The views and opinions expressed in this collection are those of the authors and do not necessarily reflect the positions of the Association of American Medical Colleges.
Eric Nagarajan is a third-year medical student at University of Minnesota. He is interested in well-being in healthcare, especially in medical education. He has worked with the University of Minnesota Medical School Well-being Committee and Medical Student Council to promote wellness among students, and he is engaged with quality improvement efforts in medical education.
A widely-held association with medical education (and the bane of many medical students' existence) is the daunting commitment of time and work. A recent survey of over 1,100 Florida medical students identified “medical school workload,” “time management,” and “work-life balance” as the greatest stressors in their education,1 echoing the findings of past studies which have linked these stressors to outcomes like burnout and decreased empathy.2,3 The Florida study emphasized a lack of social and administrative support as contributors to stress in a new generation of medical students. As a medical student, I see how demands to be successful are compounded with feelings of isolation, as the degree of time-stress is not always normalized among students or addressed by an institution
At the University of Minnesota, successes in the issue of time strain have been achieved at multiple levels, via a student-led Medical School Well-Being Committee and thoughtful action by administration. Our multidimensional approach to well-being targets Community, Relationships, Health, Purpose, Environment, and Security as contributors to overall wellness.4 Initial data from graduating students since the formation of the Well-Being Committee in 2016 to 2018 shows an increase from 10.4% to 29.9% of students “very satisfied” with “student programs/activities that promote effective stress management, balanced lifestyle, and overall well-being.”5 We hope these strategies inspire other medical schools as we work together to produce great, caring physicians. By increasing support from the student community and administrative action following a comprehensive wellness program, we have helped protect students’ time for hobbies and recreation to promote balance and well-being in medical education.
Student initiatives to build community and relationships
At the level of a student community, structured efforts can promote spending time on hobbies and recreation. The University of Minnesota Medical School Well-Being Committee targets multiple dimensions of wellness among medical students. For the past three years, the Well-Being Committee has run a program through a scavenger hunt app that incentivizes students to engage in hobbies, physical activity, and other small actions that promote wellness and balance. By completing challenges and sharing their activities, students earn points for wellness-related prizes at the end of the semester. Users see photos and progress from their peers, building community and encouragement to reach goals. A community that normalizes and rewards taking time for wellness can reinforce engagement in hobbies and recreation, even pushing students to try something new. Ongoing efforts by the Well-Being Committee include promotion of extra-curricular events in the student community, recognition of students who have gone out of their way to support others, and individualized support to students in times of personal stress.
Support from administrative action to promote student health and purpose
Medical students at University of Minnesota benefit from structural changes by an engaged administration. Scheduling regulations are currently being implemented in clerkships, requiring students one full day off every week, with a consecutive full day off or half day off on alternating weeks. Every year, preclinical course directors streamline lecture content based on student feedback to increase protected independent study hours, lessening the need for students to fill nights and weekends with content review. Formal time regulations and protected study hours help students more clearly understand study expectations. Students can more confidently maintain a healthy balance of activities and more freely engage in research, volunteering, and leadership opportunities. Importantly, these goals and changes are vocalized to students, so students are aware, feel comfortable approaching administration with further feedback, and gain a sense of support. We encourage other schools to implement similar changes, and we encourage students to advocate for their well-being needs.
Amid the many pressures facing medical students, free time becomes valuable and vulnerable. Understandably, hobbies and recreation are sacrificed to a rigorous academic schedule. While our data show no significant change in graduating student disengagement and exhaustion from 2016 to 2018, we hope to see improvement over the next few years with our changes in place.5 Considering the relatively high prevalence of burnout and psychological distress among medical students, it is imperative that strategies are employed by student communities and institutions to defend student freedom to find balance in hobbies or recreation.6 These strategies promote well-being for the maintenance of great learners and the development of great physicians.
Eric Nagarajan
Medical Student
University of Minnesota Medical School
Michael Kim, MD
Assistant Dean for Student Affairs
University of Minnesota Medical School
References
- Hill, Monica R., Shelby Goicochea, and Lisa J. Merlo. "In their own words: stressors facing medical students in the millennial generation." Medical education online. 23.1 (2018): 1530558.
- Santen, Sally A., et al. "Burnout in medical students: examining the prevalence and associated factors." Southern medical journal.103.8 (2010): 758-763.
- Neumann, Melanie, et al. "Empathy decline and its reasons: a systematic review of studies with medical students and residents." Academic medicine. 86.8 (2011): 996-1009.
- “The wellbeing model.” Taking Charge of Your Health & Wellbeing, Regents of the University of Minnesota (2016): https://www.takingcharge.csh.umn.edu/wellbeing-model
- “Medical School Graduation Questionnaire 2018 Individual School Report: University of Minnesota.” Association of American Medical Colleges. (2018).
- Dyrbye, Liselotte N., Matthew R. Thomas, and Tait D. Shanafelt. "Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students." Academic medicine. 81.4 (2006): 354-373.