The core principle wellness retreats are an easy way to add to the legitimacy of a school sponsored wellness initiative. Medical students quickly learn that there are very few programs or events for which medical school administrators will pardon absence from class or grant time off from clerkship rotations. These generally consist of presenting research at national meetings or residency interviews. That being said, excusing students from their class and clerkship obligations to attend a retreat focused on wellness greatly legitimizes wellness as a fundamental component of a medical education. Below are some key components to creating a successful core wellness retreat program:
Retreats must be mandatory
- By making the retreats mandatory it sends the message that the content of the retreat is deemed vital to a medical student's education by the administration.
- Additionally, it removes the 'what is everyone else doing?' stress, allowing students to refrain from being spiteful towards the time commitment of the retreat.
Structured programming should only encompass half of the day, with students being given the remainder of the day off from class or clerkship obligations
- Many students comment that, for them, wellness entails having a free day off. By giving students the afternoon off and specifically forbidding the scheduling of class or clerkship activities that afternoon; students are provided with guilt-free time off.
Retreats should take place off campus
- By having retreats off-campus at a peaceful location (local park, campgrounds, meeting site, etc.) students are removed from reminders of their stressors and distractions in their environment. This allows for more open discussion and reflection by students and creates space within which they may truly be able to hear what is being said by small group leaders and their fellow students.
Retreats must remain flexible to the needs of the students
- Often small group conversation will stray from the workshop template to what is at the forefront of many students’ minds: classroom and clerkship stressors. It is not the role of the small group leaders to keep to the structured content via an iron fist. What truly makes an outstanding small group moderator is the ability to link current student concerns to the topic of the retreat and allow the discussion to naturally involve the goals of the retreat while still addressing student concerns.
Hopefully it has been apparent that a consistent requirement for the development of each aspect of an all-encompassing school sponsored wellness initiative is institutional buy-in. Without support from the institution any attempt at the development of a wellness initiative is doomed to failure.
Upon reflection on the evolution of the Vanderbilt Wellness Program is becomes readily apparent that much of the program’s success was dependent on the consistent efforts of the Dean of Students who, in having the ear of the Dean of Medicine and the ability to gain access to the key decision makers at Vanderbilt, was able to make the vision of the Wellness Program a reality. Having a point person for implementation within the Dean’s Office is vital to the success of a program such as this. While the Dean of Students at Vanderbilt took up that charge, there may be others at your institution that can serve as the administrative point person for this effort and provide the key support needed within the Dean’s Office.
Institutional buy-in as a whole exists in several forms with the most obvious, but not necessarily the most crucial, being financial support. It goes without saying that the substantial financial support that the Vanderbilt Wellness Program receives annually has had a great impact on the current state of the program. It has allowed for the provision of 30% protected salary time for faculty serving as College Mentors, which enables these faculty members to contribute significant portions of their time to their role as College Mentors without detracting from departmental benchmarks. The Student Wellness Committee's annual $10,000 budget allows for extensive annual programming as well as the flexibility to attempt new programming and initiatives each year. Lastly, funding of the annual Wellness Retreats for each class, including transportation, food, meeting space and free-day entertainment options, is an expense that goes a long way toward legitimizing the importance of wellness.
However, we would argue that this is not the most crucial aspect of institutional buy-in. An institution must truly believe that maintaining wellness is a crucial aspect of medical education which will ultimately have a substantial impact on a student's future success as a physician. This type of buy-in is manifested by school administrators’ presence at key wellness events, their comments on wellness when discussing institutional goals, and their willingness to illustrate wellness in their own lives. This must be the first step in the creation of any wellness initiative. It is not necessary for everyone to instantly start professing the virtues of wellness, but rather that key leaders demonstrate an openness to the idea that the goals of a school-sponsored wellness initiative benefit students and, thereby, the institution as a whole. Following this first step, financial investments in wellness appear much more plausible as institutional leaders are able to see that wellness initiatives result in more successful students which develop into thriving physicians.
The length of time required for this type of institutional buy-in to be accomplished is extremely variable. However, we feel that the information we have learned about the success and impact of our Wellness Program, as discussed previously, should help legitimize the importance of a school-sponsored wellness initiative and should help encourage administrators to make the cultural, if not financial, investment in a similar program at your institution.
FACULTY AND STUDENT BUY-IN
As with institutional buy-in, garnering support from faculty is crucial to the success of any program. You may have all the financial resources you need, but if do not have faculty who are interested in devoting a considerable portion of time to mentoring and supporting students then no wellness program can be successful. However, it is likely that certain faculty members within your institution already stand out because of their ability to actively engage with students in the processes we have described above. Undoubtedly upon searching through your institution for such individuals you would quickly find a multitude of excited faculty members who would revel in being involved in such a program. Also, by demonstrating support from the administration, faculty members can utilize involvement in these activities for career advancement, thus further supporting the time and energy a faculty member would be investing into such a program.
