Investing in student wellbeing: A design-based educational research approach to develop a longitudinal proactive program to improve wellbeing of medical students

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Hameleers, A. Jasmijn Terlouw, Roland F.J.M. Laan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2317703/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Many medical students suffer from psychosocial distress and mental health problems, raising concerns about their sustainable employability and subjective wellbeing. Therefore, our faculty decided to design a wellbeing program building on the paradigm that in order to sustainably take care of others and deliver high-quality and safe patient care, (future) health professionals should take care of their own wellbeing first. The aim of our research was to design a theory-informed program on student wellbeing allowing students to acquire skills in this regard. In this paper, we describe the iterative design process and the results of our longitudinal proactive wellbeing program. Methods We conducted an educational design approach in four phases to construct the program in order to simultaneously gain new insights and develop practical solutions. We implemented the phases of educational design research over the course of two academic years. Phase 1 consisted of a review of the literature and a context and needs analysis in order to draft design principles and requirements. Phase 2 consisted of the cyclical and iterative process of design, construction and interim evaluation and adjustments of the wellbeing program (WB-program). In phase 3, evaluation and reflection, the program was implemented and evaluated. Phase 4 consisted of ongoing maturation and theoretical understanding of the program. Results With our educational design-based approach to construct a WB-program, we were able to design, construct and evaluate an evidence-informed longitudinal proactive wellbeing program for all bachelor of medicine students at our faculty. The most noteworthy result thus far is that students who are exposed to a longitudinal program with recurring attention on improving and maintaining wellbeing learn to value the importance of self-care and wellbeing and develop skills in this regard. Conclusion Taken together, our study suggests that it is possible to integrate wellbeing in a core undergraduate curriculum on a large scale. We therefore consider the results of this educational design-based development of our WB-program as a proof of concept for a longitudinal integrated program to support student wellbeing. Educational Philosophy and Theory wellbeing undergraduate longitudinal proactive Figures Figure 1 Figure 2 Introduction Scientific as well as popular media report historically high levels of mental health concerns among medical students.[1, 2] Some already suffer from burnout before even starting their professional career.[3, 4] This raises many concerns about the sustainable employability and subjective wellbeing of these future healthcare professionals, since workload is bound to increase during their professional life.[5] Stress and mental illness levels are high among medical interns, and recent surveys revealed that up to 25% of them consider cessation of their postgraduate medical specialty training for this reason.[6, 7] These mental health concerns are not limited to medical students; they are widely spread throughout the academic world.[8, 9] Many universities have recognized issues regarding students’ personal development and subjective wellbeing and invested in mental health services, tutoring and wellbeing programs.[10–12] Despite all these initiatives, psychosocial distress and mental health problems remain substantial.[8, 11, 13, 14] This might be related to the structure of programs that focus on counselling and support when distress arises, but only partly on maintaining or improving subjective wellbeing. Moreover, most programs with regard to mental health, tutoring and wellbeing are organized outside core curricula and are mostly reactive and problem-solving in nature. However, there are far fewer proactive or preventive programs that focus on coaching and improving subjective wellbeing. The lack of preventive programs implies that students who are experiencing uncomplicated academic and personal development, but could benefit from these programs as well, are overlooked.[15–18] Improving subjective wellbeing throughout the entire student population carries the additional benefit of building resilience against mental illness and improving subjective wellbeing.[19] We propose that it is of vital importance for all students to receive training in order to acquire the skills that have been shown to be of essential importance for a successful professional and personal life.[19–22] In the past few months, several authors made moving pleas to focus on developing the student as a whole, since mental health and subjective wellbeing are vital for student success, and to change university culture in this regard.[9, 14] Moreover, increasing stress levels in medical students and physicians not only undermine their subjective wellbeing but also put the quality of patient care at risk.[4, 14, 23] In contrast to the majority of academic studies, a personal–professional development program is part of most medical undergraduate curricula.[24, 25] However, these programs are often short or with low intensity.[26, 27] Several years ago, our medical faculty recognized the major wellbeing challenges among students and young graduates and called for strategies to improve student wellbeing. Therefore, we decided to develop a longitudinal program – aiming to improve student wellbeing – integrated in our medical undergraduate curriculum that is based upon self-determination theory and lifelong learning principles.[28] Research on self-determination and lifelong learning suggests that supporting personal development and psychological needs may help to protect students’ subjective wellbeing and enhance their growth as well as improve the quality of patient care.[29–31] We therefore designed this wellbeing program building on the paradigm that in order to sustainably take care of others and deliver high-quality and safe patient care, (future) health professionals should take care of their own wellbeing first. The aim of this research was to design a theory-informed program on student wellbeing allowing students to acquire skills in this regard. In this paper, we describe the iterative design process and the first results of our longitudinal program on student wellbeing. Methods Setting This study was conducted at the Faculty of Medical Sciences of the Radboud University Nijmegen, the Netherlands and describes the design, adjustments and evaluation of our new longitudinal program on student wellbeing (WB program). Context and setting Our medical faculty features a compulsory longitudinal professional development (LPD) program embedded into the core curriculum.[32] The LPD program is organized in groups of eight students and one teacher-coach and covers the entirety of the three-year bachelor curriculum of medicine. Every year, each student attends six individual coach sessions with the teacher-coach and eight group meetings.[32] All bachelor of medicine students at Radboudumc participate in the LPD program (~ 1000 students). The WB program is offered in the same small student groups, consisting of approximately eight students and one teacher-coach, as in the LPD program. Design We used an educational design approach to construct the program in order to simultaneously develop new insights and practical solutions, which is important when designing and developing new educational programs. [33] We formed a design group consisting of a core of two physician educators and one educationalist and invited undergraduate students, young professionals, medical educators and student counselors to participate and collaborate. We implemented the four phases of educational design research as follows.[33] Phase 1, the orientation phase, consisted of a review of the literature as well as a context and needs analysis to acquire understanding of the problem, in order to draft design principles and requirements (March 2019–August 2019). Phase 2 consisted of the cyclical and iterative process of design, construction and interim evaluation and adjustments of the WB program (September 2019–July 2020). In phase 3, evaluation and reflection, the program was implemented and evaluated (September 2020–June 2021). Phase 4 consisted of the ongoing maturation and theoretical understanding of the program (from September 2021 onwards). The different phases are closely linked and merge into one another as depicted in Fig. 1 , which summarizes the phases and data-collection activities. Phases 1–3 are discussed in detail in the Results section; phase 4 is discussed in the Discussion section. Evaluation In May 2021, at the end of academic year 2020/2021, the developed WB program was evaluated using a combination of panel discussions and an individual online survey. At the end of the final education session of the year, every student group of second- and third-year bachelor students participated in a structured group discussion, based upon several open-ended questions (Table 1 ).[34, 35] Every group as a whole wrote down their collective answers in an online database (Lime survey). Next to the questions that were discussed in the group, every student filled out a personal online survey with both open- and close-ended evaluation questions (Lime survey) (Table 1 ). The narrative answers on the open-ended questions were independently reviewed by two authors (RH and AJT); themes emerging from these responses were identified and analyzed.[36] These themes were then discussed in the research team (RH, AJT, RL and MvdP); discrepancies were resolved by consensus discussion. Likert scales (Table 1 ) were used to quantify the close-ended questions. Ethical considerations The research participants are not subjected to acts that are subject to the WMO (WMO = Wet medisch Wetenschappelijk Onderzoek met mensen: Medical Research Involving Human Subjects Act) and they are not subject to any conduct that is subject to the WMO. On this basis, the CMO region Arnhem-Nijmegen the Netherlands declares that the research does not fall under the remits of the WMO (Dossier number: 020-6518). Subsequently the research protocol was approved by the research board of Medicine (COMOS, Dossier number 4550714–4566939). All participating students and teacher/coaches gave written informed consent. All data are anonymized. Results Phase 1: Analysis and exploration The design process started in 2018 after alarming reports about deteriorating wellbeing and increasing stress levels among (medical) students.