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Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review.

ABSTRACT: Importance:Concerns exist about the current quality of undergraduate medical education and its effect on students' well-being. Objective:To identify best practices for undergraduate medical education learning environment interventions that are associated with improved emotional well-being of students. Data Sources:Learning environment interventions were identified by searching the biomedical electronic databases Ovid MEDLINE, EMBASE, the Cochrane Library, and ERIC from database inception dates to October 2016. Studies examined any intervention designed to promote medical students' emotional well-being in the setting of a US academic medical school, with an outcome defined as students' reports of well-being as assessed by surveys, semistructured interviews, or other quantitative methods. Data Extraction and Synthesis:Two investigators independently reviewed abstracts and full-text articles. Data were extracted into tables to summarize results. Study quality was assessed by the Medical Education Research Study Quality Instrument (MERQSI), which has a possible range of 5 to 18; higher scores indicate higher design and methods quality and a score of 14 or higher indicates a high-quality study. Findings:Twenty-eight articles including at least 8224 participants met eligibility criteria. Study designs included single-group cross-sectional or posttest only (n?=?10), single-group pretest/posttest (n?=?2), nonrandomized 2-group (n?=?13), and randomized clinical trial (n?=?3); 89.2% were conducted at a single site, and the mean MERSQI score for all studies was 10.3 (SD, 2.11; range, 5-13). Studies encompassed a variety of interventions, including those focused on pass/fail grading systems (n?=?3; mean MERSQI score, 12.0), mental health programs (n?=?4; mean MERSQI score, 11.9), mind-body skills programs (n?=?7; mean MERSQI score, 11.3), curriculum structure (n?=?3; mean MERSQI score, 9.5), multicomponent program reform (n?=?5; mean MERSQI score, 9.4), wellness programs (n?=?4; mean MERSQI score, 9.0), and advising/mentoring programs (n?=?3; mean MERSQI score, 8.2). Conclusions and Relevance:In this systematic review, limited evidence suggested that some specific learning environment interventions were associated with improved emotional well-being among medical students. However, the overall quality of the evidence was low, highlighting the need for high-quality medical education research.

SUBMITTER: Wasson LT

PROVIDER: S-EPMC5240821 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review.

Wasson Lauren T LT Cusmano Amberle A Meli Laura L Louh Irene I Falzon Louise L Hampsey Meghan M Young Geoffrey G Shaffer Jonathan J Davidson Karina W KW

JAMA 20161201 21

<h4>Importance</h4>Concerns exist about the current quality of undergraduate medical education and its effect on students' well-being.<h4>Objective</h4>To identify best practices for undergraduate medical education learning environment interventions that are associated with improved emotional well-being of students.<h4>Data sources</h4>Learning environment interventions were identified by searching the biomedical electronic databases Ovid MEDLINE, EMBASE, the Cochrane Library, and ERIC from data ...[more]

PMID: 27923091

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Project description:IntroductionMedical students experience higher rates of distress and burnout compared with their age-similar peers overall. Coaching has been proposed as one means of combating distress and burnout within the medical profession. The purpose of this systematic review is to synthesise the current evidence on the effects of coaching interventions on medical student well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms.Methods and analysisWe will conduct a systematic review of interventional and observational comparative studies that assess the effects of coaching interventions on well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms among undergraduate medical students internationally. We will search PubMed (MEDLINE), Embase (OVID), PsycINFO (OVID), Scopus, ERIC, Cochrane Database of Systematic Reviews (OVID) and Cochrane Central Register of Controlled Trials (OVID) from their respective inception dates using the following search terms: (medical students OR medical student OR undergraduate medical education) AND (coach OR coaching OR coaches). Studies in any language will be eligible. Studies that report one or more outcomes of distress or well-being among medical students who receive a coaching intervention will be included. Data on participant and intervention characteristics, outcomes and instruments used will be collected as well as quality/risk of bias assessments. Two reviewers will screen studies against the inclusion criteria and perform data extraction. We will conduct a narrative synthesis, with meta-analysis if evidence permits quantitative pooling of results. Heterogeneity of results across studies according to study design, learner level and study risk of bias will be evaluated, as well as publication bias.Ethics and disseminationEthical approval is not required for this review. Results will be disseminated by publication in a scientific journal.Prospero registration numberCRD42022322503.

Project description:ImportancePrevious studies have shown that medical student mistreatment and burnout are common. However, few longitudinal data exist to describe how mistreatment and other learning environment experiences are associated with subsequent burnout and other student characteristics.ObjectiveTo examine the association between mistreatment and perceptions of the learning environment with subsequent burnout, empathy, and career regret among US medical students.Design, setting, and participantsThis cohort study analyzed data from the 2014-2016 Association of American Medical Colleges (AAMC) Medical School Year 2 Questionnaire (Y2Q) and 2016-2018 AAMC Graduation Questionnaire (GQ). Medical students from 140 allopathic medical schools who responded to both AAMC surveys were included in the analysis. Data were analyzed from December 1, 2019, to January 11, 2021.ExposuresSelf-reported medical student mistreatment (eg, experiences of negative behaviors and discrimination related to sex, race/ethnicity, and sexual orientation) and perceptions of the learning environment (Medical School Learning Environment Survey subscales for faculty, emotional climate, and student-student interactions).Main outcomes and measuresBurnout, empathy, and career regret as measured by Oldenburg Burnout Inventory data for burnout, Interpersonal Reactivity Index scores for empathy, and a single item assessing career regret.ResultsData from 14 126 medical students were analyzed; 52.0% were women, and the mean (SD) age was 27.7 (2.9) years at graduation. Mistreatment was reported by 22.9% of respondents on the Y2Q. In multivariable analysis adjusted for Y2Q measures, mistreatment reported on the Y2Q was associated with a higher exhaustion score (1.81 [95% CI, 1.60-2.02]), a higher disengagement score (0.71 [95% CI, 0.58-0.84]), and higher likelihood of career regret on the GQ (186 of 989 [18.8%]; all P < .001). A more positive emotional climate reported on the Y2Q was associated with a lower exhaustion score (for each 1-point increase, -0.05 [95% CI, -0.08 to -0.02]; P = .001) and lower disengagement score (for each 1-point increase, -0.04 [95% CI, -0.06 to -0.02]; P < .001) on the GQ. More positive faculty interactions on the Y2Q were associated with higher empathy score on the GQ (for each 1-point increase, 0.02 [95% CI, 0.01-0.05]; P = .04). Better student-student interactions were associated with lower odds of career regret during year 4 of medical school (odds ratio for each 1-point increase, 0.97 [95% CI, 0.95-1.00]; P = .04).Conclusions and relevanceThe findings of this cohort study suggest that medical students who experienced mistreatment and perceived the learning environment less favorably were more likely to develop higher levels of exhaustion and disengagement, lower levels of empathy, and career regret compared with medical students with more positive experiences. Strategies to improve student well-being, empathy, and experience should include approaches to eliminate mistreatment and improve the learning environment.

Dataset Information

Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review.

Publications

Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review.

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