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What undergraduate medical education learning environment interventions are associated with improved emotional well-being among medical students?
In a systematic review of the medical literature, only 28 articles described empirically evaluated interventions and only 3 included randomization, so methodologic rigor was limited. However, some data support preclinical pass/fail grading, mental health programs, wellness programs, mentoring programs, curricular restructuring, and multicomponent program reform.
There is limited evidence to support learning environment interventions for improvement of emotional well-being among medical students. High-quality research is needed.
Concerns exist about the current quality of undergraduate medical education and its effect on students’ well-being.
To identify best practices for undergraduate medical education learning environment interventions that are associated with improved emotional well-being of students.
Learning environment interventions were identified by searching the biomedical electronic databases Ovid MEDLINE, EMBASE, the Cochrane Library, and ERIC from database inception dates to October 2016. Studies examined any intervention designed to promote medical students’ emotional well-being in the setting of a US academic medical school, with an outcome defined as students’ reports of well-being as assessed by surveys, semistructured interviews, or other quantitative methods.
Data Extraction and Synthesis
Two investigators independently reviewed abstracts and full-text articles. Data were extracted into tables to summarize results. Study quality was assessed by the Medical Education Research Study Quality Instrument (MERQSI), which has a possible range of 5 to 18; higher scores indicate higher design and methods quality and a score of 14 or higher indicates a high-quality study.
Twenty-eight articles including at least 8224 participants met eligibility criteria. Study designs included single-group cross-sectional or posttest only (n = 10), single-group pretest/posttest (n = 2), nonrandomized 2-group (n = 13), and randomized clinical trial (n = 3); 89.2% were conducted at a single site, and the mean MERSQI score for all studies was 10.3 (SD, 2.11; range, 5-13). Studies encompassed a variety of interventions, including those focused on pass/fail grading systems (n = 3; mean MERSQI score, 12.0), mental health programs (n = 4; mean MERSQI score, 11.9), mind-body skills programs (n = 7; mean MERSQI score, 11.3), curriculum structure (n = 3; mean MERSQI score, 9.5), multicomponent program reform (n = 5; mean MERSQI score, 9.4), wellness programs (n = 4; mean MERSQI score, 9.0), and advising/mentoring programs (n = 3; mean MERSQI score, 8.2).
Conclusions and Relevance
In this systematic review, limited evidence suggested that some specific learning environment interventions were associated with improved emotional well-being among medical students. However, the overall quality of the evidence was low, highlighting the need for high-quality medical education research.
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Corresponding Author: Karina W. Davidson, PhD, MASc, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W 168th St, PH 9-314, New York, NY 10032 (email@example.com).
Correction: This article was corrected for an incomplete funding statement on February 19, 2019.
Author Contributions: Drs Davidson and Wasson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Wasson, Cusmano, Meli, Louh, Young, Davidson.
Acquisition, analysis, or interpretation of data: Wasson, Cusmano, Meli, Louh, Falzon, Hampsey, Shaffer.
Drafting of the manuscript: Wasson, Cusmano, Meli, Louh, Falzon, Hampsey, Davidson.
Critical revision of the manuscript for important intellectual content: Wasson, Meli, Louh, Young, Shaffer, Davidson.
Obtained funding: Davidson.
Administrative, technical, or material support: Cusmano, Meli, Falzon, Hampsey, Davidson.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: Dr Davidson was supported by research grant K24 HL084034 from the National Heart, Lung, and Blood Institute. Dr Wasson was supported by research grant K08 HS024598 from the Agency for Healthcare Research and Quality. Ms Falzon was supported by the National Institutes of Health Science of Behavior Change Common Fund Program through an award administered by the National Institute on Aging (U24AG052175) and contract S15-0142 by Columbia University Medical Center.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
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