Interventions to Support Student Wellbeing to Improve Retention and Learning

by Alyssa Hooter, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Burnout, a term to describe a state of exhaustion from working excessively, was first used in 1974.¹ Burnout can also be used to describe the depleted mental state and mental exhaustion students develop toward their studies. This is often seen in students pursuing professional degrees in the health professions, including medicine, pharmacy, dentistry, and others.  Students need to recharge so that their long-term performance and success is not hindered. To combat student burnout, many institutions have implemented a variety of interventions to help students build up the stamina needed to pursue a career in healthcare.

Health professional students commonly experience burnout due to exhaustion and the gradual loss of excitement to pursue their career. Sometimes burnout can lead to physical manifestations, such as diseases like hypertension, and negative psychological states, like depression, and behavioral problems, like substance use or suicidal thoughts.¹ A meta-analysis of 39 learning burnout intervention studies, including 3,400 students, evaluated the effects of different interventions that were most effective in decreasing burnout.¹ The interventions were divided by type: individual, organizational, matching interventions, and learning engagement. The interventions most commonly studied were exercise (an individual intervention) and group counseling (an organizational intervention).

Physical activity has been shown to promote positive moods and decreases the risk of depression and reduces tension associate with prolonged learning activities.¹ Group counseling sessions involve providing students a safe group atmosphere and a process that facilitates respectful interactions between students.  Group counseling has been shown to improve students’ self-efficacy in learning behavior and the selection of positive coping strategies.

Healthcare workers are at particularly high risk for burnout, including medical students. Reducing the risk of student burnout can be done by individual faculty and the institution.  The American Medical Association (AMA) released an AMA STEPS Forward^TM initiative that describes the measures medical schools can take to promote well-being.² The first step is to recognize shared responsibility by assigning a faculty member with the obligation to oversee student well-being and evaluate resources to make school-level changes. Often, this person is deemed the Director of Student Well-Being.  The second step involves measuring student well-being regularly by using a standardized instrument to compare progress as the institution implements changes. Third, the AMA emphasizes the importance of optimizing the curriculum. Research has found that pass-fail grading is associated with a reduced risk of burnout. Even if pass-fail grading is not practical for every course, it can be beneficial in non-clinical courses. Moreover, changing to pass-fail has not had a detrimental impact on learning as measured by the United States Medical Licensing Examination Step tests. Fourth, the AMA report also acknowledges that student debt is a major factor that contributes to burnout.

Another strategy to decrease burnout is to optimize the institution’s learning environment and cultivate a supportive community. This can be done through displays of support from faculty and empowering students in the clinical setting to build confidence and inspiration within themselves. Step 6 is to promote self-care and resiliency. Why is this step 6?  This is intentional. A student can only progress and excel in an environment that supports and nourishes growth. Trying to have discussions about self-care to students who do not feel supported by their institutions or who feel discouraged during their clinical experiences will not go far. Once empowered and given appropriate resources to prevent burnout, students may begin to understand their self-doubt and how their thoughts may be a source of discouragement.  It is imperative that students are given time to reshape their thoughts and work through these feelings without added pressure from their institutions. This can be accomplished through designated well-being days, specific quiet areas, and free counseling services. Step 7 is to provide adequate services for students are already affected by burnout or distress. Lastly, the AMA report encourages the funding of studies that measure the impact of organizational changes on student well-being.

Pharmacy students also experience burnout.  The American Association of Colleges of Pharmacy (AACP) has a Community for Wellness and Resiliency with the goal of providing “quality resources and ideas to infuse well-being science into pharmacy education.”  This is a great start for pharmacy schools — addressing mental health in students “has been on the back burner for several years.”² Given the added stress of the COVID-19 pandemic, it is imperative that programs not only be developed, but enforced.  I believe an individualized student-specific approach will result in improved mental resilience that will carry the student from the classroom throughout their career.

A valuable starting place to support the well-being of a student is to show them that they are not just a generic student, but rather, an individual who has needs. One way we can do that is by allowing the student to have at least one day per month that they can use, similar to how a full-time employee would use paid time off. Explanations would not need to be given and the day can be used however the student needs. Other methods of demonstrating respect and understanding for students is for professors to talk about personal and professional hardships, during class sessions or advising meetings, and what they did to overcome or learn from those experiences.  This can help students realize they are not alone as all of us have experienced difficulties and hardships. It takes both an institutional approach and an individual willingness to reach out and truly assist learners to reduce the risk of burnout. Addressing these issues while students are in school can help ensure that their future patients’ lives are in confident and competent hands.

References

1. Tang L, Zhang F, Yin R, Fan Z. Effect of interventions on learning burnout: A systematic review and meta-analysis. Front Psychol 2021; 12: Article 645662.
2. Rooney J. A Renewed Focus on Resilience. Academic Pharmacy Now 2020: https://www.aacp.org/article/renewed-focus-resilience
3. Brook J, Aitken L, MacLaren J, Salmon D. An Intervention to Decrease burnout and Increase Retention of Early Career Nurses: A Mixed Methods Study of Acceptability and Feasibility. BMC Nursing 2021; 20(1):19.
4. Harris R. Embracing Your Demons: An Overview of Acceptance and Commitment Therapy. Psychother Austr 2006; 4:1-7.