Surviving vs. Thriving: Understanding the difference

2. 
   Motivated abilities: Connecting with one's natural talents
   

3. 
   Professionalism and Professional Health and Wellness
   

4. 
   Integration and choices: Putting into practice lessons from years 1-3
   

While the topic of each retreat varies, the general template of faculty moderated discussions remains consistent. The College Mentors play a key role in the success of these sessions by discussing their own struggles and being open about their own strengths and weaknesses that led them to where they are today. In addition Student Affiliate Advisors also attend the first and second year retreats to offer their perspectives.

FINANCIAL SUPPORT

The provision of substantial financial support has certainly contributed to the breadth of programming, the variety of experiential learning, and the organization and “running” of the day-to-day activities of the Student Wellness Committee, the Colleges, and the annual Retreats within Vanderbilt’s Wellness Program. However, the Program did not start with the budget and resources we currently enjoy today. Vanderbilt’s Wellness initiatives began with a core group of passionate students and faculty members armed with little in the way of funding but a great deal in the way of commitment. As time progressed and the efforts of this core group demonstrated success in terms of student satisfaction, student wellness, and burnout prevention, the funding (in terms of programming dollars and salary support) followed. Even if your resources are limited, we believe that you can gain a foothold for wellness within your institution in the hopes that your successful outcomes will result in increased funding opportunities.

At the time of the creation of the Student Wellness Committee, this volunteer group of students was granted funding on an event by event basis, with spending tightly controlled. Otherwise, the organization and administration of the Committee was completely run by student volunteers. Similarly, when the initial task force met to interview and select the first faculty mentors for the new Colleges system, these busy faculty were asked to donate their time freely to student mentorship. Surprisingly, perhaps, in spite of busy clinical and research endeavors, the core group of eight College Mentors were willing to donate what amounted to about 3-5 hours weekly (averaged annually) to group activities and individual advising within the College system. College Mentors were provided with $3000 per College to spend on activities to promote College identity and foster faculty/student relationships. Additionally, approximately 20 other faculty members agreed to serve as Faculty Affiliate Advisors to pinch-hit and participate as they were able.

Following the success of the Colleges during their first year of implementation, the School of Medicine committed to providing 10% salary support (to a maximum of $20,000 per College Mentor in order to provide them more protected time for College events and individual mentoring. While actual student activities and advising often took up more than 10% of a typical work-week, these faculty were dedicated to their students, to the Colleges, and to the mission of establishing a culture of Wellness at Vanderbilt. The budget for programming for each college was also raised to $5000 annually. Additional funding was then garnered from the School of Medicine in order to fund two Wellness Retreats: one for the First Year students and one for the Second Year students. Surveys and focus groups following these two events documented success in terms of attitudes toward wellness and knowledge about how to maintain wellness in medical school thus solidifying the role of this retreat as a core component of the Wellness Program.

Over the last few years, significant changes have been made in the financial contributions to Wellness at Vanderbilt Medical School. A separate donation fund has been established that has successfully funded the annual College Cup (~$6,000 annually), an intercollegiate competition held every Fall that helps to establish the identities of the College, foster friendly competition, and encourage students to continue to include physical wellness as a priority in their medical school lives. The Student Wellness Committee has continued to expand in terms of student volunteers and leaders and now has a stable annual budget of $10,000, over which they have complete autonomy, enabling it to provide a host of programs, events, and outings. The Wellness Retreats, now offered four times each year to each individual class of students, requires $2,000 for off-campus meeting space, food, transportation, and entertainment options. Within the Colleges, the eight core College Mentors now earn 30% salary support which allows them to host office hours, attend group events, and teach in the pre-clinical years. Each College’s programming budget has expanded to $7,500 annually in order to provide Mentors, FAAs, and SAAs with the necessary funds to allow frequent and variable large-group events and small-group get-togethers.

