Teaching Health Profession Students the Skills Needed to Maintain Wellbeing

by Anna Carroll Harris, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Numerous studies have been published exploring burnout among healthcare workers. Health profession students are also prone to burnout due to the vigorous course load required to obtain their degrees. The WHO defines burnout as a syndrome that is directly correlated with an environment that exposes workers or students to chronic stress and where the stressors are not successfully handled. It is characterized by feelings of emotional exhaustion, amplified feelings of negativism towards one’s job, and decreased professional worth.

The occurrence of burnout not only affects those working and learning in the healthcare industry, but also the patients to whom they provide care. For example, pharmacists who are experiencing increased levels of stress and emotional exhaustion may feel a sense of depersonalization towards patients they are caring for. This in turn can lead to medication errors and harmful events for patients.¹ It is imperative that schools and colleges of pharmacy, and other health professional degree programs, help students develop the skillset and positive behavior practices that needed to maintain their wellbeing and prevent burnout throughout their careers.²

Many professional organizations have noted the need to provide health profession students and healthcare practitioners with resources to encourage a state of well-being and prevent burnout. The American Association of Colleges of Pharmacy has published two policies, a 2017 and 2018 statement, in response to the increasing realization that burnout is prevalent. Both statements encourage and hold schools and colleges of pharmacies accountable for effectively promoting wellness and implementing management methods directed to students, faculty, preceptors, and staff.³ In reaction to these statements, schools and colleges of pharmacy across the country are putting programs into place that foster an environment for creating and maintaining well-being. For example, the Ohio State University College of Pharmacy has a “Wellness Corner” dedicated to providing faculty, staff, and students an environment that promotes and protects well-being. They have been recognized across their campus as having a strong culture of wellness by implementing evidence-based wellness strategies and providing tools to achieve a sense of wellbeing.⁴

The University of Kentucky College of Pharmacy completed a study where they “nudged” pharmacy students to adopt well-being behaviors. Over a span of 4 months, a series of optional well-being challenges were embedded in their pharmacy management course. These challenges included limiting smartphone use, emphasizing feelings of gratitude, good sleep hygiene, and engaging in regular exercise. Participants completed a reflection at the end of the course that explored reasons for participation, prior behaviors, and if participants planned to continue to implement the new behaviors after completion of the challenges. The majority of participants indicated that they planned on maintaining the positive behaviors moving forward.⁵

The specific stressors that lead to burnout have been identified in many studies. A study that included pharmacy students in an urban Midwestern region identified strategies that pharmacy students utilized to protect their wellbeing and prevent burnout. Students participating in a social and administrative science course were to write a reflection on factors that they believed had the greatest impact, either positively, negatively or mixed, on their wellbeing during pharmacy school. Four specific themes emerged as strategies that students use to cope with stressors during pharmacy school:⁶

1. Availability and accessibility of institutional resources
2. Personal time management and organizational strategies
3. Personal, mental, and physical health strategies
4. Activities that maintain social relationships

These results provide schools and colleges of pharmacy specific ways they can augment their campuses' attempts to foster wellbeing. Ensuring that institutional resources, such as the medical library and faculty, are readily available to students can help reduce stress and maintain wellbeing. Offering counseling and health services to those who needed them is supportive of students’ wellbeing. A few of the wellness activities mentioned in the Ohio State University College of Pharmacy “Wellness Corner” were a take five-station, a mental timeout area where students could play a game or create a craft, as well as monthly wellness walks. Ensuring that students maintain a healthy balance between schoolwork and leisure activities can reduce stress. Emphasizing the need for students to take time for themselves to socialize with friends and family and maintain hobbies is important.

In the unprecedented times of a pandemic, providing students with resources and teaching them skills to protect their well-being is more essential than ever. With COVID-19 disrupting the lives and wellbeing of so many, health profession students are dealing with the added stressors of helping take care of family members and serving on the frontlines of healthcare, in addition to their demanding coursework.⁷ The loss of person-to-person contact and being isolated away from one’s family has taken a toll on many students. What once provided a means for students to reset and take a break from the rigors of academic coursework is now discouraged.  Schools and colleges need to find creative ways to provide ongoing support to their students, faculty, and staff.  See Table 1.

Table 1: Examples of support during a pandemic

Virtual group exercise	Email check-ins	Virtual mentorships programs
Virtual game nights	Virtual group meditations	PPE drives/mask-making
Virtual book clubs	Virtual dinner dates	Virtual tutoring

As health profession students graduate, they will continue to experience stressful times and emotional exhaustion that can lead down the path of burnout. Health profession programs should work to implement programming and strategies early in their curricula that can provide students with a skillset to prevent burnout. General professional development courses, which are often part of the curriculum, would be a great place to embed lectures about managing stress and including periodic wellbeing challenges for students. These longitudinal courses should be pass/fail due to the nature of the content and should encourage students to adopt and execute tactics that best fit their personal circumstances and needs. Learning about and implementing these healthy habits while in school can help students cope with the stressors they will face throughout their careers.

References

1. World Health Organization. Burn-out an "occupational phenomenon": International Classification of Diseases. Accessed November 18, 2020.
2. Hagemann TM, Reed BN, Bradley BA, et al. Burnout among clinical pharmacists: Causes, interventions, and a call to action. J Am Coll Clin Pharm 2020; 3:832–842.
3. American Association of Colleges of Pharmacy. AACP Statement on Commitment to Clinician Well-being and Resilience. Accessed November 18, 2020. https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/jac5.1256
4. The Ohio State University College of Pharmacy. Wellness Corner. https://pharmacy.osu.edu/wellness-corner. Access November 18, 2020.
5. Cain J. Effectiveness of Issuing Well-being Challenges to Nudge Pharmacy Students to Adopt Well-being Protective Behaviors. Am J Pharm Educ 2020; 84(8) Article 7875.
6. Abraham O, Babal, JC, Brasel KV, Gay S. Strategies first year doctor of pharmacy students use to promote well-being. Currents in Pharmacy Teaching and Learning. 2021; 13:29–35.
7. Schlesselman LS, Cain J, DiVall M. THE COVID-19 PANDEMIC ACROSS THE ACADEMY: Improving and Restoring the Well-being and Resilience of Pharmacy Students during a Pandemic. Am J Pharm Educ 2020; 84 (6) Article 8144.