Rachel S. Wasson, M.A., Bowling Green State University; Kelsey M. Dietrich, B.A., Bowling Green State University; Clare Barratt, Ph.D., Bowling Green State University; William O’Brien, Ph.D., Bowling Green State University

The specific aims of this study were to: 1) assess feasibility and acceptability of the newly developed Self-compassion, Yoga, and Mindfulness for Burnout: Integrating Online Sessions and Interpersonal Support (SYMBIOSIS) program, and 2) evaluate preliminary psychological and behavioral health outcomes. The process of developing a tailored, evidenced-based multi-component wellness program is an auxiliary aspect of this project.

Medical students experience elevated stress, burnout, depression, suicidal ideation, and compassion fatigue. Researchers have demonstrated that a variety of mindfulness and wellness interventions can improve stress, burnout, and self-compassion in this population. However, from a biopsychosocial conceptualization, the literature is missing evidence that wellness programs can foster improvements in health promoting behaviors and the social environment for medical students. If a program can demonstrate an influence on health behaviors and social support, this may be a promising area to explore how to maintain long-term benefits into residency and beyond.

The SYMBIOSIS program development followed the six steps in quality intervention development model. To determine program content, the medical student coping reservoir model and results from a previous focus group study were utilized. Participants were recruited via email and posts in a private medical student Facebook group. After providing informed consent, 20 participants were enrolled in one of two groups for the virtual 8-week SYMBIOSIS program conducted via Webex. Sessions were held weekly on Wednesday and Thursday evenings for 50 minutes. The program was facilitated by a master?s level clinical psychology doctoral student who was also a Certified Yoga Teacher. The co-facilitator was a psychology research assistant with a trauma-sensitive YogaFit Certification. Participants completed online surveys via Qualtrics at pre, post, and four weeks after completing the intervention. They also completed weekly home practice assessments online. A mixed-methods approach was utilized to investigate feasibility, acceptability, and effects of the program using open-ended questions and validated measures (i.e., Burnout Measure-Short, Perceived Stress Scale-10, Self-Compassion Scale-Short Form, Five-Facet Mindfulness Questionnaire-15, and Health Promoting Lifestyle Profiles II).

Participants were first- and second-year medical students at a U.S. mid-western medical college who participated from October 2020 to December 2020. The groups were filled four days after recruitment began. The program was determined to have adequate treatment fidelity, based on results from two raters using a protocol compliance checklist. Nineteen participants completed the program yielding a 95% retention rate. All participants attended six or more sessions and the average participant attendance rate was 90%. On average, participants rated the overall program information and skills as “Very easy to use,” “Very helpful,” and “Very valuable.” Participants reported using each skill about “1-2 times” per week outside of the sessions. Repeated measures ANOVAs with Bonferroni?s corrections revealed that participants had significant improvements in several wellness outcomes across time. Burnout significantly decreased from pre to post (p = .022, d = 0.67) and from pre to follow-up (p = .009, d = 0.75). Perceived stress had a non-significant decrease from pre to post (p = .072, d = 0.60) but a significant decrease from pre to follow-up (p = .001, d = 1.13). Self-compassion significantly increased from pre to post (p = .005, d = 0.59) and from pre to follow-up (p = .001, d = 0.92). The health promoting behaviors total score significantly increased from pre to post (p = .007, d = 0.65) and from pre to follow-up (p = .000, d = 0.87). Subscales of the health promoting behaviors measure indicated significant improvements for interpersonal relations, stress management, health responsibility, nutrition, and spiritual growth. Mindfulness scores did not significantly change over time. These results were supported by qualitative themes of increased social support, learned wellness skills, appreciation for the respectful and knowledgeable facilitators, and overall positive experiences.

The feasibility results in the current study were stronger than other similarly structured interventions. Participant retention and attendance rates mirror those found in programs that are highly integrated within a medical education system. This indicates that the presented approach is promising for medical schools that are interested in developing new, smaller-scale wellness programs that may be more effective and affordable. The observed effect sizes for main outcome variables were comparable to and sometimes larger than similar intervention studies. Limitations include small sample size, self-selected participants, lack of control group, and potential history effects from the COVID-19 pandemic and 2020 U.S. Presidential Election.

The current study outlines a method for program development and implementation that was flexible enough to meet the needs of this specific population. Overall, findings suggest that the SYMBIOSIS program was feasible and acceptable to medical students, and improved psychological, behavioral, and social health outcomes. Future studies should further investigate behavioral and social health outcomes and their long-term effects into residency. Also, it would be beneficial to evaluate change mechanisms, given our positive results in wellness outcomes, despite no change in mindfulness. Additional studies evaluating the SYMBIOSIS program are warranted.

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