Much of the funding for the Vanderbilt School of Medicine Wellness Program is derived from the school’s annual White Coat Fund. This fund allows alumni and friends of Vanderbilt the opportunity to contribute to the well-being and success of current students through individual sponsorship, generating approximately $50,000 annually. This fund was developed in conjunction with Vanderbilt’s development office, which set up the account, but much of the fundraising is a joint effort between the alumni office, school administration, and current students.

While Vanderbilt is fortunate to have high-level administrators and faculty who value the promotion of wellness and are willing to back it up with funding, we saw significant success even with smaller budgets at the onset of the development of our program. No matter where your institution lies in the financial spectrum, we believe a Wellness Program can be successfully established with the hopes that continued positive reinforcement from students and faculty alike may result in continued increases in the annual budget.

Institutional structures

Before the creation of the Vanderbilt Wellness Program, there were several key support structures already in place for students. One major resource is the Vanderbilt Student Health Center, which provides primary medical care for all Vanderbilt Students. In addition to the standard primary care office resources, the Vanderbilt Student Health Center also supplies a multitude of information on all aspects of health and even some discussion of wellness which has allowed the Vanderbilt Wellness Program to avoid recreating the wheel in terms of producing information on medical health. The Vanderbilt Student Health Center serves as an excellent resource for student referrals when issues surrounding medical health arise. More information about the Vanderbilt Student Health Center can be found at http://www.vanderbilt.edu/student_health/.

The second remarkable support structure provided for Vanderbilt Students is the Vanderbilt Psychological and Counseling Center. This is an excellent resource which offers students up to one session of counseling services free of charge per week. These services range from one-on-one counseling to group therapy on topics spanning anxiety to substance abuse to obsessive-compulsive disorder. All of these resources are confidential, and the center works seamlessly with psychiatric providers associated with the Student Health Center. More information about the Vanderbilt Psychological and Counseling Center can be found at http://www.vanderbilt.edu/pcc/.

These comprehensive healthcare resources for medical students provide an additional level of support that the Vanderbilt Wellness Program can partner with in order to provide enhanced medical and mental health support to Vanderbilt medical students.
STUDENT BUY-IN
The speed with which Vanderbilt medical students have embraced the Wellness Program is truly remarkable. The results of the published evaluations of various aspects of the program speak for themselves (see bibliography on page 6).

While much of the success of this program is due to the organization and effectiveness of the mentoring structure and programming, some of the success is due, at least in part, to students’ knowledge that this program receives a substantial amount of funding. With the slowing of the economy, cuts in spending have occurred on all fronts at medical institutions across the country. Changes in the landscape of healthcare have forced institutions to re-evaluate where they spend their money and to trim spending where possible. Vanderbilt has not been immune to these changes; however, throughout this process of development the Vanderbilt Wellness Program has seen a steady increase in its funding and support from the school's administration, and has continued to expand its reach and subsequent impact.

Students are not oblivious to this fact. They recognize that medical student wellness is something that the school feels is a worthy investment and, therefore, is something to be taken seriously. This, coupled with the fact that Vanderbilt has dedicated personnel involved with the program who consistently exude wellness and inspire involvement without which the program would not be what it is today, results in a unique medical education experience that students appreciate and therefore support.

Additionally, the speed at which initiatives were rolled out and subsequently adopted by the medical student body can be attributed to the several key charismatic student leaders who have stood at the forefront of each stage of the program’s growth. The Wellness Program has drawn the interest of strong student leaders on an annual basis. These students, through their energy, excitement, and effective communication have successfully conveyed the importance of this Program and generated the strong support it enjoys. A key reason for their success, beyond their inherent charisma, is a ‘practice what you preach’ mentality universal to all past and current student leaders. These students work on a daily basis to stay well while still continuing to enjoy academic success, a feat not overlooked by the rest of the medical student body. Thus, not only through their efforts but also by example have these student leaders been pivotal in the successful student buy-in of the Vanderbilt Wellness Program.

