The Ohio State University College of Medicine, home to more than 800 students, offers a variety of curriculum- and non-curriculum-based programs to enhance and support student well-being. Its culture, rooted in a strong sense of community, is enhanced by faculty mentorship and a clear message that student well-being is a top priority for all.
This section was informed by interviews with Daniel Clinchot, MD, Vice Dean for Education at The Ohio State College of Medicine; Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANAP, FNAP, FAAN, Vice President for Health Promotion, University Chief Wellness Officer, and Dean of The Ohio State University College of Nursing; and two current medical students.
Contact information for Dr. Clinchot: Dan.Clinchot@osumc.edu.
Introduction and Overview
In the past decade, The Ohio State College of Medicine has worked to mitigate burnout and depression and to enhance student well-being through major cultural and curricular changes. Mentorship and peer-to-peer programming are paramount to these efforts, in addition to diverse learning options for students to build personal and professional skills. Many of the key features that support well-being throughout the College of Medicine can be applied to the accreditation standards of the Liaison Committee on Medical Education (LCME) and are important steps to mitigating burnout and increasing well-being.
Administrative leadership and faculty are devoted to building a positive learning environment by breaking down hierarchies, building opportunities for students to share their voices and take action, and treating students with respect. A dean is on call at all times to offer students support on any issue related to their professional or personal lives. Ohio State medical students consulted for this case study were quick to note the importance of having leadership who openly discuss their own stress and encourage students to do the same to support one another.
“Our Deans and leadership are so important for student well-being. Their transparency, honesty, and support trickles down to students, and we feel that we have a strong support system when times are hard. Our Deans are rooting for us. It genuinely feels that they want us to succeed. They show up for us every day.” (Medical student at The Ohio State University College of Medicine)
The journey into medicine is challenging. At the College of Medicine, student well-being is placed at the heart of the curriculum and programming—a signal from leadership of not only the importance of helping students develop professional skills, but also the value in fundamentally supporting their well-being through programming, coursework, and mentorship. At the core of each student’s education is an integrated, required curriculum designed to help students build professional and personal life-enhancing skills that will support their well-being in medical school and will last far into their careers. Relevant academic program committees and the Executive Curriculum Committee review and approve all curricular components related to well-being before incorporating them into the curriculum. Student representatives participate on all review committees and are responsible for collecting student feedback and providing it to committees before activities are added to the curriculum.
Well-being is an integrated part of the curriculum @OhioStateMed. Learn more on how the Ohio State College of Medicine is intentionally supporting student well-being through mentorship, assessment, and more #ClinicianWellBeing #MedEd
Ohio State’s Lead, Serve, Inspire curriculum includes eight core competencies. In accordance with LCME accreditation standards, several medical education program objectives (MEPOs) guide the selection of curriculum content. Several of Ohio State’s MEPOs, listed below, are directly related to student well-being:
- Develop the abilities to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors.
- Demonstrate health coping mechanisms to respond to stress.
- Manage conflict between personal and professional responsibilities.
The full list of MEPOs is available online. Several programs support these objectives and offer students structured and dedicated time for mentorship, skills building, personal and professional development, and resources for physical and mental health.
Students at Ohio State are evaluated on a pass/fail basis in the first two years of the curriculum, a decision that was implemented in 2017 by the Executive Curriculum Committee as a way to assess student performance while minimizing stress and anxiety. Students noted that they believe the pass/fail evaluation is critical to developing a collaborative culture in which students want to see one another succeed. One student said, “The pass/fail grading system lowered my stress levels a lot. I think it has done the same for many others. Instead of trying to outcompete one another for the highest grade, we all come together to support each other in learning new material. We study together, we share notes, and we celebrate together after an exam is completed. My peers are not my competition. They are my friends.”
Upon entering medical school, students partake in Career Exploration Week. As part of Career Exploration Week, each student is required to develop an individual wellness plan. Each student reviews their wellness plan with an assigned portfolio coach, a dedicated and trained faculty member who works with the student during their entire medical school career.
