Journal Article

“One size does not fit all” – lessons learned from a multiple-methods study of a resident wellness curriculum across sites and specialties

Chaukos, Deanna, Bernstein, Carol, Zebrowski, Jonathan P., Celik, Alper, Chad-Friedman, Emma, Genfi, Afia, Denninger, John W., Teitelbaum, Aviva, Benson, Nicole M., Cook, Rebecca

2021

Overview

Background There is growing recognition that wellness interventions should occur in context and acknowledge complex contributors to wellbeing, including individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress. The authors conducted a multiple-methods study exploring contributors to wellbeing for junior residents in diverse medical environments who participated in a brief resilience and stress-reduction curriculum, the Stress Management and Resiliency Training Program for Residents (SMART-R). Methods Using a waitlist-controlled design, the curriculum was implemented for post-graduate year (PGY)-1 or PGY-2 residents in seven residency programs across three sites. Every three months, residents completed surveys, including the Perceived Stress Scale-10, General Self-Efficacy Questionnaire, a mindfulness scale (CAMSR), and a depression screen (PHQ-2). Residents also answered free-text reflection questions about psychological wellbeing and health behaviors. Results The SMART-R intervention was not significantly associated with decreased perceived stress. Linear regression modeling showed that depression was positively correlated with reported stress levels, while male sex and self-efficacy were negatively correlated with stress. Qualitative analysis elucidated differences in these groups: Residents with lower self-efficacy, those with a positive depression screen, and/or female residents were more likely to describe experiencing lack of control over work. Residents with higher self-efficacy described more positive health behaviors. Residents with a positive depression screen were more self-critical, and more likely to describe negative personal life events. Conclusions This curriculum did not significantly modify junior residents’ stress. Certain subpopulations experienced greater stress than others (female residents, those with lower self-efficacy, and those with a positive depression screen). Qualitative findings from this study highlight universal stressful experiences early in residency, as well as important differences in experience of the learning environment among subgroups. Tailored wellness interventions that aim to support diverse resident sub-groups may be higher yield than a “one size fits all” approach. Trial registration NCT02621801 , Registration date: December 4, 2015 – Retrospectively registered.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Codes / Coding / Content analysis / Control Groups / Coping / COVID-19 / Curricula / Curriculum / Depression (Psychology) / Education / Education, Medical, Graduate / Feedback (Response) / Female / Graduate medical education / Group Instruction / Health aspects / Health Behavior / Humans / Individual Needs / Internal Medicine / Internship and Residency / Intervention / Learning environment / Male / Marital Status / Medical Education / Medical screening / Medicine / Methods / Mindfulness / Perspective Taking / Postgraduate medical education / Programming Languages / Psychological aspects / Regression (Statistics) / Relaxation Training / Research Article / Research Committees / Resident / Resident wellbeing / Resident wellness / Residents (Medicine) / Resilience (Personality trait) / Resilience (Psychology) / Self Efficacy / Sleep / Stress / Stress Management / Surveys and Questionnaires / Teaching Methods / Theory of Medicine/Bioethics / Training / Wellbeing / Wellness / Wellness programs