[1, 37] Two physician educators (RH and MvdP) with extensive experience in coaching and mentoring and an educationalist (AJT), who is also a student counselor, formed the design group. The design group started the project with exploring the problem through discussions with students, student counselors and teachers (initial orientation). These first discussions led to a broad problem definition and background questions: What are effective solutions and preventive measures to reduce mental illness and incorporate the promotion of wellbeing? How can we educate students in this regard? In order to answer these questions, the design group held interviews with stakeholders and subsequently studied written reports about student wellbeing in the Netherlands (initial context analysis). Based upon these, the design group conducted a narrative literature review that served as a starting point for the in-depth stakeholder interviews and the definition of the design requirements (context and needs analysis). Appendix A provides a more detailed step-by-step overview of the narrative review process. Based upon the literature review, the design team concluded that brief positive psychology interventions can enhance subjective wellbeing; however, most effects last only a short time and most studies had small sample sizes.[38–41] The need to invest in student wellbeing has been assimilated, over the past decade, by the health sciences; most investments are brief or positioned outside the core curricula.[19, 27] Providing an effective learning environment for the improvement of subjective wellbeing asks for transformative educational approaches.[27, 42–44] Results of the narrative review were discussed with stakeholders, which led to the following problem definition: Can we improve subjective wellbeing of medical students with an educational program? And how can we do that? The corresponding generated design requirements are depicted in Table 2 . This resulted in the following design proposition: ‘ To design a longitudinal preventive and proactive wellbeing program for students, in order to improve their subjective wellbeing.’ Phase 2: Design and construction The development team consisted of the design group (RH, AJT and MvdP) regularly consulting students, teacher colleagues, clinician colleagues and student counselors to test ideas, teaching methods and the program outline. First design cycle : In September 2019, we piloted the first few educational components and outline of the program for first- and second-year bachelor students. The first design cycle comprised self-study assignments with additional literature, brief web lectures and accompanying group sessions. The program was developed as a ‘buffet,’ inviting students to mix and match modules to their own liking. Lessons were divided into themes and placed on our digital learning environment platform (Brightspace). Prior to a coach-group session, the student group selected a lesson of their choice from the WB program website and prepared the group session. In every coach-group session from the LPD program, 30–60 minutes were reserved for the lesson from the WB program. During the first quarter (September 2019–December 2019), the design group regularly contacted groups of students and their teacher-coaches to discuss the experiences with the WB program. Students as well as teacher-coaches appreciated the themes of the WB program and reported needing more guidance to achieve the learning objectives. The purpose of design cycles and testing is to reinforce and validate principles for the design. After the first testing, we added more educational instruction for both students and teacher-coaches. At the end of the first semester (February 2020), we ran a short online survey to ask all participating students what they learned from and missed in the WB program. Overall, students stated that the key learning experience of the new WB program was the realization of the importance of taking care of their own wellbeing. There was much appreciation for the topics, and students asked for more practical tools. “How can I improve or maintain my subjective wellbeing on a daily basis, please provide some tools or tips and tricks.” One of the important learning points from testing and adjusting the interim evaluation was the validation of the design requirements. However, the WB program needed further development: the outline of the WB program on the digital learning platform needed refinement, and not all lessons were intuitive enough and required practical tools to help students implement taking care of their wellbeing. Second design cycle : Upon the results of the survey and discussions with colleagues and student counselors, great effort was invested in creating more interactivity and practicality in the lessons. The adjusted WB program was implemented during the second semester. At the end of that semester (July 2020), 14 students volunteered to participate in an interview with the design group, invited by their teacher-coaches. The interviews confirmed the earlier findings that students highly appreciate the content of the WB program. During the lessons, students start to conceptualize the elements of their individual wellbeing and develop a vocabulary in this regard. Several students expressed their desire for more exercises stimulating in-depth discussions about wellbeing with their fellow students, because this stimulates normalizing the need for consideration about wellbeing. “In one of the lessons, I discovered that my fellow students have the same uncertainties as I have.” While students appreciated the WB program in general, they preferred a longitudinal design with mandatory topics as opposed to the current mix-and-match cafeteria model (buffet). “There are so many lessons and topics to choose from; how do I know what will teach me the most valuable lessons…?” All students would prefer a longitudinal program with a gradual build-up of the topics and still more practical assignments, starting with the ‘lighter’ topics and working their way up toward interpersonal development with regard to wellbeing. One student stated “If I can choose, I tend to avoid heavy topics even though I learn the most from them.” Some topics needed additional repetition and elaboration with regard to integration of the WB program with the LPD program. New topics that emerged from the interviews were reloading and rest , as well as transition stress (from high school to university) . Third design cycle : Based upon the interviews, we restructured the existing content of our WB program from a ‘buffet’ to a program with a step-by-step structure in order to guide students in their development. We integrated and connected the WB program with the structure of the LPD program. The outline of the final WB program is depicted in Table 3 . In addition, we rescheduled the layout of our digital learning environment platform (Brightspace) to both visualize the main themes of the program and provide guidance in counselling and referral possibilities (Fig. 2 ). The result of our iterative design and construction process was a longitudinal WB program for all bachelor students that is embedded in the curriculum and its LPD program. Phase 3: Evaluation and reflection As of September 2020, the WB program has been implemented in all three years of our bachelor of medicine curriculum (Table 3 and Fig. 2 ). All student coach groups of bachelor years 2 and 3 participated in the structured group discussion (80 groups of eight; 640 students in total). 74% of the students (476 students: 231 second-year students and 245 third-year students) also filled out the individual online questionnaire. Analysis of the Likert-scale questions : Over 82% of the students (score ≥ 4 on a 5-point scale) report discussing their subjective wellbeing always with their teacher-coach during their individual meetings. The topics of the WB program are considered useful or very useful for their personal development by 81% (score ≥ 4 on 6-point scale). When queried about the teaching methods of the WB course, 62% (score ≥ 4 on 6-point scale) found them appealing. The balance in the course could be improved. About 63% thought the amount of attention paid to wellbeing in the program is exactly right (score 3 on a 5-point scale), 15% thought there was too little attention (score 1 on a 5-point scale) and 22% considered it too much (score 5 on a 5-point scale). Analysis of the narrative group answers : The structured group discussions were centered around three open-ended questions (see Table 1 ). Several themes emerged as positive elements of the WB program. The most important and most frequent mentioned was the mere fact that wellbeing is on the agenda. One student group summed it up with “It is very instructive to make wellbeing a priority in education as well. Through discussions with other students, we personally grow, and we realize that we are not alone. We are often in the same boat and can learn from each other.” Other important positive themes were: ‘many topics to choose from’ and ‘a variety of assignments and lesson types.’ “Some lessons don’t seem interesting at a first glance, but because we discuss them in the group, we always learn something from them.” On the negative side, some student groups would prefer more interaction in the lessons, and they missed long-term goals or learning objectives. “It would help if we were stimulated to define long-term goals with regard to our personal wellbeing and that necessary topics are repeated.” The content of the program is based on scientific evidence about the specific topics. Some student groups valued discussion about the scientific background, while other groups preferred the more practical lessons. When asked, ‘what did you learn from the program?,’ all student groups responded that they learned how important self-care and wellbeing are and received practical and scientific based tools to maintain and improve subjective wellbeing. “The combination of studying wellbeing literature with practical assignments on the topic really inspired us to pay more attention to self-care.” Moreover, the student groups appreciated that the WB program is taught in the same student group as the professional development (LPD) program, which guaranteed a well-known and trusted group environment enabling informative discussions. The program stimulates an environment that is open to discussing mental health issues and guides students who need professional help in a stepwise approach toward professional healthcare. Analysis of the narrative individual answers : In the individual open-ended questions, students gave us useful insights in how they could apply the learning objectives of the WB program into their lives. About half of the students responded that they initially found it difficult to name behavioral changes with regard to their wellbeing. However, many students mentioned in their narrative responses that the fact that attention is paid to wellbeing made them somehow feel better. Students who were able to define behavioral changes mentioned ‘practicing gratitude,’ ‘eating healthier,’ ‘following a stricter sleep regime,’ ‘being able to discuss my feelings with others’ and ‘reframing stress.’ One student wrote: “I feel more reflective now and am able to deal with stress in a different way. A bit of pressure helps me to perform better, too much stress asks for a period of rest.” The importance of discussing topics related to wellbeing became evident from both the group and individual answers. Discussion With our educational design-based approach to construct a wellbeing program, we were able to design, construct and evaluate an evidence-informed longitudinal proactive wellbeing program for all bachelor of medicine students at our faculty. This study makes an important contribution to the development of longitudinal integrated wellbeing programs. To our knowledge, this is the first study to develop and evaluate the effects of a longitudinal integrated course on subjective wellbeing. Working through iterative cycles of design and interim evaluation offered new theoretical and empirical knowledge on what elements in education can improve student wellbeing. Previous research has established that wellbeing can be taught and can exert small increases in subjective wellbeing.[22, 39, 45] Our results suggest that integrating a longitudinal and proactive WB program into the bachelor curriculum enables students to actively change their behavior with regard to maintaining and improving their subjective wellbeing. A systematic review by Wasson et al. showed that there is limited evidence that learning environment interventions can improve medical student wellbeing.[27] However, most studies in that review were focused on supporting students with mental health issues instead of coaching mentally healthy students toward sustainable wellbeing. A study by Greeson et al. found reduced stress and anxiety, better mood and higher distress tolerance after a short four-week workshop program.[46] Against this background, our program is longitudinal during the entirety of our three-year bachelor curriculum and includes a combination of practical and theoretical lessons. Therefore, we expect the program to have a lasting effect on the subjective wellbeing of our students, especially since the majority of students were able to make behavioral changes. A recent study by Dewa et al. – integrating a seven-lesson mental wellbeing course in the graduate plant biology program – showed behavioral changes with regard to positive wellbeing in their students as well.[47] Acquiring practical skills and making behavioral changes positively influences wellbeing and may also stimulate an attitude of lifelong learning that is necessary for every medical professional.[29, 48] Strengths and limitations Our study has several important limitations. First, the program is developed based upon a needs analysis of a narrative review, not a systematic one. It is therefore possible that we missed publications about student wellbeing that could have deepened our understanding of the topic. However, we used the literature review as a basis for discussions with a broad panel of stakeholders with extensive experience in the field of wellbeing, which was part of our iterative process and enabled us to define design requirements for our WB program. Before future adjustments of our program, we will expand our literature review. A second limitation concerns the fact that the first evaluation of the WB program is evaluated by second- and third-year students. Due to logistics in the end-of-year program, the first-year students were not able to participate in the panel discussions. Fortunately, first-year students did participate in the interim evaluations. Moreover, the second- and third-year students who participated in the evaluation did participate in the first-year program in academic year 2019–2020. In our ongoing further development in the future, we will include first-year students’ evaluations as well. A third limitation concerns the unavailability of long-term evaluations of the WB program. Our results indicate a tendency toward behavioral changes – mostly persistent – in students.[38, 49] Phase 1 and the start of phase 2 of the design of the WB program took place before the COVID-19 pandemic. Further iterative design, implementation and evaluation occurred largely during the COVID-19 pandemic, which might have influenced our findings, since the mental health of society at large was under pressure due to all COVID-measures.[50, 51] We consider it positive that we were able to support students in actively change their behavior toward maintaining subjective wellbeing during these challenging times regarding the COVID-pandemic. Our study has several strengths as well. First, we used a systematic educational design base, which is suitable for developing innovative educational programs.[33] Second, we involved a large interdisciplinary group of stakeholders, including many students, and we adjusted the program to emerging insights. A third strength is the fact that our WB program normalizes talking about wellbeing and mental health, which empowers students in this regard. And fourth, the WB program is fully embedded in our medical curriculum, which emphasizes the importance of wellbeing and self-care. Phase 4: Ongoing maturation and theoretical understanding of the program The most noteworthy result from our WB program thus far is that students who are exposed to a longitudinal program with recurring focus on improving and maintaining wellbeing learn to value the importance of self-care and wellbeing and develop skills in this regard. We consider the results of this educational design-based development of our WB program as a proof of concept for a longitudinal integrated program. We would like to share the chief lessons we learned during the research, design and evaluation process. Firstly, involving students in all phases of the process enables the alignment the program to their needs. Different students have different needs with regard to maintaining and improving their wellbeing. In the ongoing maturation, we therefore aim to further develop the WB program with both students and experts from different fields of wellbeing research. Currently we are also expanding the WB program to our master’s curriculum to further ensure persistent behavioral changes. Secondly, students considered that a safe environment is important to discuss their wellbeing concerns with peers. We think that the already existing student groups contributed to the positive results and advise curriculum designers to take this into account when designing a program. Thirdly, further research is necessary to deepen our understanding of the active elements and to help us to improve the WB program. Moreover, we need to further investigate how to support lifelong learning with regard to maintaining subjective wellbeing after graduation, when other challenging factors such as work culture, workload and work–life balance put subjective wellbeing under pressure.[4, 23, 29] Conclusion We developed a longitudinal proactive WB program for bachelor of medicine students that contributes to positive behavior changes with regard to subjective wellbeing. Taken together, our study suggests that it is possible to integrate wellbeing in a core undergraduate curriculum on a large scale. References 1. Rothenberger DA: Physician Burnout and Well-Being: A Systematic Review and Framework for Action . Dis Colon Rectum 2017, 60 (6):567-576. 2. Dopmeijer JM: Running on empty: The impact of challenging student life on wellbeing and academic performance. ; 2021. 3. Dyrbye L, Shanafelt T: A narrative review on burnout experienced by medical students and residents . Med Educ 2016, 50 (1):132-149. 4. Dewa CS, Loong D, Bonato S, Trojanowski L, Rea M: The relationship between resident burnout and safety-related and acceptability-related quality of healthcare: a systematic literature review . BMC medical education 2017, 17 (1):195. 5. West CP, Dyrbye LN, Shanafelt TD: Physician burnout: contributors, consequences and solutions . J Intern Med 2018, 283 (6):516-529. 6. Kleijne I: Kwart aiossen overweegt te stoppen met opleiding . In . , 11 dec 2020 edn. Medisch Contact; 2020. 7. Bustraan J, Dijkhuizen K, Velthuis S, van der Post R, Driessen E, van Lith JMM, de Beaufort AJ: Why do trainees leave hospital-based specialty training? A nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands . BMJ Open 2019, 9 (6):e028631. 8. Jacobsen B, Norup I: Young people's mental health: Exploring the gap between expectation and experience . Educ Res-Uk 2020, 62 (3):249-265. 9. Leshner AI: Target student mental well-being . Science 2021, 371 (6527):325-325. 10. Stallman HM: Embedding resilience within the tertiary curriculum: a feasibility study . High Educ Res Dev 2011, 30 (2):121-133. 11. Baik C, Larcombe W, Brooker A: How universities can enhance student mental wellbeing: the student perspective . High Educ Res Dev 2019, 38 (4):674-687. 12. Gander F, Proyer RT, Ruch W: Positive Psychology Interventions Addressing Pleasure, Engagement, Meaning, Positive Relationships, and Accomplishment Increase Well-Being and Ameliorate Depressive Symptoms: A Randomized, Placebo-Controlled Online Study . Front Psychol 2016, 7 :686. 13. Park SY, Andalibi N, Zou Y, Ambulkar S, Huh-Yoo J: Understanding Students' Mental Well-Being Challenges on a University Campus: Interview Study . JMIR Form Res 2020, 4 (3):e15962. 14. Veal CT: We Burn Out, We Break, We Die: Medical Schools Must Change Their Culture to Preserve Medical Student Mental Health . Academic Medicine 2021, 96 (5):629-631. 