Introduced in 2012, portfolio coaches act as mentors and are matched to students in their first semester. Students meet with their portfolio coaches seven to eight times per year to discuss career plans and opportunities, challenges they may be facing, their individual wellness plans, school-life integration, and more. Portfolio coaches also help students develop their academic and professional portfolio, which is shared with residency programs. Each coach may work with no more than eight students, ensuring that coaches are able to adequately devote time to each of their students and provide feedback and support as needed. Portfolio coaches are compensated for their time through central funding from the medical school.
During Career Exploration Week, students also complete Ohio State’s suicide prevention training: REACH. Funded by a partnership between Ohio State’s Office of Student Life and the College of Education and Human Ecology, REACH training helps students to recognize warning signs of suicide and to help one another access care and treatment immediately.
The MINDSTRONG program is an evidence-based cognitive behavioral skills-building program created by University Chief Wellness Officer Bernadette Melnyk. The program comprises seven brief sessions that constitute a workbook for students. All nursing students participate in the program as part of the curriculum. The program has been used with medical, nursing, pharmacy, and other health sciences students and clinicians at Ohio State to improve outcomes and promote cognitive behavioral skills, positive thinking, coping mechanisms for stress, healthy lifestyle behaviors, emotional intelligence, and sleep hygiene.
Based on the key concepts in cognitive behavioral therapy, the program aims to improve resiliency and self-protective factors to enhance well-being and decrease mental health risk factors. Previous research on the MINDSTRONG program (also known as “COPE” in several published studies) has shown decreased anxiety, depression, stress, and suicidal intent among participants; increased academic performance; and increased levels of healthy lifestyle behaviors and overall job satisfaction. Given the success of the program with nursing, medical, pharmacy, and other health sciences students, the MINDTRONG program will now be delivered to all first-year medical, nursing, and veterinary medical students. Beginning in fall 2019, a 1-credit MINDSTRONG course will also be available to all Ohio State students who desire to learn cognitive-behavioral skills.
Completing wellness-focused components of the curriculum is a requirement for all medical students. University leadership believes that their role as educators is to support student well-being by equipping students with necessary skills and providing them with mentorship, structured programming, and protected time to prioritize well-being. This engenders a culture in which a focus on well-being is expected and actively supported.
School policies allow for flexible student schedules. All lectures at the College of Medicine are offered in person and via live webcast, and are recorded for later viewing. Live webcasts allow students to participate in lectures from any location. One student noted that this helps her maintain a workout schedule because she can work out in the morning before her first lecture and watch her morning lecture from home while preparing for the day ahead. Recorded lectures allow students to consume information at their own pace and to watch lessons more than once. This flexibility gives students more control over their daily activities and allows them to operate in a way that makes sense for them.
Cultivating a Community of Support
Student cohorts of 12 meet with faculty in noncurricular settings (e.g., local restaurants, faculty members’ houses) to develop personal relationships with peers and faculty members. Faculty members choose their own discussion topics for these meetings. Topics have included women in medicine, work-life integration, and financial well-being. Learning communities facilitate connections between students and faculty in a manner that breaks down hierarchical narratives that often persist in medical schools. Some students have come to view faculty and advisors as their cheerleaders instead of evaluators—a large morale boost within the College. Leadership for this program gathers input from students regarding attendance requirements, meeting format, and discussion topics.
Five student volunteers constitute a Student Wellness Team that informally surveys students about challenges affecting their well-being. The team collects feedback via casual conversations and word-of-mouth discussions. The wellness team communicates student feedback to medical school administration to help them develop programs that students will actually use.
For example, the wellness team learned that students with a mental illness noted stigma around mental illness within the medical school. In response, the wellness team added a sixth volunteer to focus entirely on how the College of Medicine can be more responsive to the needs of those with a mental illness and destigmatize mental illness within the College.
The College of Medicine’s Student Council plans extracurricular student group initiatives using funding from the College of Medicine and the larger university. Individual groups can request up to $500 or partner with other groups for larger funding requests up to $2,000. Within the College of Medicine, a separate Medical Alumni Society also offers small grants to students for activities focused on wellness and other topics.
