Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review

Abstract

Background A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME. Methods We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool. Results Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups. Conclusions Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis

“…Recognizing the importance of medical student wellbeing, institutional bodies including medical schools have responded with various systemic curricular changes and support programs. However, most programs implemented to date are either post-hoc, therapy-based interventions that occur after-the-fact, or wellness and resilience curricula that lack comprehensive and longitudinal evaluation of their impact on students’ mental health and wellbeing during medical school [ 9 , 56 ]. While these strategies reflect a promising trend in medical education, they tend to focus on teaching self-care to medical students, when the main problem often originates from the environment, not the students [ 57 ].…”

“…Confronted with the alarming state of medical student well-being, several institutional bodies including medical schools have proposed and implemented various suicide prevention and wellness programs (e.g., resilience, mindfulness, stress management) [8][9][10][11]. However, the targeted risk factors and overall quality of these curricula are divergent, and little is known about their efficacy.…”

Improvisation in the Time of a Pandemic: Field Notes on Resilience

“…However, evidence-based interventions to foster resilience and well-being are few. 3,4 In this article, we reflect on our personal experiences of improv training and explore evidence linking them to bolstering resilience during the COVID-19 pandemic. Understanding and cultivating these links holds promise for a synergistic contribution to wellness.…”

Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial

“…In light of these factors, the provision of individual psychological resource-building interventions as early as during undergraduate medical training is receiving growing support [18,20,22,[29][30][31]33,38]. The past 10 years have seen a marked increase in the number of studies investigating such interventions [23]. A recent consensus statement issued by medical educators advocated for initiatives promoting "adaptive responses to stressful situations" as an important component of a broad well-being and burnout prevention plan for medical students in Australia and New Zealand [29].…”

“…Our intervention builds on existing research demonstrating the involvement of PF processes as predictors, moderators, and mediators of burnout and well-being outcomes [11,[55][56][57][58][63][64][65][66][67]69,70,72]. There is evidence that PF is an individual resource of relevance to burnout and well-being among medical students and physicians [23,32,33,71,72]; however, we are unaware of any published RCTs assessing the benefits of training the full PF skill set within this population to date. To the best of our knowledge, this is also the first individualized app-based skills training intervention targeting burnout prevention and well-being among medical students.…”