15. How colleges today are supporting student mental health [ https://greatergood.berkeley.edu/article/item/how_colleges_today_are_supporting_student_mental_health ] 16. Gulliver A, Griffiths KM, Christensen H: Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review . BMC Psychiatry 2010, 10 :113. 17. Vogan CL, McKimm J, Da Silva AL, Grant A: Twelve tips for providing effective student support in undergraduate medical education . Med Teach 2014, 36 (6):480-485. 18. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD: Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis . Lancet 2016, 388 (10057):2272-2281. 19. Tempski P, Santos IS, Mayer FB, Enns SC, Perotta B, Paro HB, Gannam S, Peleias M, Garcia VL, Baldassin S et al : Relationship among Medical Student Resilience, Educational Environment and Quality of Life . Plos One 2015, 10 (6):e0131535. 20. Diener E, Chan MY: Happy People Live Longer: Subjective Well-Being Contributes to Health and Longevity . Appl Psychol-Hlth We 2011, 3 (1):1-43. 21. Covey SR: The seven habits of highly effective people . Natl Med Leg J 1991, 2 (2):8. 22. Yaden DB, Claydon J, Bathgate M, Platt B, Santos LR: Teaching well-being at scale: An intervention study . Plos One 2021, 16 (4):e0249193. 23. Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN, Tutty MA, West CP, Shanafelt TD: Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors . Mayo Clin Proc 2018, 93 (11):1571-1580. 24. CanMEDS: Better standards, better physicians, better care [ https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e ] 25. Medical training framework 2020 [ https://www.nfu.nl/sites/default/files/2020-08/20.1577_Raamplan_Medical_Training_Framework_2020_-_May_2020.pdf ] 26. Slavin SJ, Schindler DL, Chibnall JT: Medical student mental health 3.0: improving student wellness through curricular changes . Acad Med 2014, 89 (4):573-577. 27. Wasson LT, Cusmano A, Meli L, Louh I, Falzon L, Hampsey M, Young G, Shaffer J, Davidson KW: Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review . JAMA 2016, 316 (21):2237-2252. 28. ten Cate TJ, Kusurkar RA, Williams GC: How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide No. 59 . Med Teach 2011, 33 (12):961-973. 29. Babenko O, Daniels LM, Ross S, White J, Oswald A: Medical student well-being and lifelong learning: A motivational perspective . Educ Health (Abingdon) 2019, 32 (1):25-32. 30. Tjin ATS, de Boer A, Croiset G, Koster AS, van der Burgt S, Kusurkar RA: How basic psychological needs and motivation affect vitality and lifelong learning adaptability of pharmacists: a structural equation model . Adv Health Sci Educ Theory Pract 2018, 23 (3):549-566. 31. van der Burgt SME, Nauta K, Croiset G, Kusurkar RA, Peerdeman SM: A qualitative study on factors influencing the situational and contextual motivation of medical specialists . Int J Med Educ 2020, 11 :111-119. 32. Ede A, Gorgels W, Reuzel R, Gils van M, Heemskerk S, Gurp van P: Professionalism to connect the student with the curriculum and healthcare society . In: AMEE-2019. Austria; 2019: 1147. 33. McKenney S, Reeves TC: Educational design research: Portraying, conducting, and enhancing productive scholarship . Med Educ 2021, 55 (1):82-92. 34. Cook DA: Twelve tips for evaluating educational programs . Med Teach 2010, 32 (4):296-301. 35. Edmunds S, Brown G: Effective small group learning: AMEE Guide No. 48 . Med Teach 2010, 32 (9):715-726. 36. MB Miles AH: Qualitative data analysis: An expanded sourcebook : Sage; 1994. 37. Aggie van Huisseling, Danique Keiman, Nina van Liere, Louis Mourisse, Thomas Ohlenforst, Daphne Pleijers, Vennes A: Welzijn onder studenten: Radboud Cares . Radboud university; 2018. 38. Lyubomirsky S, Sheldon KM, Schkade D: Pursuing happiness: The architecture of sustainable change . Rev Gen Psychol 2005, 9 (2):111-131. 39. White CA, Uttl B, Holder MD: Meta-analyses of positive psychology interventions: The effects are much smaller than previously reported . Plos One 2019, 14 (5). 40. Seligman MEP, Steen TA, Park N, Peterson C: Positive psychology progress - Empirical validation of interventions . American Psychologist 2005, 60 (5):410-421. 41. Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E: Positive psychology interventions: a meta-analysis of randomized controlled studies . BMC Public Health 2013, 13 . 42. Tempski P, Martins MA, Paro HBMS: Teaching and learning resilience: a new agenda in medical education . Med Educ 2012, 46 (4):345-346. 43. Calo M, Peiris C, Chipchase L, Blackstock F, Judd B: Grit, resilience and mindset in health students . Clin Teach 2019, 16 (4):317-322. 44. Cook DA, Artino AR, Jr.: Motivation to learn: an overview of contemporary theories . Med Educ 2016, 50 (10):997-1014. 45. Sin NL, Lyubomirsky S: Enhancing Well-Being and Alleviating Depressive Symptoms With Positive Psychology Interventions: A Practice-Friendly Meta-Analysis . Journal of Clinical Psychology 2009, 65 (5):467-487. 46. Greeson JM, Toohey MJ, Pearce MJ: An adapted, four-week mind-body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care . Explore (NY) 2015, 11 (3):186-192. 47. Dewa CS, Nieuwenhuijsen K, Holmes-Sullivan KJ, Singh AK, Drakakaki G: Introducing plant biology graduate students to a culture of mental well-being . Plant Direct 2020, 4 (4):e00211. 48. Deci EL, Ryan RM: Facilitating Optimal Motivation and Psychological Well-Being Across Life's Domains . Can Psychol 2008, 49 (1):14-23. 49. Kahneman D: Thinking, Fast and Slow . Fortune 2015, 172 (1):20-20. 50. Zhai Y, Du X: Addressing collegiate mental health amid COVID-19 pandemic . Psychiatry Res 2020, 288 :113003. 51. Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L, McKyer ELJ, Ahmed HU, Ma P: Epidemiology of mental health problems in COVID-19: a review . F1000Res 2020, 9 :636. Tables Table 1. Outline of evaluation survey Panel discussion questions What are positive elements of the WB program? What are negative elements of the WB program? What did you learn from the program? Individual questions: on a Likert scale from 1 to 5/6 At every individual conversation with my teacher-coach, I discuss my subjective wellbeing (never–always, 1–5) The topics of the WB program are useful for my personal development (not at all–very, 1–6) I find the teaching methods of the WB program appealing (not at all–very, 1–6) I appreciate the amount of attention that is paid to my wellbeing (too little–too much, 1–5) Individual open-ended question Did your behavior change with regard to maintaining your wellbeing? If it changed, in what way? If not, why not? Table 2. Design requirements for the first cycle of design and development of a wellbeing program Design requirement Develop a longitudinal wellbeing program for students that stimulates lifelong learning Create a preventive and proactive program Integrate the program in the curriculum Focus on improving wellbeing and resilience Normalize stress and setback (every person will face those) Provide back-up plan for coaching/counseling and referral for students with serious mental health issues Table 3. Designed wellbeing program in relation to the professional development program Structure Per academic year: 6 individual coaching sessions 8 group sessions, 2 hours 30–60 minutes: group coaching 30–60 minutes educational content on professional development 30–60 minutes focus on a wellbeing topic Self-study and practical assignments Professional development program Wellbeing program Basic skills Self-reflection, feedback, collaboration, goal-setting, professional responsibilities Critical thinking, life-long learning Study/career orientation, professional attitude Healthcare developments Current affairs Group coaching Exchange learning experiences Connection with WB program Skill training in the WB program à Semester 1 Introduction to wellbeing, transition, sleep and exercise, wellbeing and the brain, procrastination and motivation Semester 2 Learn how to learn, the language of wellbeing, stress explained, performance anxiety Semester 3 Personal leadership, proactivity, motivation, resilience Semester 4 Happiness or stress, positive psychology, prioritize Semester 5 Expressing feelings (new vocabulary), stress, distress, flow, empowerment Semester 6 Happiness (4 lessons), thinking fast and slow, exercise and sleep Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2317703","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":155378969,"identity":"23080c52-d7b3-4aa1-8318-5a12a901eb8c","order_by":0,"name":"Ron J.M.G. Hameleers","email":"","orcid":"https://orcid.org/0000-0002-2206-5177","institution":"University Medical Center Nijmegen: Radboudumc","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ron","middleName":"J.M.G.","lastName":"Hameleers","suffix":""},{"id":155378970,"identity":"88e1d892-a568-4d03-935f-db2b33b7beba","order_by":1,"name":"A. Jasmijn Terlouw","email":"","orcid":"https://orcid.org/0000-0001-7677-2275","institution":"University Medical Center Nijmegen: Radboudumc","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"A.","middleName":"Jasmijn","lastName":"Terlouw","suffix":""},{"id":155378971,"identity":"dc0b56b3-b22a-46dd-8213-4edafe70f7cd","order_by":2,"name":"Roland F.J.M. Laan","email":"","orcid":"https://orcid.org/0000-0002-8005-7685","institution":"University Medical Center Nijmegen: Radboudumc","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Roland","middleName":"F.J.M.","lastName":"Laan","suffix":""},{"id":155378972,"identity":"b557f28c-9753-4220-8ad0-1f584a153e64","order_by":3,"name":"Marjolein H.J. van de Pol","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-0977-7954","institution":"University Medical Center Nijmegen: Radboudumc","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Marjolein","middleName":"H.J. van","lastName":"de Pol","suffix":""}],"badges":[],"createdAt":"2022-11-27 13:08:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2317703/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2317703/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":29691367,"identity":"e6a82727-99ed-4358-aa81-7c26f9a81e30","added_by":"auto","created_at":"2022-11-29 23:51:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49342,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic outline of the design process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2317703/v1/74daf160cc211c2ec6ec79bf.png"},{"id":29691368,"identity":"8e661e00-dd72-46ac-8add-5bb81084fcf3","added_by":"auto","created_at":"2022-11-29 23:51:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38131,"visible":true,"origin":"","legend":"\u003cp\u003eThematic layout of the WB program\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-2317703/v1/a00c07e840fbdb923fa14f1d.png"},{"id":29691885,"identity":"a905e162-917d-4f81-8974-25568a2dcf79","added_by":"auto","created_at":"2022-11-29 23:59:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1304163,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2317703/v1/68a31853-3441-49cc-85c9-2b9b5d6c3e71.pdf"},{"id":29691883,"identity":"b2ac2226-f871-4117-9d4c-bec0906a0ab0","added_by":"auto","created_at":"2022-11-29 23:59:20","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46948,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-2317703/v1/0742423bbf87524f91be5fd7.docx"}],"financialInterests":"\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e","formattedTitle":"\u003cp\u003e\u003cstrong\u003eInvesting in student wellbeing: A design-based educational research approach to develop a longitudinal proactive program to improve wellbeing of medical students\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eScientific as well as popular media report historically high levels of mental health concerns among medical students.