The Wellness Initiative Network (WIN) is the central hub for wellness-related initiatives and clubs at the University of British Columbia (UBC) Faculty of Medicine. It advocates for policy and systemic change to improve medical students’ wellness, resiliency and sense of community.
What makes WIN unique is that its wellness content is delivered to first- and second-year students by its student members (primarily third- and fourth-year learners) — a strong example of peer-delivered wellness content best practices.
While WIN started out focused on hosting wellness events, its first executive director, Jack Yuan, quickly saw the opportunity to expand into advocacy.
“People were interested in advocacy and super committed to it — and things magically happened,” Yuan explains. “Working with faculty has been key. Our program is unique because of our close ties with faculty.”
Driving policy change
WIN’s top priority is leading organizational and systemic change to influence policies that can contribute to a healthier medical school culture. It has drafted papers for undergraduate medical offices, deans and governing bodies recommending wellness policy changes that have improved student wellness.
One of the organization’s biggest wins was negotiating two flexible personal days each year for third- and fourth-year medical students. (These days off were previously available only to first- and second-year students.) Faculty strongly supported WIN’s recommendation and, with the help of faculty leadership in the Undergraduate Medical Education Committee, the new policy was passed. Students regularly thank WIN members for the opportunity to take part in important life activities — or simply take a day to care for themselves and get back on their feet.
New tools to support student well-being
WIN also created a Wellness Self-Check-in Tool. Students can download and use this chart to become more aware of their own well-being by privately tracking their physical and mental well-being, nutritional health, burnout and mood.
“We wanted to fill a gap in the current mental health resource toolkit for medical students,” says Renée Reimer, WIN’s current executive director. “We have excellent resources to help students in acute crises, such as help lines, but not many that help students be proactive with their own well-being.”
Using this tool, students can take their own “wellness temperature” and feel empowered about making upstream changes to prevent mental health crises.
To create the tool, WIN started by conducting a literature review to find validated medical learner well-being scales, then composed a composite questionnaire adapting components and themes from various sources. Faculty were involved extensively throughout the process with multiple consultations with portfolio leads, the Student Affairs department, the Student Assessment department, the undergraduate dean and the Undergraduate Medical Education Committee.
Although WIN would like to see the tool adopted into the formal curriculum, there have been roadblocks.
“There’s not a lot of evidence on what interventions change medical students’ wellness outcomes, so implementing a new program like this might be a bit of an experiment,” says Yuan. “But we feel it would be a very useful tool and we’re working on how to integrate it formally.”
WIN is also working on policy recommendations regarding medical student workloads. During clerkship and elective years, weekly maximum allowable hour limits for clinical duties are often exceeded, but students don’t feel comfortable speaking up when it happens. WIN is collecting data to present to faculty to collaborate on a solution that balances learning time and clinical experience with time for self-care and life’s other demands.
Peer-delivered wellness curriculum
In everything WIN has achieved, faculty have been a key ally in promoting change.
“Don’t be afraid to reach out to faculty,” says Yuan. “WIN started with unsolicited requests to faculty members. They’re very busy, but approach them anyway. They are receptive and will make time for you.”
One of the organization’s early requests was an idea to incorporate more student perspectives into wellness lectures — and faculty was receptive. With their support, WIN was invited to collaborate on wellness lectures led by the Student Affairs department in the Faculty of Medicine. These lectures were so well received by students that Student Affairs eventually handed them over to WIN, providing the platform the organization needed to begin shaping its peer-delivered wellness curriculum.
Yuan and Reimer spent a year building UBC Medicine’s first longitudinal wellness curriculum to deliver lectures on topics not usually covered: how to approach a call shift, the updated definition of wellness, how to find balance in a medical career, expectations of our own learning, maintaining relationships in medicine, burnout and more.
“We see high rates of burnout and suicide [around 37% of Canadian medical students meet the criteria for burnout] and yet burnout isn’t usually talked about in medical school,” says Yuan.
WIN’s peer-delivered wellness content is tailored to each stage of medical undergraduate studies:
- First year:
- Wellness basics for medical school, including strategies for reducing burnout and staying balanced, creating a wellness mindset, and time management
- Second year
- Clerkship issues and related distress
- Third year:
- Maintaining wellness and setting realistic expectations in clinical education
- Avoiding burnout
- Maintaining balance and perspective
- Fourth year:
- Wellness in residency
WIN often hosts student panels during these lectures to provide honest feedback and advice from peers who have been through these situations recently.
Yuan notes that traditional wellness talks are often vague and repeatedly emphasize the importance of staying active, eating nutritious food, and staying connected to friends and family.
“I saw that the student body often felt slightly patronized, being told things we already knew, with no further depth on how to actually achieve these practices in the medical school setting,” he says.
WIN’s longitudinal approach provides a series of in-depth lectures and revisits topics, validating medical students’ realities, normalizing their struggles and acknowledging real problems.
“Wellness isn’t just yoga every day and sleeping, it’s about thriving in your context,” says Yuan. “With our students delivering curriculum, we gained ground with the student body, and our name and website are now known.”
WIN also holds Q&A sessions about CaRMS and conducts polls on what students are most concerned about. Its curriculum features guest speakers as well, such as UBC medical educator Dr. Peter Choi.
Wellness events and clubs
A WIN group leads wellness-related events such as an annual resiliency workshop, virtual seminars, visits from wellness advocates, puppy therapy sessions and trivia nights. WIN also promotes several clubs to help students pursue wellness without stigma through activities such as martial arts, yoga, golf, writing, exercise, jazz, rock climbing and many others.
From student club to national advocate
When Yuan first joined WIN, it was a small club with only a handful of members, most of whom were moving on to clinical education. Yuan became executive director in his second year, restructured the group and recruited around 20 students to fill the open positions. Under his leadership, WIN grew into one of Canada’s largest, most formalized medical student organizations for well-being advocacy.
“I wanted to support my colleagues in a system that was not built to promote physicians’ or medical learners’ well-being,” he says.
Even his approach to restructuring was intended to be sustainable and lighten the load on busy students. With full meetings only every two months, members could spend the rest of the time focusing on their own projects, other work and personal needs.
In 2018, the Medical Undergraduate Society invited Jack to attend the Western University Dean’s Medical Education Conference. As he discussed absence and attendance policies with deans of medical schools from across the country, he realized WIN had the potential to go beyond simply hosting wellness events to effecting significant organizational change.
As more faculty and students came to trust the group, WIN’s advocacy branch was born. That branch became WIN’s workhorse for identifying policy and structural issues, finding solutions with faculty, and running major projects.
Leading change at other medical schools
While many wellness initiatives focus on personal steps medical students can take to be more resilient, such as sleeping and eating well, WIN aims to redefine wellness, emphasizing that the organization and the individual medical student, resident or physician share responsibility for decreasing burnout and mental health disorders. WIN members also believe that working with organizations to institute systemic change will make the most meaningful impact.
Now serving as the national officer of wellness for the Canadian Federation of Medical Students, Jack has created a team to help him draft policy recommendations to improve medical student well-being to share with all Canadian medical schools.
The CMA wants to learn more about wellness initiatives at Canada’s medical schools and residency programs. Have a story to share? Please contact us.
Are you in distress? Get help now.