Mens sana in corpore sano: Student Well-being and the Development of Resilience 

This month’s journal club post references a Medical Education article:  Mens sana in corpore sana: Student Well-Being and the Development of Resilience by Diana F. Wood

We’ve all heard the seasoned attending lamenting the modern era of work-hour restrictions and 24 hour attending support in comparison to their training wild wild west. For decades, residents learned medicine through a baptism by fire, with those trained in the era recounting 100+ hour work weeks, unsupervised paracenteses in the ED with nothing more than an EKG probe and an LP needle, and shifts long enough to make a stretcher in the corner look more comfortable than the penthouse suite of a Hilton. Much like military boot-camp, many survivors of this antiquated training herald it as the only way to develop the resiliency needed to become an exceptional physician. However, as study after study has shown, this resilience (if truly gained) comes at a high price to patients and trainees alike.

Yet in the modern world of elongated terms of parental support and petting zoos to alleviate student’s stress, is it possible that well-intended institutional support has crippled the development of resilience and may even counterintuitively be contributing to physician burn-out? Studies show that medical students, particularly males, continue to show signs of burnout manifested in depression, reduced empathy, and changed attitudes toward palliative care and cadaveric dissection.

  1. How can students be taught resilience without compromising patient safety or contributing to burnout?
  2. What, if any, unique attributes did physicians learn prior to work-hour restrictions?
  3. What, if any, unique attributes do physicians learn now after emplacement of work-hour restrictions
  4. Are there any forms of resident/medical student support which may be deleterious to the development of resilience?

References:

1. Farnan JM, Petty LA, Georgitis E, Martin S, Chiu E, Prochaska M, Arora VM. A systematic review: the effect of clinical supervision on patient and residency education outcomes. Acad Med 2012;87:428–42.
2. Quince T, Abbas M, Murugesu S, Crawley F, Hyde S, Wood D, Benson J. Leadership and management in the undergraduate medical curriculum: a qualitative study of students’ attitudes and opinions at one UK medical school. BMJ Open 2014;4:e005353.
3. Goldie J, Dowie A, Cotton P, Morrison J. Professionalism. In: Walsh K ed. Oxford Textbook of Medical Education. Oxford university press; 2013. p. 274–6.
4. Papdakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79:244–9.
5. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ2016;50(1):132–149.
6. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, Shanafelt TD. Burnout among US medical students, residents and early career physicians relative to the general US population. Acad Med 2014;89:443–51.
7. Briggs ARJ, Clark J, Hall I. Building bridges: understanding student transition to university. Quality in Higher Education 2012;18:3–21.
8. Adams R. Surge in young people seeking help for exam stress. http://www.theguardian.com/education/2015/may/14/calls-to-childline-over-exam-stress-break-records. [Accessed 11 August 2015].
9. Cohen D, Winstanley S, Palmer P. Allen J, Howells S, Greene G, Rhydderch M. Factors that impact on medical student wellbeing – perspectives of risks. 2013. http://www.gmc-uk.org/Factors_that_impact_on_medical_student_wellbeing____Perspectives_of_risks_53959480.pdf. Accessed [26 August 2015].
10. Shapiro J. From strength to strength. https://www.insidehighered.com/views/2014/12/15/essay-importance-not-trying-protect-students-everything-may-upset-them. Accessed [11 August 2015].
11. Havergal C. Partnership agreements ‘infantilise’ students. https://www.timeshighereducation.co.uk/news/partnership-agreements-infantilise-students-colloquium-hears/2016060.article. Accessed [11 August 2015].
12. Quince TA, Wood DF, Parker RA, Benson J. Prevalence and persistence of depression among undergraduate medical students: a longitudinal study at one UK medical school. BMJ Open 2012;2:e001519.
13. Quince TA, Parker RA, Wood DF, Benson JA. Stability of empathy among medical students: a longitudinal study at one UK medical school. BMC Med Educ 2011;11:90.
14. Quince T, Barclay S, Spear M, Parker R, Wood D. Student attitudes towards cadaveric dissection at a UK medical school. Anatomical Sciences Education 2011;4:200–7.
15. Barclay S, Whyte R, Thiemann P, Benson J, Wood DF, Parker RA, Quince T. An important but stressful part of their future work: medical students’ attitudes to palliative care throughout their course. J Pain Symptom Manage 2015;49:231–42.
16. Whyte R, Quince T, Benson J, Wood D, Barclay S. Medical students’ experience of personal loss: incidence and implications. BMC Med Educ 2013;13:36.
17. Thiemann P, Quince T, Benson J, Wood D, Barclay S. Medical Students’ Death Anxiety: Severity and Association with Psychological Health and Attitudes Toward Palliative Care. J Pain Symptom Manage 2015;50:335-–342.e2.
18. Howe A, Smajdor A, Stöckl A. Towards an understanding of resilience and its relevance to medical training. Med Educ 2012;46(4):349–56.

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