[1, 2] Some already suffer from burnout before even starting their professional career.[3, 4] This raises many concerns about the sustainable employability and subjective wellbeing of these future healthcare professionals, since workload is bound to increase during their professional life.[5] Stress and mental illness levels are high among medical interns, and recent surveys revealed that up to 25% of them consider cessation of their postgraduate medical specialty training for this reason.[6, 7]\u003c/p\u003e \u003cp\u003eThese mental health concerns are not limited to medical students; they are widely spread throughout the academic world.[8, 9] Many universities have recognized issues regarding students\u0026rsquo; personal development and subjective wellbeing and invested in mental health services, tutoring and wellbeing programs.[10\u0026ndash;12] Despite all these initiatives, psychosocial distress and mental health problems remain substantial.[8, 11, 13, 14] This might be related to the structure of programs that focus on counselling and support when distress arises, but only partly on maintaining or improving subjective wellbeing. Moreover, most programs with regard to mental health, tutoring and wellbeing are organized outside core curricula and are mostly reactive and problem-solving in nature. However, there are far fewer proactive or preventive programs that focus on coaching and improving subjective wellbeing. The lack of preventive programs implies that students who are experiencing uncomplicated academic and personal development, but could benefit from these programs as well, are overlooked.[15\u0026ndash;18] Improving subjective wellbeing throughout the entire student population carries the additional benefit of building resilience against mental illness and improving subjective wellbeing.[19] We propose that it is of vital importance for all students to receive training in order to acquire the skills that have been shown to be of essential importance for a successful professional and personal life.[19\u0026ndash;22] In the past few months, several authors made moving pleas to focus on developing the student as a whole, since mental health and subjective wellbeing are vital for student success, and to change university culture in this regard.[9, 14] Moreover, increasing stress levels in medical students and physicians not only undermine their subjective wellbeing but also put the quality of patient care at risk.[4, 14, 23]\u003c/p\u003e \u003cp\u003eIn contrast to the majority of academic studies, a personal\u0026ndash;professional development program is part of most medical undergraduate curricula.[24, 25] However, these programs are often short or with low intensity.[26, 27]\u003c/p\u003e \u003cp\u003eSeveral years ago, our medical faculty recognized the major wellbeing challenges among students and young graduates and called for strategies to improve student wellbeing. Therefore, we decided to develop a longitudinal program \u0026ndash; aiming to improve student wellbeing \u0026ndash; integrated in our medical undergraduate curriculum that is based upon self-determination theory and lifelong learning principles.[28] Research on self-determination and lifelong learning suggests that supporting personal development and psychological needs may help to protect students\u0026rsquo; subjective wellbeing and enhance their growth as well as improve the quality of patient care.[29\u0026ndash;31]\u003c/p\u003e \u003cp\u003eWe therefore designed this wellbeing program building on the paradigm that in order to sustainably take care of others and deliver high-quality and safe patient care, (future) health professionals should take care of their own wellbeing first. The aim of this research was to design a theory-informed program on student wellbeing allowing students to acquire skills in this regard.\u003c/p\u003e \u003cp\u003eIn this paper, we describe the iterative design process and the first results of our longitudinal program on student wellbeing.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting\u003c/h2\u003e \u003cp\u003eThis study was conducted at the Faculty of Medical Sciences of the Radboud University Nijmegen, the Netherlands and describes the design, adjustments and evaluation of our new longitudinal program on student wellbeing (WB program).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eContext and setting\u003c/h2\u003e \u003cp\u003eOur medical faculty features a compulsory longitudinal professional development (LPD) program embedded into the core curriculum.[32] The LPD program is organized in groups of eight students and one teacher-coach and covers the entirety of the three-year bachelor curriculum of medicine. Every year, each student attends six individual coach sessions with the teacher-coach and eight group meetings.[32] All bachelor of medicine students at Radboudumc participate in the LPD program (~\u0026thinsp;1000 students). The WB program is offered in the same small student groups, consisting of approximately eight students and one teacher-coach, as in the LPD program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eWe used an educational design approach to construct the program in order to simultaneously develop new insights and practical solutions, which is important when designing and developing new educational programs. [33] We formed a design group consisting of a core of two physician educators and one educationalist and invited undergraduate students, young professionals, medical educators and student counselors to participate and collaborate.\u003c/p\u003e \u003cp\u003eWe implemented the four phases of educational design research as follows.[33] Phase 1, the orientation phase, consisted of a review of the literature as well as a context and needs analysis to acquire understanding of the problem, in order to draft design principles and requirements (March 2019\u0026ndash;August 2019). Phase 2 consisted of the cyclical and iterative process of design, construction and interim evaluation and adjustments of the WB program (September 2019\u0026ndash;July 2020). In phase 3, evaluation and reflection, the program was implemented and evaluated (September 2020\u0026ndash;June 2021). Phase 4 consisted of the ongoing maturation and theoretical understanding of the program (from September 2021 onwards). The different phases are closely linked and merge into one another as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which summarizes the phases and data-collection activities. Phases 1\u0026ndash;3 are discussed in detail in the \u003cspan refid=\"Sec8\" class=\"InternalRef\"\u003eResults\u003c/span\u003e section; phase 4 is discussed in the \u003cspan refid=\"Sec12\" class=\"InternalRef\"\u003eDiscussion\u003c/span\u003e section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation\u003c/h2\u003e \u003cp\u003eIn May 2021, at the end of academic year 2020/2021, the developed WB program was evaluated using a combination of panel discussions and an individual online survey. At the end of the final education session of the year, every student group of second- and third-year bachelor students participated in a structured group discussion, based upon several open-ended questions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).[34, 35] Every group as a whole wrote down their collective answers in an online database (Lime survey). Next to the questions that were discussed in the group, every student filled out a personal online survey with both open- and close-ended evaluation questions (Lime survey) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The narrative answers on the open-ended questions were independently reviewed by two authors (RH and AJT); themes emerging from these responses were identified and analyzed.[36] These themes were then discussed in the research team (RH, AJT, RL and MvdP); discrepancies were resolved by consensus discussion. Likert scales (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) were used to quantify the close-ended questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThe research participants are not subjected to acts that are subject to the WMO (WMO\u0026thinsp;=\u0026thinsp;Wet medisch Wetenschappelijk Onderzoek met mensen: Medical Research Involving Human Subjects Act) and they are not subject to any conduct that is subject to the WMO. On this basis, the CMO region Arnhem-Nijmegen the Netherlands declares that the research does not fall under the remits of the WMO (Dossier number: 020-6518). Subsequently the research protocol was approved by the research board of Medicine (COMOS, Dossier number 4550714\u0026ndash;4566939). All participating students and teacher/coaches gave written informed consent. All data are anonymized.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePhase 1: Analysis and exploration\u003c/h2\u003e \u003cp\u003eThe design process started in 2018 after alarming reports about deteriorating wellbeing and increasing stress levels among (medical) students.