Student buy-in exists on two fronts: seeking students willing to lead and organize the efforts of a wellness initiative as well as convincing the student body of the importance of seeking and maintaining wellness. Much of the second point has been described above including programming that responds to student needs, seeking out engaged faculty, and garnering administration support. The first point however is a more subtle but profoundly important one. Wellness at your institution will be entirely dependent on how your student leaders portray it. For example, if your student wellness leader only discusses training for triathlons and the need to go to the gym every day of week, then that is exactly what the student body will perceive wellness to be. Subsequently, if a student is incapable of that or disagrees with that, they will likely come to the conclusion that 'wellness isn't for me'. Seeking out students who actually embody the true sense of wellness as well as who are able to convey that message to others is of the utmost importance, and is something that must be done before attempting to move forward.
FINANCIAL SUPPORT FLOWSHEETs As has been discussed previously, financial support has a great impact on what can be achieved by a wellness initiative, as well as how quickly. The amount of financial support an institution can initially provide to a wellness initiative is understandably variable. The following flowsheets, figures 3 through 5, attempt to assist you in determining how best to allocate resources based on varying degrees of institutional support.
With the creation of a school sponsored wellness initiative you are also attempting to create a culture of wellness at your institution. This is, undoubtedly, an endeavor that takes a considerable amount of time and patience and is not something that can be thrust on a medical school all at once. While the time it will take to achieve this goal is remarkably variable (and greatly depends on everything that has been discussed thus far) there are some general steps that should be taken in sequence for the best chance of success, as shown in figure 6.
FIGURE 7: IMPLEMENTATION TIMELINE
ESTABLISHMENT OF A WELLNESS COMMUNITY
WELLNESS ORGANIZATIONS within medical colleges (wowmc)
With the acquisition of this guidebook and your expressed interest in the creation of a school sponsored wellness initiative at your institution, you are expressing your support of the importance of wellness in medical education and your commitment to spreading that message at your institution.
It is the goal of Vanderbilt to more formally recognize that commitment with the creation of a medical society encompassing medical institutions that support medical student wellness: the Wellness Organizations Within Medical Colleges (WOWMC). With the creation of this society, we hope to send the message that wellness is not simply an extracurricular activity at a handful of institutions, but rather an integral component of the medical profession that institutions have made a commitment to pursue.
This society in only just now in its infancy, but it is our vision that as wellness initiatives are adopted at medical institutions across the country and around the world, this society will lead the way in the development and advancement of wellness principles and will allow for the sharing and disseminating of information quickly for the benefit of medical students world-wide.
We strongly encourage you to constantly evaluate your program’s effectiveness. It is our belief that only through regular evaluation and scrutiny will a program continue to remain effective and relevant. Through the regular use of surveys as well as tracking student participation, your program will better be able to meet the needs of your individual students, and thus remain relevant at your institution.
Vanderbilt has developed several assessment tools to evaluate our wellness programming and would happily share these resources with other institutions. As your program gets underway, please remain in contact with us so that we may continue to assist you in the development of self-assessment tools that target the needs of your specific program.
Ideally, with the creation and expansion of WOWMC, this type of information will be easily disseminated amongst institutions and will allow all involved programs to continue to improve their own self-evaluation.
varying models for success
While we are understandably confident in our model for a school sponsored wellness initiative we do recognize that there are alternative approaches that may be as, or even more, successful than our approach at encouraging and supporting our students’ wellness.
Just as we are happy to share our approaches, we would love to learn what is successful at your institution so that we also can continue to improve the ways in which we support our medical student population. Open exchange of information is vital to the successful adoption of wellness as an integral part of medical education.
Ideally, this will become a major component of the work done through WOWMC as it is developed, and will help all involved institutions to continually improve the reach and impact of their wellness initiatives.
leaders of a changing culture As has been stated numerous times throughout this guide, we feel that student wellness is a crucial component of medical education. While this view is beginning to spread to other institutions, it has yet to be commonly adopted into the culture of medical education.
By seeking out this information, you are acknowledging your commitment to encouraging and supporting medical student wellness, and invite you to participate in the charge to change the culture of medical education. We are thrilled that you have joined us in this endeavor and are excited to see what new ideas and energy you will bring to the table as we continue to work to change the culture of medical education to one that supports the needs of its students and acknowledges that a physician cannot effectively care for his or her patients if he or she cannot effectively care for him or herself.