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Open Access

Interventions to improve the well-being of medical learners in Canada: a scoping review

Stephana J. Moss, Krista Wollny, Mungunzul Amarbayan, Diane L. Lorenzetti and Aliya Kassam
July 20, 2021 9 (3) E765-E776; DOI: https://doi.org/10.9778/cmajo.20200236
Stephana J. Moss
Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta.
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Krista Wollny
Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta.
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Mungunzul Amarbayan
Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta.
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Diane L. Lorenzetti
Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta.
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Aliya Kassam
Departments of Community Health Sciences (Moss, Wollny, Lorenzetti, Kassam), and Critical Care Medicine (Moss, Amarbayan), Cumming School of Medicine, and Faculty of Nursing (Wollny, Amarbayan), and School of Public Policy (Amarbayan), and Health Sciences Library (Lorenzetti), University of Calgary, Calgary, Alta.
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    Figure 1:

    Study flow diagram.

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    Figure 2:

    Medical schools and learners represented among included studies.

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    Figure 3:

    Cumulative number of published studies on interventions for medical learner well-being.

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    Figure 4:

    Number of studies that reported significantly positive effects of well-being interventions by well-being domain, level of intervention and type of learner. Note: One level of intervention was recorded from each included study. More than one well-being domain could be recorded from a single study.

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    Table 1:

    Categorization of well-being domains21

    Well-being domainDescriptionExamples
    SocialState of well-being in which individuals and communities feel they understand, are a part of, and are accepted by their social environment, and are comfortable expressing their feelings, needs, identities and opinions.16 This includes processes (methods) and outcomes (experiences) of social well-being.Isolation, imposterism, equity, diversity, discrimination, race, religion, ethnicity, family support
    MentalState of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.23Mindfulness, mental health, mental illness or disorder, anger, sadness, emotions
    PhysicalPerception and expectation of well-being of an individual’s body, including the active and continuous effort to maintain optimum levels of physical activity and focus on nutrition, as well as self-care and maintenance of a healthy lifestyle.16 This acknowledges physical health and limitations can coexist in a healthy environment.Exercise, physical activity, physical health, nutrition, symptoms of burnout
    IntellectualState of well-being in which individuals are enabled to pursue creative, mentally stimulating activities that expand their knowledge, develop skills, and foster life-long learning and teaching, toward a goal of self-actualization.16 This includes processes (how) and outcomes (deliverables) of intellectual well-being.Learning, tools, outcomes, teaching, goals, learning needs
    OccupationalProtection and promotion of workers or learners by preventing and controlling occupational diseases and accidents, and by elimination of conditions hazardous to health and safety at work or school, and the development and promotion of healthy and safe work or learning, work or learning environments and organizations.24 This includes processes (responsibilities) and outcomes (trajectories) of occupational well-being.Work, (resident) rotation, job, laboratory, research (assistantship or similar)
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    Table 2:

