This section seeks to highlight some of the issues surrounding the formal education of medical students and residents by discussing recent changes in graduate medical education requirements, the development of entrustable professional activities for medical students, and presenting examples of curricula and programs that could be adapted by educators for a variety of uses.
GRADUATE MEDICAL EDUCATION
As part of a conceptual shift toward competency-based medical education, the Accreditation Council for Graduate Medical Education (ACGME) fully implemented the Next Accreditation System (NAS) beginning in July of 2014. Although this represents a tremendous step forward in medical education, it has also raised a number of questions regarding the optimal way to teach and assess residents, particularly with skills such as professionalism.
Unique to many of the gradual medical education programs, Emergency Medicine specifies a “wellness” milestone under professionalism. The table above has been excerpted directed from the ACGME milestone for Emergency Medicine.
MED ED PORTAL PUBLICATIONS
Vanderbuilt Wellness Program: Model and Implementation Guide. From MedEdPortal: “Since the development and implementation of the Vanderbilt School of Medicine Wellness Program, institutions across the country have been interested in developing similar programs. It is our belief that the Vanderbilt model of a school sponsored wellness initiative, the Vanderbilt School of Medicine Wellness Program, has had a tremendous impact over its five years in existence. We hope that institutions are able to make use of this guide as they initiate or expand medical student wellness programming at their institutions. The contents not only illustrate the Vanderbilt model for wellness programming, but offer a step-by-step approach for evaluating the needs of an institution and walk through the process of implementing the key components of a wellness initiative tailored to an institution’s needs.”
- Zackoff M, Sastre E, Rodgers S. Vanderbilt Wellness Program: Model and Implementation Guide. MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/publication/9111http://dx.doi.org/10.15766/mep_2374-8265.9111
Women in Medicine Wellness Workshop: Work-Life Integration. From MedEdPortal: “This resource provides the framework and materials needed to implement a wellness workshop for women in medicine. The purpose is to provide a unique session for faculty, residents, and students focusing on the topics of personal wellness (via a yoga session), career goal setting and work-life integration. The structure of the workshop is designed to facilitate networking and mentoring in a relaxed setting utilizing a mosaic of peer mentoring, vertical mentoring, and small group break-out sessions with one senior mentor with multiple junior mentees. A faculty facilitator guides participants through the development of an individual plan, or work-life integration strategy, using a tool for planning professional and personal goals.”
- Welch J. Women in Medicine Wellness Workshop: Work-Life Integration. MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/publication/9248 http://dx.doi.org/10.15766/mep_2374-8265.9248
The Medical Student Wellbeing Workshop. From MedEdPortal: “The goal of this workshop is to help medical students in handling their stresses. Relevant theoretical input related to stress, stressors and coping strategies in the medical context will be discussed thus participants will be able to reflect on their personal strengths and weaknesses. By the end of the workshop, students will be able to 1) gain awareness concerning their personal stress, stressors and coping strategies; 2) begin development of positive coping strategies among participants towards stressors; and 3) begin development of self-improvement strategies to improve their stress management skills.
- Yusoff M, Esa A. The Medical Student Wellbeing Workshop . MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/publication/9241 http://dx.doi.org/10.15766/mep_2374-8265.9241
Maintaining Medical Professionalism: Promoting Balance and Preventing Burnout. From MedEdPortal: “Student burnout is a significant issue to trainees in the health professions, and is particularly pertinent to pre-medical and medical students early in their training. Awareness of student burnout and its impact on future healthcare providers and their patients is a critical aspect of medical education. This presentation was created to introduce ʻImi Hoʻōla Post-baccalaureate students to the topic of student burnout and to educate them on the importance of creating a sense of balance between their academic and personal lives. It is taught as one component of a larger medical professionalism and ethics curriculum which was implemented in 2007. This presentation offers medical education training programs the opportunity for student reflection and open discussion regarding student burnout. Burnout in medicine, particularly for physicians, is a growing trend and students must be equipped to recognize, cope, and hopefully prevent burnout from occurring.”
- Lee W. Maintaining Medical Professionalism: Promoting Balance and Preventing Student Burnout. MedEdPORTAL Publications; 2014. Available from: https://www.mededportal.org/publication/9878http://dx.doi.org/10.15766/mep_2374-8265.9878
Measuring Residents’ Well-Being. From MedEdPortal: “The purpose of this submission is to share the Resident Well-Being Scale (RWB) for critical review. The submission includes an investigation of the descriptive statistics, factors and the internal reliability of residents’ responses to the RWB scale. This submission also includes an investigation of the construct validity of the RWB by exploring potential relationships between residents’ well-being and two theoretically related constructs: the quantity of sleep and rotation demands. The development of the RWB and an investigation of the internal reliability and validity of the responses help contribute to how educators can assess residents’ well-being and inform residency program implementation. This project also serves as the beginning of a long-term project to efficiently measure the well-being of residents and other learners in the health care professions.”
- Cottrell S, Warden M, Graves C, Hashmi M, Nield L, Larrabee H, Lerfald N, Clawges H, Ferrari N. Measuring Medical Residents’ Well-Being. MedEdPORTAL Publications; 2013. Available from:https://www.mededportal.org/publication/9405 http://dx.doi.org/10.15766/mep_2374-8265.9405
MINDFULNESS BASED STRESS REDUCTION (MSBR) COURSES
Palouse Mindfulness: Stress Reduction and Wellness. Free online Mindfulness Based Stress Reduction Course (FREE). From the website: “This self-guided course begins with an Introduction designed to give you a sense of mindfulness and an idea of how this course is structured. For each of the eight weeks, videos, readings and practices help you build a base of both knowledge and experience.MBSR “At a Glance” provides a brief outline of the MBSR course. All of what you will need is accessible through this web site, and whether or not you actually take yourself through the course, the wealth of material here, including videos and writings by the teachers mentioned above and others is freely available to you.”
Center for Mindfulness. Mindfulness Based Stress Reduction 8-Week Course. Originally developed in 1979 by Jon Kabat-Zinn at the University of Massachusetts Medical Center to help patients struggling with mood disorders, mindfulness-based stress reduction (MSBR) techniques have since been widely used and modified for a variety of different learners and situations. The original course consists of eight, three-hour sessions once a week and one all day class. The UMass program offers both in-person one-day, eight-week, and online MBSR training courses.
Insight Meditation Society. From the website: “IMS is one of the Western world’s oldest and most-respected meditation retreat centers. We are dedicated to providing a spiritual refuge for all who seek freedom of mind and heart. Our experienced teachers offer guidance in Buddhist meditations known as vipassana (insight) and metta (lovingkindness). While the context is the Buddha’s teachings, these practices are universal. They help to develop awareness and compassion in ourselves, giving rise to greater peace and happiness in the world. Our two adjacent retreat facilities – the Retreat Center and the Forest Refuge – are set on some 240 secluded wooded acres in the quiet countryside of central Massachusetts.”