A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training

Abstract

Introduction: Burnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness. Methods: Our resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre-and postcurriculum surveys, and a social media activity guide. Results: This curriculum was delivered to 144 clerkship students at two academic institutions over the 2017-2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges. Discussion: Students valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels.

Medical Students’ Perceptions and Retention of Skills From Active Resilience Training

“…Bird et al report a range from 51% to 77% between two institutions in student agreement with resiliency training being a valuable use of time; similar results were reported for a voluntary program conducted for first-year residents. 8,9 The degree of variability between studies is likely due to their differing target audiences. Both this study and that by Williams et al included only firstand second-year medical students.…”

“…7 Bird et al's studies targeting clerkship students and interns reported lower percent agreement values. 8,9 This suggests that earlier exposure to resiliency training improves valuation, perhaps because preclinical students have more time to engage with course material and implement new habits. Unlike other elective resilience curricula reported to date, this study tracked students' use of learned skills over time.…”

Pedagogical approaches to support student resilience in higher-education settings: A systematic literature review

“…With respect to the former, a general set of therapeutic and self-care approaches seemed to emerge, with some variation depending on the target audience. Techniques prescribed for medical students included loving-kindness meditation, Tonglen attitude/breathing practices (Bird et al, 2020) and behavioral strategies to address commonly held thought distortions (Chaukos et al, 2018); for undergraduates, mindful walks and eating, habit-breaking (Galante et al, 2018), breathing, imagining, meditating and muscle awareness relaxation (Maddi et al, 2009) strategies were taught; while nursing students participated in role-playing activities and engaged in workplace empowerment and disempowerment strategies (Pines et al, 2014), as well as mindfulness practices encouraging focused attention on observing emotions and thoughts (Van der Riet et al, 2015). Alternatively, some programs focused on enhancing personal organization skills such as a seminar-based initiative for psychology undergraduate students, which emphasized developing realistic expectations, balance, connectedness and complementary strategies of positive self-talk, stress-management and taking-action concepts (Stallman, 2010).…”

“…Development of students' interpersonal skills were employed in a few resilience programs, with competency training related to communication and building social connections being most common. Germane approaches covered compassionate listening training, instruction for finding meaning (Bird et al, 2020), goal clarifying in interpersonal situations and balancing interpersonal objectives skills (Lee and Mason, 2019), social interaction promotions for students studying abroad (Dresen et al, 2019) and sessions teaching students about creating meaningful connections and how decisions to maintain being a part of or withdrawing from social networks can affect behavior and health (Dolbier et al, 2010;Steinhardt and Dolbier, 2008). Another relevant approach consisted of methods targeting positive interpersonal engagement strategies.…”

“…In furtherance of incorporating resilience-focused content into HE instruction, this review did identify a few relatively simple and effective behavioral changes that instructors can promote to their students. Notably, support was documented for the effectiveness of techniques including providing instruction for finding meaning (e.g., avoiding wasting energy on trying to control what is beyond a student's to control), thought activities (e.g., weighing evidence, 4 compartmentalization) (Rose et al, 2013), promoting compassionate listening (e.g., reminding students of the importance of being there for each other, acknowledging each other's' experiences) (Bird et al, 2020), and socially-supportive interactions (e.g., giving and getting assistance) (Maddi et al, 2009).…”