Section III:

WELLNESS AT YOUR INSTITUTION

EXISTING STRUCTURE

Firstly, it is important to be clear that even before the official creation of the Wellness Program at Vanderbilt, there was what many describe as an existing 'culture of wellness' which made incorporation of the Wellness Program into the structure of the medical school a much smoother process.

The very fact that you sought out this information would suggest that a similar interest in supporting and encouraging medical student wellness exists at your institution. Along the same lines, it is vital to consider what programs and structures already exist at your institution and to integrate a Wellness Program into this system rather than establish a competing endeavor or discard an existing program that is effective but doesn't match the Vanderbilt model. Some questions to consider before getting started may help in avoiding redundancy or unnecessary restructuring:

FACULTY LED MENTORING PROGRAM

Does an advising system already exist at your institution?

Does it involve faculty dedicated to the mentoring role or is it a minor responsibility?

Are there faculty at your institution who would want an increased role in mentoring?

Are there faculty at your institution who would be willing to play a supportive role?

Does a system for student-to-student mentoring already exist?

Are there senior students at your institution willing to take on additional mentoring responsibilities during their final year?

STUDENT LED PROGRAMMING

CORE PRINCIPLE WELLNESS RETREATS

These might seem like fairly obvious questions, but they are important to consider prior to making the substantial logistical and financial investments in a school sponsored wellness initiative.

While we believe that the ideal model for encouraging and supporting wellness is to utilize all three components of our model of a wellness program, we are well aware that there are often limitations in what different institutions are willing and able to implement at any one time. The following sections attempt to frame the major aspects of each program that can be utilized independently as well as offer some guidance for scaling based on the size of your institution.

FACULTY LED MENTORING PROGRAM

The Colleges at Vanderbilt are arguably the most impact-full and well-received component of the Wellness Program. Therefore, we highly recommend that any attempt at creating a wellness program at your institution involve the creation of a faculty led mentoring program. Below are the key components that have led to its success:

• 
  Developing a structure to house mentoring groups to allow for the development closer communities within your greater medical school community
  

• 
  Limiting the number of faculty serving as mandatory mentors for students
  

• 
  Pairing faculty to give students access to two potential mentors working collaboratively
  

• 
  Incorporating other faculty to provide additional sources of mentoring for various needs
  

• 
  Incorporating senior students to serve as mentors
  

STUDENT LED PROGRAMMING

A strong group of students is key to the effectiveness of the overall Wellness Program. As discussed above, the senior leaders of the Student Wellness Committee play a vital role in the organization and implementation of all three components. Below are the key components that lead to a successful student led programming component:

• 
  Strong senior leadership
  

• 
  All or none approach to subcommittee chairs
  

• 
  Address the most pressing needs first with 'programming for a purpose'
  

- Take time to evaluate the needs of your students and support them through their greatest challenges first. This will establish both the effectiveness of and need for a wellness program at your institution and will garner the necessary student interest to expand programming to other venues.

TABLE 5: TYPICAL UNIVERSAL SOURCES OF STUDENT DISTRESS

- Gross Anatomy practical exams

- USMLE Step I

- School year transitions - new expectations, classroom to the wards, etc.

- Applying to residency

- Of course many other stressors exist for medical students, but these are some of the universal ones where implementation of effective supportive programming may allow the student led wellness programming committee to be viewed as an advocate and trusted source of support for students.

- Eventually, programming can expand into other venues, however if options for expansion remain limited due to lack of financial support or faculty support, the very effort of disseminating information about the other aspects of wellness and establishing the committee as a source of support in any area will greatly expand the potential for developing future initiatives.

• 
  Well-rounded programming schedule
  

• 
  Consistency and dependability
  

• 
  Branding, Branding, Branding...
  

TABLE 6: USEFUL STRATEGIES FOR BRANDING

- Use of a logo representing your wellness program - to be placed on everything the committee does

- Consistent email format for all student led wellness committee announcements

- Visible support by the faculty member associated with your wellness program - follow up supportive emails, attendance at events, etc.