    Summary of findings from qualitative studies1,2*

    StudyWell-being domain†LevelNo. and type of studentsInterventionAnalysisThemes or theoryAuthor findings from original study
    Undergraduate medical students
    Brown et al., 201830Intellectual, occupationalIndividual123; first-year undergraduate medical studentsProgram for Improvement in Medical Education for engagement in quality improvement trainingThematicContinuous support; genuine interest in improving medical education; team-based learning and problem solving; regular project feedback; access to education resources for quality improvementMedical education is an appropriate setting to teach preclerkship medical students about quality improvement, which might lead to increased knowledge of quality improvement.
    Byszewski et al., 201732Intellectual, occupationalIndividual93; undergraduate medical studentsMultimedia podcast resource on what a geriatric specialty entailsThematicStudents found the podcast a creative method to present a specialty and suggested creating podcasts for other medical fields; students provided suggestions for including patient testimonials and “A day in the life of …”A multimedia podcast for medical students can raise awareness of geriatric medicine as a potential career choice and can be used as a novel multimedia approach for a variety of career options when considering residency programs.
    Cadieux et al., 201733Intellectual, occupationalSystem62; first-year undergraduate medical studentsLeadership course grounded in business pedagogyThematicUnderstanding change; effective teamwork; leading in patient safety; leadership in actionLeadership in medical education should be applicable to the learner’s stage of training and may be better supported if leadership is framed as a competency throughout their career.
    Chew et al., 201236Intellectual, occupationalIndividual18; second-year undergraduate medical studentsPreclerkship HIV electiveThematicEnthusiasm for small group sessions; clinical observerships; community agency placements; diversity of topics coveredStudent-run initiatives can supplement medical curriculum content and promote student leadership and interest, community partnerships, and faculty mentorship.
    Ellaway et al., 201445Social, intellectualSystem101; first-year undergraduate medical studentsMobile device programGrounded theoryMobile devices augment, but are not replacements for, laptop computers, and mobile devices in medical education are perceived as a tool and source of supportMedical learners use mobile devices depending on the learning culture and contexts of their specific medical programs and education ecologies.
    Law et al., 201966Intellectual, occupationalIndividual17; undergraduate medical studentsComputer programming certificate courseThematicValue of the course; potential application of learningComputer science and medicine would benefit from enhanced 2-way communication when developing technology for use in medicine.
    Lynch et al., 201468Social, intellectualIndividual4; undergraduate medical studentsLinking students from North America and Europe with a peer-to-peer learning approachThematicPeer connection; trust in data veracity; aid to clinical learning processConnecting students across continents in a community of peer-to-peer learning encourages peer cooperation with potential to disseminate key clinical learnings.
    Welsher et al., 201888IntellectualIndividual23; preclerkship undergraduate medical studentsVideo-based observational practice communities that augment simulation-based skill education and connect geographically distributed learnersThematicEase of use; technical knowledge; versatile and accessible; observational tools beneficial to learning; desire for more networked, observational learning activitiesVideo-based observational practice communities are feasible to support simulation-based learning of clinical skills in a distributed group of health professional trainees.
    Yeung et al., 201790Social, intellectualIndividual20; second-year undergraduate medical studentsLongitudinal Students as Teachers programThematicProgram increased perceived knowledge and provided students with opportunities to practice teaching and to provide and receive feedback, and to reflect on their practiceEarly exposure to medical education theories allows opportunity to apply theories practically through ongoing teaching and feedback sessions that include reflective exercises.
    Postgraduate medical students
    Campagna-Vaillancourt et al., 201434SocialProgram45; otolaryngology–head and neck surgeryMultiple Mini Interview (MMI) for the selection of applicants to residencyThematicMeet more staff; less stressful; multiple first impressions; different aspects of personality; objective and fair; team assessmentUsing the MMI for admission to a residency program has good acceptability and reliability, and is feasible.
    Malhotra et al., 200869Mental, intellectualProgram12; internal medicineMini Clinical Evaluation ExercisePhenomenologicalEducation; assessment; exam preparationThe mini Clinical Evaluation Exercise is anxiety provoking at first, but may provide insight into clinical competence over time.
    Myden et al., 201274Intellectual, occupationalProgram6; orthopedicsComputer-assisted surgery simulationsThematicConfidence; awareness; deepening knowledge; changed perspectivesHigh-impact educational interventions endorsing cognitive flexibility increases confidence, changes awareness, and deepens knowledge and perspectives.
    Sachedina et al., 201977OccupationalIndividual17; cardiac critical careCode Blue Simulation Program (CBSP)ThematicThe CBSP is a useful tool to help prepare residents to serve as code blue learners and the authenticity of the CBSP cases was usefulThe CBSP enhanced resident preparedness. Differences between simulated and real codes should be addressed to enhance fidelity.
    Sukhera et al., 201883MentalSystem10; psychiatryMental illness implicit association testGrounded theoryVulnerability provoked tension between personal and professional identities reconciled through striving for ideal while acknowledging the actualAddressing implicit bias among health professionals is influenced by the process of recognizing and managing biases.
    Tait et al., 201384Mental, intellectual, occupationalIndividual7; family medicine, psychiatryThe Dignity InterviewThematicExperience of the interview; patient as teacher; residents reflecting on their own lives; resident reflections on palliative or end-of-life care education; physician role in conflictConversations with dying patients and soliciting a patient’s story are poorly taught and modelled in medical education.
    Tan et al., 201385Social, occupationalProgram130; family medicineOnline virtual patient clinical case in palliative careThematicUseful content; beneficial teaching modality; realism of case; awkward navigation; worried about missing key points in the caseThe online virtual patient case in palliative care is a useful teaching tool to address need for increased formal palliative care experience in medical education.
    • ↵* Reported as per the Summary of Qualitative Findings Table structure.26

    • ↵† Well-being domains include social, mental, physical, intellectual or occupational well-being. Levels include individual, program or system level.

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CMAJ Open: 9 (3)
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Interventions to improve the well-being of medical learners in Canada: a scoping review
Stephana J. Moss, Krista Wollny, Mungunzul Amarbayan, Diane L. Lorenzetti, Aliya Kassam
Jul 2021, 9 (3) E765-E776; DOI: 10.9778/cmajo.20200236

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Interventions to improve the well-being of medical learners in Canada: a scoping review
Stephana J. Moss, Krista Wollny, Mungunzul Amarbayan, Diane L. Lorenzetti, Aliya Kassam
Jul 2021, 9 (3) E765-E776; DOI: 10.9778/cmajo.20200236
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