Background: Medical student wellness, including physical health, emotional health, and levels of perceived stress, appears to decline during training, with students reporting high levels of depression, anxiety, and burnout as early as the first year of medical school. The impact of curricular changes on health and stress remains unclear, and a modified curriculum that compresses training of the foundational sciences and its effect on wellness has not been studied. Oregon Health & Science University School of Medicine has recently instituted a unique competency-based model, which provides an important opportunity to assess the effects of curricular change on student wellness. Objective: Assess the effects of curricular change on student wellness. Design: Medical students at a single institution were administered the SF-8, an 8-item healthrelated quality of life survey, as well as the Perceived Stress Scale, a 10-item scale that measures the degree to which life situations are appraised as stressful, at baseline (matriculation) and at the end of Year 1, 2 and 3. Individual variables were assessed over time, as well as a trend analysis of summary domain scores over the 4 time periods. Results: Physical, emotional, and overall health were highest at baseline and lowest at the end of Year 1, after which they improved but never again reached baseline levels. Physical health declined less than emotional health. Perceived stress levels did not change over time but remained moderately high. There were no differences in health or perceived stress based on demographic variables. Conclusions: In a competency-based curriculum, physical, emotional and overall health significantly worsened during Year 1 but improved thereafter, while perceived stress remained unchanged. Early in training, stress and poor overall health may be related to concerns about self-efficacy and workload. Although advanced students show improved wellness, concerns remained about emotional difficulties, such as anxiety and irritability, and feeling a lack of control.

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Context: Prevailing leadership development programs emphasize technical strategies that foster transactional working relationships, which can contribute to team burnout and inequities. The Relational Leadership Institute (RLI) is an interprofessional leadership training that aims to narrow harmful impacts of power differentials, build community, and change systems by transforming the relationships within them. With increasing levels of burnout, health care workers could benefit from relational leadership development to foster workspaces that are more human-centered, authentic, and inclusive.Objective: To evaluate the impact of RLI on participants' well-being.

Purpose Medical trainees experience significant exam-related stress, such as preparing for the USA Licensing Medical Examination Step 1, which often negatively affects emotional health. Nourish , a novel Step 1 support program, was designed to foster improved self-efficacy and well-being during the process of studying for and taking the exam. Nourish was piloted at Oregon Health & Science University between December 2018 and February 2019. Methods Program elements were guided by Self-Efficacy Theory and included community building, wellness support, peer tutoring and social persuasion. Program evaluation included pre- and post-program surveys. Participation was optional and included 46 of 154 students (30%) with 40 of the 46 students (87%) completing pre and post evaluations. The pre-survey was given during the Nourish orientation in December prior to the Step 1 study period, and the post-survey was given in early February when most students had taken their exam but none had received their scores. Results While summary self-efficacy scores increased between baseline and post program (24.9 vs 27.7, p < 0.001), summary emotional health scores worsened (8.15 vs 8.75, p = 0.03). Summary scores for physical health also dropped but this difference was not statistically significant. Summary perceived stress scores increased from 15.5 at baseline to 23.7 post program (p < 0.001). All students who routinely participated in Nourish passed their USMLE Step 1 exam. One student who participated only in the orientation session did not pass. Conclusion Nourish appeared to improve self-efficacy, even though students reported being stressed with low emotional health. The program appeared to help students align task demands with their own personal resources and set reasonable expectations and strategies to pass the exam. Medical schools should consider similar peer- and faculty mentor-based wellness and tutoring programs to support medical students while they work to achieve academic success.