“There is always a finite amount of resources at any institution. A small investment can have a large return. Well-being does not always require a large budget. We started small and have grown over time after demonstrating that small things, like mentors and wellness areas, have helped our students. You have to start somewhere and it is best to start sooner rather than later. You will see an incremental return on investment. A little goes a long way.” (Dr. Daniel Clinchot, The Ohio State University College of Medicine).
Optional Resources for Student Use
Medical students use exercise area. Photo provided by The Ohio State Univeristy.
A wellness room within the College of Medicine includes light therapy lamps, meditation spaces, yoga mats, meditation rugs, pull-out couches, and more. Donated by the class of 1974, this space is open 24/7, and students can use it to de-stress in between classes or clinical work. Students can also invite faculty to lead well-being activities in this space. Mindfulness in Motion, a stress reduction and resiliency-building program, has been hosted in this space and is free for students to participate. Students guided the overall design of this space and were essential in determining what kinds of resources would be included. Current students most often use this space during the 10- to 15-minute breaks between classes or curricular activities to mentally check in with themselves, rest, or meditate before their next class or rotation. Students can also access a free exercise area between class and clinical assignments.
A full-time counselor is available for all medical students and is free of charge. To maximize anonymity, the counselor’s office is located away from the routes that students typically take to and from class and clinical assignments. Students schedule appointments directly with the counselor, never needing to interact with their academic advisors, peers, or faculty. A part-time psychiatrist is also available for students to use and is free of charge. Neither the counselor nor the psychiatrist participate in teaching or the evaluation of students.
An academic advisor is available for all students, to help them navigate the curriculum and career options. The academic advisor has access to faculty and collegial tutors so that students can participate in individual and group tutoring if desired.
Assessment and Continuous Improvement
Buckeye Wellness Onboarding Program
The University offers the opportunity to participate in a wellness onboarding program to all medical, nursing, pharmacy, and other health sciences students within the first two weeks of entering their professional programs. Students complete a personalized wellness assessment—including the PHQ-9 for depression, the GAD-7 for anxiety, and the BIPS inventory for stress—along with questions related to their healthy lifestyle behaviors, including physical activity; sleep; healthy eating; alcohol, tobacco, e-cigarette, and drug use; and stress reduction practices. Students then create a personalized wellness plan and are matched with a nurse practitioner student who delivers the MINDSTRONG program with an additional module on sleep, healthy eating, and physical activity. Students who enroll in the program benefit from it, as evidenced by decreases in depression, anxiety, and stress over the first year of their programs and increases in healthy lifestyle beliefs and behaviors.
Measuring Burnout and Well-Being
Measuring student well-being is central to building, adapting, and enhancing well-being program components. The College of Medicine annually administers a version of the Maslach Burnout Inventory, Interpersonal Reactivity Index, and an internally generated measure of quality of life and the learning environment. Collectively, these tools measure overall quality of life and burnout in Ohio State’s medical students. Overall, 94% of students report feeling engaged during their first two years of medical school. Data from the annual medical student survey is de-identified and included in a repository that faculty can access to measure the effectiveness of interventions from year to year. Faculty present results of the previous year’s survey during orientation, in conjunction with a presentation on the support resources that are available to students. Additionally, the Executive Curriculum Committee and the Office of Student Life monitor student reports from the Association of American Medical Colleges Graduation Questionnaire. Over the past five years, rates of student burnout have decreased by 4% within the College of Medicine.
Cappelucci, K., M. Zindel, H.C. Knight, N. Busis, and C.M. Alexander, eds. 2019. Improving clinician well-being at The Ohio State University: A case study. NAM Action Collaborative on Clinician Well-Being and Resilience, National Academy of Medicine, Washington, DC. https://nam.edu/clinicianwellbeing/case-study/ohio-state-university.
Conceptual Model Factors
- Culture, Leadership, and Student Engagement
- Professional Development Opportunities
- Power Dynamics
- Relationships and Social Support
- Collaborative vs. Competitive Environment
- Work-Life Integration
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