[1, 37] Two physician educators (RH and MvdP) with extensive experience in coaching and mentoring and an educationalist (AJT), who is also a student counselor, formed the design group. The design group started the project with exploring the problem through discussions with students, student counselors and teachers (initial orientation). These first discussions led to a broad problem definition and background questions: What are effective solutions and preventive measures to reduce mental illness and incorporate the promotion of wellbeing? How can we educate students in this regard?\u003c/p\u003e \u003cp\u003eIn order to answer these questions, the design group held interviews with stakeholders and subsequently studied written reports about student wellbeing in the Netherlands (initial context analysis). Based upon these, the design group conducted a narrative literature review that served as a starting point for the in-depth stakeholder interviews and the definition of the design requirements (context and needs analysis). Appendix A provides a more detailed step-by-step overview of the narrative review process. Based upon the literature review, the design team concluded that brief positive psychology interventions can enhance subjective wellbeing; however, most effects last only a short time and most studies had small sample sizes.[38\u0026ndash;41] The need to invest in student wellbeing has been assimilated, over the past decade, by the health sciences; most investments are brief or positioned outside the core curricula.[19, 27] Providing an effective learning environment for the improvement of subjective wellbeing asks for transformative educational approaches.[27, 42\u0026ndash;44]\u003c/p\u003e \u003cp\u003eResults of the narrative review were discussed with stakeholders, which led to the following problem definition: Can we improve subjective wellbeing of medical students with an educational program? And how can we do that? The corresponding generated design requirements are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. This resulted in the following design proposition: \u0026lsquo;\u003cem\u003eTo design a longitudinal preventive and proactive wellbeing program for students, in order to improve their subjective wellbeing.\u0026rsquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePhase 2: Design and construction\u003c/h2\u003e \u003cp\u003eThe development team consisted of the design group (RH, AJT and MvdP) regularly consulting students, teacher colleagues, clinician colleagues and student counselors to test ideas, teaching methods and the program outline.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFirst design cycle\u003c/span\u003e: In September 2019, we piloted the first few educational components and outline of the program for first- and second-year bachelor students. The first design cycle comprised self-study assignments with additional literature, brief web lectures and accompanying group sessions. The program was developed as a \u0026lsquo;buffet,\u0026rsquo; inviting students to mix and match modules to their own liking. Lessons were divided into themes and placed on our digital learning environment platform (Brightspace). Prior to a coach-group session, the student group selected a lesson of their choice from the WB program website and prepared the group session. In every coach-group session from the LPD program, 30\u0026ndash;60 minutes were reserved for the lesson from the WB program. During the first quarter (September 2019\u0026ndash;December 2019), the design group regularly contacted groups of students and their teacher-coaches to discuss the experiences with the WB program. Students as well as teacher-coaches appreciated the themes of the WB program and reported needing more guidance to achieve the learning objectives. The purpose of design cycles and testing is to reinforce and validate principles for the design. After the first testing, we added more educational instruction for both students and teacher-coaches.\u003c/p\u003e \u003cp\u003eAt the end of the first semester (February 2020), we ran a short online survey to ask all participating students what they learned from and missed in the WB program. Overall, students stated that the key learning experience of the new WB program was the realization of the importance of taking care of their own wellbeing. There was much appreciation for the topics, and students asked for more practical tools. \u003cem\u003e\u0026ldquo;How can I improve or maintain my subjective wellbeing on a daily basis, please provide some tools or tips and tricks.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eOne of the important learning points from testing and adjusting the interim evaluation was the validation of the design requirements. However, the WB program needed further development: the outline of the WB program on the digital learning platform needed refinement, and not all lessons were intuitive enough and required practical tools to help students implement taking care of their wellbeing.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSecond design cycle\u003c/span\u003e: Upon the results of the survey and discussions with colleagues and student counselors, great effort was invested in creating more interactivity and practicality in the lessons. The adjusted WB program was implemented during the second semester. At the end of that semester (July 2020), 14 students volunteered to participate in an interview with the design group, invited by their teacher-coaches.\u003c/p\u003e \u003cp\u003eThe interviews confirmed the earlier findings that students highly appreciate the content of the WB program. During the lessons, students start to conceptualize the elements of their individual wellbeing and develop a vocabulary in this regard. Several students expressed their desire for more exercises stimulating in-depth discussions about wellbeing with their fellow students, because this stimulates normalizing the need for consideration about wellbeing. \u003cem\u003e\u0026ldquo;In one of the lessons, I discovered that my fellow students have the same uncertainties as I have.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eWhile students appreciated the WB program in general, they preferred a longitudinal design with mandatory topics as opposed to the current mix-and-match cafeteria model (buffet).\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There are so many lessons and topics to choose from; how do I know what will teach me the most valuable lessons\u0026hellip;?\u0026rdquo;\u003c/em\u003e All students would prefer a longitudinal program with a gradual build-up of the topics and still more practical assignments, starting with the \u0026lsquo;lighter\u0026rsquo; topics and working their way up toward interpersonal development with regard to wellbeing. One student stated \u003cem\u003e\u0026ldquo;If I can choose, I tend to avoid heavy topics even though I learn the most from them.\u0026rdquo;\u003c/em\u003e Some topics needed additional repetition and elaboration with regard to integration of the WB program with the LPD program. New topics that emerged from the interviews were \u003cem\u003ereloading and rest\u003c/em\u003e, as well as \u003cem\u003etransition stress (from high school to university)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eThird design cycle\u003c/span\u003e: Based upon the interviews, we restructured the existing content of our WB program from a \u0026lsquo;buffet\u0026rsquo; to a program with a step-by-step structure in order to guide students in their development. We integrated and connected the WB program with the structure of the LPD program. The outline of the final WB program is depicted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In addition, we rescheduled the layout of our digital learning environment platform (Brightspace) to both visualize the main themes of the program and provide guidance in counselling and referral possibilities (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The result of our iterative design and construction process was a longitudinal WB program for all bachelor students that is embedded in the curriculum and its LPD program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePhase 3: Evaluation and reflection\u003c/h2\u003e \u003cp\u003eAs of September 2020, the WB program has been implemented in all three years of our bachelor of medicine curriculum (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). All student coach groups of bachelor years 2 and 3 participated in the structured group discussion (80 groups of eight; 640 students in total). 74% of the students (476 students: 231 second-year students and 245 third-year students) also filled out the individual online questionnaire.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnalysis of the Likert-scale questions\u003c/span\u003e: Over 82% of the students (score\u0026thinsp;\u0026ge;\u0026thinsp;4 on a 5-point scale) report discussing their subjective wellbeing always with their teacher-coach during their individual meetings. The topics of the WB program are considered useful or very useful for their personal development by 81% (score\u0026thinsp;\u0026ge;\u0026thinsp;4 on 6-point scale). When queried about the teaching methods of the WB course, 62% (score\u0026thinsp;\u0026ge;\u0026thinsp;4 on 6-point scale) found them appealing. The balance in the course could be improved. About 63% thought the amount of attention paid to wellbeing in the program is exactly right (score 3 on a 5-point scale), 15% thought there was too little attention (score 1 on a 5-point scale) and 22% considered it too much (score 5 on a 5-point scale).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnalysis of the narrative group answers\u003c/span\u003e: The structured group discussions were centered around three open-ended questions (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Several themes emerged as positive elements of the WB program. The most important and most frequent mentioned was the mere fact that wellbeing is on the agenda. One student group summed it up with \u003cem\u003e\u0026ldquo;It is very instructive to make wellbeing a priority in education as well. Through discussions with other students, we personally grow, and we realize that we are not alone. We are often in the same boat and can learn from each other.\u0026rdquo;\u003c/em\u003e Other important positive themes were: \u003cem\u003e\u0026lsquo;many topics to choose from\u0026rsquo;\u003c/em\u003e and \u003cem\u003e\u0026lsquo;a variety of assignments and lesson types.\u0026rsquo; \u0026ldquo;Some lessons don\u0026rsquo;t seem interesting at a first glance, but because we discuss them in the group, we always learn something from them.