Three fourth-year medical students have developed a longitudinal elective that focuses on the well-being of students as they learn in clinical rotations at WMed.
The elective, called “Emotional Awareness and Well-Being Skills in the Clinic,” started as a germ of an idea when Christine Maisano was in her third year and starting a psychiatry rotation.
During the rotation’s orientation, the issue of suicidality arose. Maisano, who will graduate next month with a Well-Being in Medicine Distinction, said she thought about the juxtaposition between faculty members who see mental health conditions in patients regularly and medical students who may be encountering them for the first time.
“For a medical student just starting a clinical rotation, they may never have even been around someone who was so depressed that they were suicidal,” Maisano said. “I wondered how we can support people in this process because this is not the only upsetting thing that medical students encounter.”
While WMed does an excellent job of having awareness of these factors, students did not have a formal space to debrief events they encounter on clinical rotations, Maisano said. She spoke to Karen Horneffer-Ginter, PhD, the medical school’s chief wellness officer and associate dean for Culture, who was enthusiastic about the idea and suggested she connect with two fellow students who were pursuing the distinction and had an interest in supporting their classmates.
Maya Giaquinta and Rachel Zamihovsky had previously demonstrated a desire to help their classmates by starting a virtual support group for students at the beginning of the COVID-19 pandemic. Their support group focused on personal stressors or difficulties in the classroom for students in their pre-clinical years. The group met regularly for about a year, until most instruction and classes returned to face-to-face meetings.
The three students developed a curriculum for the elective and led its four in-person sessions. In all, 12 M3s participated in the elective, which ran from September through December, and focused on identifying traumatic experiences that patients go through, identifying emotions and showing empathy to patients. In the course’s final session, participants presented their capstone project in which they had five to 10 minutes to present on a topic related to the elective. Students presented projects about nutrition, cooking, art, music and other topics.
The group’s momentum was bolstered by Dr. Horneffer-Ginter, who recognized the power of the elective coming from near peers. She trusted the students to put together an elective that was worthwhile and beneficial to students, Maisano said. Dr. Horneffer-Ginter served as a sounding board and offered input as the three students pulled together the course’s content.
“I think an elective like this is part of how we change the culture of medicine to be more authentically supportive of physicians’ well-being, by offering them the tools and not only the permission, but the expectation to reflect and take care of their well-being,” Dr. Horneffer-Ginter said. “It brings me such joy to see the way our student leaders are rising to the invitation to create offerings that best support our student learners and their peers.”
There is no guidebook given to medical students to explain how they should deal with traumatic situations at work, Zamihovsky said.
“It really is a huge gap, I think, in medicine, of addressing our own emotions as providers,” Zamihovsky said. “The patient comes first and there is this mentality within medicine that you just have to pick yourself up and keep moving forward for the patients. Sometimes that doesn’t end up helping the patients and hurts them more when we don’t stop to take care of ourselves and address whatever emotions we’re feeling when we come face to face with these traumatic situations.”
Giaquinta said she is grateful for how well-received the elective was and that other students felt it was useful. Students who took the elective said they were happy they had the opportunity to talk to their classmates face to face and to see that others are going through similar struggles.
“We all wanted something that would truly make an impact and all the students who joined, I think, got something out of it,” Zamihovsky said. “I hope they carry that to wherever they end up in their future and it spreads that way. I hope to take some of these skills that I learned to residency and create something similar at that point.”
This is the second student-inspired wellness-related elective to be developed at WMed. The first one, WMed’s "Mind-Body Medicine Elective," was first offered by the Class of 2021’s Ellen (Nastassia) Drosdick with Dr. Mark Schauer and Dr. Horneffer-Ginter supervising. That elective has been offered six times for M1s and M2s, and each year a participant or participants in the course facilitate it the next year. Students are exposed to content from the literature on emotional awareness and intelligence, mindfulness, resilience and vulnerability and practice well-being skills in the context of real-life clinical scenarios.
“Emotional Awareness and Well-Being Skills in the Clinic,” will continue to be offered annually, with two of this year’s participants, M3s Bethany Beelen and Joshua McGarry, facilitating it in their fourth year. Participants will earn two credits toward their 20 electives credits needed to graduate by taking the elective. McGarry said the elective had a significant impact on him and aligned with his passions of advocating for physician well-being, student well-being, work-life balance and professional boundaries.
“The transition from the first to pre-clinical years to being in the clinic can be pretty dramatic for some people,” McGarry said. "There can be a lot of emotional experiences in medicine, and when you're encountering those for the first time, it can be helpful to have a way to process that with other people who are going through the same thing.”
By the time he had signed up for the elective, McGarry said, he already had some patient interactions that had impacted him and had some experiences that he wanted help processing. He encountered his first patient death on his first rotation, in surgery, and being able to process that with other students was helpful, he said.
During the elective, several M3s expressed difficulty finding the time and the emotional energy to properly process their experiences between fulfilling their clinical duties and studying for exams, McGarry said.
“I think a lot of us carried around emotional baggage from various patient encounters and experiences we had,” McGarry said. “In the clinic, a lot of times, something difficult happens and you have a minute or two to think about it, and then it’s onto the next patient. There’s not a whole lot of time to properly decompress after some of the events that we witness. Having an outlet to think about how it affected me was really helpful.”