwiatkowski and Ethan Cassidy. Special thanks to Pam Bere and Dr. Michael Rieder (Learner Equity & Wellness), Dr. Robert Hammond (Student Support Team), Dr. Michael Kaufmann (PHP Medical Director), the Western Student Development Centre and Alison Kealey (Queen’s MPH).
Contributing Writer Emeritus
Schulich School of Medicine & Dentistry at Western University
Dr. Dueck practices emergency medicine, primary care, and addiction medicine. He is an adjunct professor in Family Medicine at the Schulich School of Medicine & Dentistry at Western University and completed residency at McMaster University. He is active in the medical humanities, the author of the blog Aboot Medicine, and co-founder of the student wellness project Western Vitals.