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eOn the negative side, some student groups would prefer more interaction in the lessons, and they missed long-term goals or learning objectives. \u003cem\u003e\u0026ldquo;It would help if we were stimulated to define long-term goals with regard to our personal wellbeing and that necessary topics are repeated.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe content of the program is based on scientific evidence about the specific topics. Some student groups valued discussion about the scientific background, while other groups preferred the more practical lessons.\u003c/p\u003e \u003cp\u003eWhen asked, \u0026lsquo;what did you learn from the program?,\u0026rsquo; all student groups responded that they learned how important self-care and wellbeing are and received practical and scientific based tools to maintain and improve subjective wellbeing. \u003cem\u003e\u0026ldquo;The combination of studying wellbeing literature with practical assignments on the topic really inspired us to pay more attention to self-care.\u0026rdquo;\u003c/em\u003e Moreover, the student groups appreciated that the WB program is taught in the same student group as the professional development (LPD) program, which guaranteed a well-known and trusted group environment enabling informative discussions. The program stimulates an environment that is open to discussing mental health issues and guides students who need professional help in a stepwise approach toward professional healthcare.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAnalysis of the narrative individual answers\u003c/span\u003e: In the individual open-ended questions, students gave us useful insights in how they could apply the learning objectives of the WB program into their lives. About half of the students responded that they initially found it difficult to name behavioral changes with regard to their wellbeing. However, many students mentioned in their narrative responses that the fact that attention is paid to wellbeing made them somehow feel better. Students who were able to define behavioral changes mentioned \u003cem\u003e\u0026lsquo;practicing gratitude,\u0026rsquo; \u0026lsquo;eating healthier,\u0026rsquo; \u0026lsquo;following a stricter sleep regime,\u0026rsquo; \u0026lsquo;being able to discuss my feelings with others\u0026rsquo;\u003c/em\u003e and \u003cem\u003e\u0026lsquo;reframing stress.\u0026rsquo;\u003c/em\u003e One student wrote: \u003cem\u003e\u0026ldquo;I feel more reflective now and am able to deal with stress in a different way. A bit of pressure helps me to perform better, too much stress asks for a period of rest.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe importance of discussing topics related to wellbeing became evident from both the group and individual answers.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith our educational design-based approach to construct a wellbeing program, we were able to design, construct and evaluate an evidence-informed longitudinal proactive wellbeing program for all bachelor of medicine students at our faculty. This study makes an important contribution to the development of longitudinal integrated wellbeing programs. To our knowledge, this is the first study to develop and evaluate the effects of a longitudinal integrated course on subjective wellbeing. Working through iterative cycles of design and interim evaluation offered new theoretical and empirical knowledge on what elements in education can improve student wellbeing.\u003c/p\u003e \u003cp\u003ePrevious research has established that wellbeing can be taught and can exert small increases in subjective wellbeing.[22, 39, 45] Our results suggest that integrating a longitudinal and proactive WB program into the bachelor curriculum enables students to actively change their behavior with regard to maintaining and improving their subjective wellbeing. A systematic review by Wasson et al. showed that there is limited evidence that learning environment interventions can improve medical student wellbeing.[27] However, most studies in that review were focused on supporting students with mental health issues instead of coaching mentally healthy students toward sustainable wellbeing.\u003c/p\u003e \u003cp\u003eA study by Greeson et al. found reduced stress and anxiety, better mood and higher distress tolerance after a short four-week workshop program.[46] Against this background, our program is longitudinal during the entirety of our three-year bachelor curriculum and includes a combination of practical and theoretical lessons. Therefore, we expect the program to have a lasting effect on the subjective wellbeing of our students, especially since the majority of students were able to make behavioral changes. A recent study by Dewa et al. \u0026ndash; integrating a seven-lesson mental wellbeing course in the graduate plant biology program \u0026ndash; showed behavioral changes with regard to positive wellbeing in their students as well.[47] Acquiring practical skills and making behavioral changes positively influences wellbeing and may also stimulate an attitude of lifelong learning that is necessary for every medical professional.[29, 48]\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eOur study has several important limitations. First, the program is developed based upon a needs analysis of a narrative review, not a systematic one. It is therefore possible that we missed publications about student wellbeing that could have deepened our understanding of the topic. However, we used the literature review as a basis for discussions with a broad panel of stakeholders with extensive experience in the field of wellbeing, which was part of our iterative process and enabled us to define design requirements for our WB program. Before future adjustments of our program, we will expand our literature review. A second limitation concerns the fact that the first evaluation of the WB program is evaluated by second- and third-year students. Due to logistics in the end-of-year program, the first-year students were not able to participate in the panel discussions. Fortunately, first-year students did participate in the interim evaluations. Moreover, the second- and third-year students who participated in the evaluation did participate in the first-year program in academic year 2019\u0026ndash;2020. In our ongoing further development in the future, we will include first-year students\u0026rsquo; evaluations as well. A third limitation concerns the unavailability of long-term evaluations of the WB program. Our results indicate a tendency toward behavioral changes \u0026ndash; mostly persistent \u0026ndash; in students.[38, 49]\u003c/p\u003e \u003cp\u003ePhase 1 and the start of phase 2 of the design of the WB program took place before the COVID-19 pandemic. Further iterative design, implementation and evaluation occurred largely during the COVID-19 pandemic, which might have influenced our findings, since the mental health of society at large was under pressure due to all COVID-measures.[50, 51] We consider it positive that we were able to support students in actively change their behavior toward maintaining subjective wellbeing during these challenging times regarding the COVID-pandemic.\u003c/p\u003e \u003cp\u003eOur study has several strengths as well. First, we used a systematic educational design base, which is suitable for developing innovative educational programs.[33] Second, we involved a large interdisciplinary group of stakeholders, including many students, and we adjusted the program to emerging insights. A third strength is the fact that our WB program normalizes talking about wellbeing and mental health, which empowers students in this regard. And fourth, the WB program is fully embedded in our medical curriculum, which emphasizes the importance of wellbeing and self-care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePhase 4: Ongoing maturation and theoretical understanding of the program\u003c/h2\u003e \u003cp\u003eThe most noteworthy result from our WB program thus far is that students who are exposed to a longitudinal program with recurring focus on improving and maintaining wellbeing learn to value the importance of self-care and wellbeing and develop skills in this regard. We consider the results of this educational design-based development of our WB program as a proof of concept for a longitudinal integrated program.\u003c/p\u003e \u003cp\u003eWe would like to share the chief lessons we learned during the research, design and evaluation process. Firstly, involving students in all phases of the process enables the alignment the program to their needs. Different students have different needs with regard to maintaining and improving their wellbeing. In the ongoing maturation, we therefore aim to further develop the WB program with both students and experts from different fields of wellbeing research. Currently we are also expanding the WB program to our master\u0026rsquo;s curriculum to further ensure persistent behavioral changes. Secondly, students considered that a safe environment is important to discuss their wellbeing concerns with peers. We think that the already existing student groups contributed to the positive results and advise curriculum designers to take this into account when designing a program. Thirdly, further research is necessary to deepen our understanding of the active elements and to help us to improve the WB program. Moreover, we need to further investigate how to support lifelong learning with regard to maintaining subjective wellbeing after graduation, when other challenging factors such as work culture, workload and work\u0026ndash;life balance put subjective wellbeing under pressure.[4, 23, 29]\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe developed a longitudinal proactive WB program for bachelor of medicine students that contributes to positive behavior changes with regard to subjective wellbeing. Taken together, our study suggests that it is possible to integrate wellbeing in a core undergraduate curriculum on a large scale.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Rothenberger DA: \u003cstrong\u003ePhysician Burnout and Well-Being: A Systematic Review and Framework for Action\u003c/strong\u003e. \u003cem\u003eDis Colon Rectum\u0026nbsp;\u003c/em\u003e2017, \u003cstrong\u003e60\u003c/strong\u003e(6):567-576.