A wave of integrating wellness into medical education curricula in medical schools across the country stems from a high prevalence of physician burnout and stress nationwide. Moreover, the COVID-19 pandemic has further contributed to a decline in medical student wellness. Awareness of mental health and burnout concerns amongst physicians is simply insufficient; there is a dearth in actionable guidelines for training programs and medical schools to better medical student wellbeing. An inherent flaw of the wellness paradigm in medical education is that teaching about it places wellness in a category with pharmacology, physiology, anatomy and histology. Creating an educational core competency for mental health is one step forward, but until wellness is inherent to the culture of a program, little change can be enacted.
Several medical schools have created “Wellness Weeks” or scheduled mental health activities. A week-long break to take a step back from medicine would be a great addition to all medical schools, giving students time during the year for a much-needed pause and moment for self-reflection. Health and wellbeing programs improve emotional regulation and academic performance. While medical students are surely grateful for any time off, a week of wellness is shockingly ephemeral. Discussing the topic for a short period of time and then sparingly thereafter causes many students to revert their mindset and subsequently forget about its importance. Additionally, many wellness programs are optional for students and do not reach the entirety of their target audience. Although there is an anecdotal, general dissatisfaction among medical students towards mandatory events, a balance is imperative to ensure a movement toward a culture of wellness.
A letter to the editor published in the Journal of the Association of American Medical Colleges in 2017 states the necessity for a paradigm shift in the wellness movement. The letter to the editor urged the acceptance of wellness as a culture and a life-long philosophy, not a week. Dedicating a short period of time to mental health can initiate a phenomenon of a “wellness to-do list,” where working on your wellbeing is an item to check off your list rather than an integration into every other task. We run the risk of trivializing the concept of “wellness.”
Lectures about wellness are useful to a certain extent. If medical students don’t understand the importance of the topic, it is difficult to self-actualize it. In addition to this, the American Medical Association suggests measuring wellbeing throughout the year with brief anonymous surveys. The surveys inform medical schools how their students are doing compared to the national average. Also, students taking the surveys are forced to question their state of mental health outside of a lecture or program context. Lastly, built-in wellness days throughout the year, rather than a week, would foster continuous self-improvement. Some medical schools have clerkship years that include personal days, and this would be extremely fruitful for preclinical students as well.
Medical students learn best from their mentors and their peers. Medical schools can foster relationships between their students and their faculty by having guest lecturers speak on their own journey to wellness, allowing students to connect with these faculty members. I have learned many strategies that are used to overcome stress since starting medical school, in part because I seek to hear from others about this topic. Addressing an entire class about this issue would once again reiterate its importance. It would also humanize the need for wellness — faculty members and students alike experience the stressful nature of the medical profession.
In order to tackle the pervasive issue of physician burnout, we need to develop lasting, actionable ways to improve the well-being of the next generation of physicians. Wellness must therefore be slightly detached from other educational core competencies such as the aforementioned pharmacology, physiology, anatomy and histology. It is crucial for medical students to want to work towards mental health goals early on in their careers to prevent downstream ripple effects.
Insofar as medical students take a personal interest in wellness, medical schools can supplement with grassroots organized efforts to build a culture. We must acknowledge that the medical field is filled with inevitable stressors; in general, life is filled with unavoidable stressful circumstances. Strategies can improve our reaction to stressors, and an uplifting culture can ease burnout symptoms. Integrating wellness into medical education as a core competency is a quick fix. However, the culture needs to be addressed at all levels — from undergraduates up to faculty members — to realize a lasting change.