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Dopmeijer JM: \u003cstrong\u003eRunning on empty: The impact of challenging student life on wellbeing and academic performance.\u003c/strong\u003e; 2021.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Dyrbye L, Shanafelt T: \u003cstrong\u003eA narrative review on burnout experienced by medical students and residents\u003c/strong\u003e. \u003cem\u003eMed Educ\u0026nbsp;\u003c/em\u003e2016, \u003cstrong\u003e50\u003c/strong\u003e(1):132-149.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Dewa CS, Loong D, Bonato S, Trojanowski L, Rea M: \u003cstrong\u003eThe relationship between resident burnout and safety-related and acceptability-related quality of healthcare: a systematic literature review\u003c/strong\u003e. \u003cem\u003eBMC medical education\u0026nbsp;\u003c/em\u003e2017, \u003cstrong\u003e17\u003c/strong\u003e(1):195.\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;West CP, Dyrbye LN, Shanafelt TD: \u003cstrong\u003ePhysician burnout: contributors, consequences and solutions\u003c/strong\u003e. \u003cem\u003eJ Intern Med\u0026nbsp;\u003c/em\u003e2018, \u003cstrong\u003e283\u003c/strong\u003e(6):516-529.\u003c/p\u003e\n\u003cp\u003e6.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Kleijne I: \u003cstrong\u003eKwart aiossen overweegt te stoppen met opleiding\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e, 11 dec 2020 edn. Medisch Contact; 2020.\u003c/p\u003e\n\u003cp\u003e7.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Bustraan J, Dijkhuizen K, Velthuis S, van der Post R, Driessen E, van Lith JMM, de Beaufort AJ: \u003cstrong\u003eWhy do trainees leave hospital-based specialty training?\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eA nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands\u003c/strong\u003e. \u003cem\u003eBMJ Open\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e9\u003c/strong\u003e(6):e028631.\u003c/p\u003e\n\u003cp\u003e8.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Jacobsen B, Norup I: \u003cstrong\u003eYoung people\u0026apos;s mental health: Exploring the gap between expectation and experience\u003c/strong\u003e. \u003cem\u003eEduc Res-Uk\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e62\u003c/strong\u003e(3):249-265.\u003c/p\u003e\n\u003cp\u003e9.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Leshner AI: \u003cstrong\u003eTarget student mental well-being\u003c/strong\u003e. \u003cem\u003eScience\u0026nbsp;\u003c/em\u003e2021, \u003cstrong\u003e371\u003c/strong\u003e(6527):325-325.\u003c/p\u003e\n\u003cp\u003e10.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Stallman HM: \u003cstrong\u003eEmbedding resilience within the tertiary curriculum: a feasibility study\u003c/strong\u003e. \u003cem\u003eHigh Educ Res Dev\u0026nbsp;\u003c/em\u003e2011, \u003cstrong\u003e30\u003c/strong\u003e(2):121-133.\u003c/p\u003e\n\u003cp\u003e11.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Baik C, Larcombe W, Brooker A: \u003cstrong\u003eHow universities can enhance student mental wellbeing: the student perspective\u003c/strong\u003e. \u003cem\u003eHigh Educ Res Dev\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e38\u003c/strong\u003e(4):674-687.\u003c/p\u003e\n\u003cp\u003e12.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gander F, Proyer RT, Ruch W: \u003cstrong\u003ePositive Psychology Interventions Addressing Pleasure, Engagement, Meaning, Positive Relationships, and Accomplishment Increase Well-Being and Ameliorate Depressive Symptoms: A Randomized, Placebo-Controlled Online Study\u003c/strong\u003e. \u003cem\u003eFront Psychol\u0026nbsp;\u003c/em\u003e2016, \u003cstrong\u003e7\u003c/strong\u003e:686.\u003c/p\u003e\n\u003cp\u003e13.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Park SY, Andalibi N, Zou Y, Ambulkar S, Huh-Yoo J: \u003cstrong\u003eUnderstanding Students\u0026apos; Mental Well-Being Challenges on a University Campus: Interview Study\u003c/strong\u003e. \u003cem\u003eJMIR Form Res\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e4\u003c/strong\u003e(3):e15962.\u003c/p\u003e\n\u003cp\u003e14.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Veal CT: \u003cstrong\u003eWe Burn Out, We Break, We Die: Medical Schools Must Change Their Culture to Preserve Medical Student Mental Health\u003c/strong\u003e. \u003cem\u003eAcademic Medicine\u0026nbsp;\u003c/em\u003e2021, \u003cstrong\u003e96\u003c/strong\u003e(5):629-631.\u003c/p\u003e\n\u003cp\u003e15.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eHow colleges today are supporting student mental health\u0026nbsp;\u003c/strong\u003e[\u003ca href=\"https://greatergood.berkeley.edu/article/item/how_colleges_today_are_supporting_student_mental_health\"\u003ehttps://greatergood.berkeley.edu/article/item/how_colleges_today_are_supporting_student_mental_health\u003c/a\u003e]\u003c/p\u003e\n\u003cp\u003e16.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gulliver A, Griffiths KM, Christensen H: \u003cstrong\u003ePerceived barriers and facilitators to mental health help-seeking in young people: a systematic review\u003c/strong\u003e. \u003cem\u003eBMC Psychiatry\u0026nbsp;\u003c/em\u003e2010, \u003cstrong\u003e10\u003c/strong\u003e:113.\u003c/p\u003e\n\u003cp\u003e17.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Vogan CL, McKimm J, Da Silva AL, Grant A: \u003cstrong\u003eTwelve tips for providing effective student support in undergraduate medical education\u003c/strong\u003e. \u003cem\u003eMed Teach\u0026nbsp;\u003c/em\u003e2014, \u003cstrong\u003e36\u003c/strong\u003e(6):480-485.\u003c/p\u003e\n\u003cp\u003e18.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;West CP, Dyrbye LN, Erwin PJ, Shanafelt TD: \u003cstrong\u003eInterventions to prevent and reduce physician burnout: a systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eLancet\u0026nbsp;\u003c/em\u003e2016, \u003cstrong\u003e388\u003c/strong\u003e(10057):2272-2281.\u003c/p\u003e\n\u003cp\u003e19.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tempski P, Santos IS, Mayer FB, Enns SC, Perotta B, Paro HB, Gannam S, Peleias M, Garcia VL, Baldassin S\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eRelationship among Medical Student Resilience, Educational Environment and Quality of Life\u003c/strong\u003e. \u003cem\u003ePlos One\u0026nbsp;\u003c/em\u003e2015, \u003cstrong\u003e10\u003c/strong\u003e(6):e0131535.\u003c/p\u003e\n\u003cp\u003e20.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Diener E, Chan MY: \u003cstrong\u003eHappy People Live Longer: Subjective Well-Being Contributes to Health and Longevity\u003c/strong\u003e. \u003cem\u003eAppl Psychol-Hlth We\u0026nbsp;\u003c/em\u003e2011, \u003cstrong\u003e3\u003c/strong\u003e(1):1-43.\u003c/p\u003e\n\u003cp\u003e21.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Covey SR: \u003cstrong\u003eThe seven habits of highly effective people\u003c/strong\u003e. \u003cem\u003eNatl Med Leg J\u0026nbsp;\u003c/em\u003e1991, \u003cstrong\u003e2\u003c/strong\u003e(2):8.\u003c/p\u003e\n\u003cp\u003e22.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Yaden DB, Claydon J, Bathgate M, Platt B, Santos LR: \u003cstrong\u003eTeaching well-being at scale: An intervention study\u003c/strong\u003e. \u003cem\u003ePlos One\u0026nbsp;\u003c/em\u003e2021, \u003cstrong\u003e16\u003c/strong\u003e(4):e0249193.\u003c/p\u003e\n\u003cp\u003e23.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tawfik DS, Profit J, Morgenthaler TI, Satele DV, Sinsky CA, Dyrbye LN, Tutty MA, West CP, Shanafelt TD: \u003cstrong\u003ePhysician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors\u003c/strong\u003e. \u003cem\u003eMayo Clin Proc\u0026nbsp;\u003c/em\u003e2018, \u003cstrong\u003e93\u003c/strong\u003e(11):1571-1580.\u003c/p\u003e\n\u003cp\u003e24.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eCanMEDS: Better standards, better physicians, better care\u0026nbsp;\u003c/strong\u003e[\u003ca href=\"https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e\"\u003ehttps://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e\u003c/a\u003e ]\u003c/p\u003e\n\u003cp\u003e25.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eMedical training framework 2020\u0026nbsp;\u003c/strong\u003e[\u003ca href=\"https://www.nfu.nl/sites/default/files/2020-08/20.1577_Raamplan_Medical_Training_Framework_2020_-_May_2020.pdf\"\u003ehttps://www.nfu.nl/sites/default/files/2020-08/20.1577_Raamplan_Medical_Training_Framework_2020_-_May_2020.pdf\u003c/a\u003e]\u003c/p\u003e\n\u003cp\u003e26.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Slavin SJ, Schindler DL, Chibnall JT: \u003cstrong\u003eMedical student mental health 3.0: improving student wellness through curricular changes\u003c/strong\u003e. \u003cem\u003eAcad Med\u0026nbsp;\u003c/em\u003e2014, \u003cstrong\u003e89\u003c/strong\u003e(4):573-577.\u003c/p\u003e\n\u003cp\u003e27.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Wasson LT, Cusmano A, Meli L, Louh I, Falzon L, Hampsey M, Young G, Shaffer J, Davidson KW: \u003cstrong\u003eAssociation Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review\u003c/strong\u003e. \u003cem\u003eJAMA\u0026nbsp;\u003c/em\u003e2016, \u003cstrong\u003e316\u003c/strong\u003e(21):2237-2252.\u003c/p\u003e\n\u003cp\u003e28.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;ten Cate TJ, Kusurkar RA, Williams GC: \u003cstrong\u003eHow self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide No. 59\u003c/strong\u003e. \u003cem\u003eMed Teach\u0026nbsp;\u003c/em\u003e2011, \u003cstrong\u003e33\u003c/strong\u003e(12):961-973.\u003c/p\u003e\n\u003cp\u003e29.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Babenko O, Daniels LM, Ross S, White J, Oswald A: \u003cstrong\u003eMedical student well-being and lifelong learning: A motivational perspective\u003c/strong\u003e. \u003cem\u003eEduc Health (Abingdon)\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e32\u003c/strong\u003e(1):25-32.\u003c/p\u003e\n\u003cp\u003e30.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tjin ATS, de Boer A, Croiset G, Koster AS, van der Burgt S, Kusurkar RA: \u003cstrong\u003eHow basic psychological needs and motivation affect vitality and lifelong learning adaptability of pharmacists: a structural equation model\u003c/strong\u003e. \u003cem\u003eAdv Health Sci Educ Theory Pract\u0026nbsp;\u003c/em\u003e2018, \u003cstrong\u003e23\u003c/strong\u003e(3):549-566.\u003c/p\u003e\n\u003cp\u003e31.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;van der Burgt SME, Nauta K, Croiset G, Kusurkar RA, Peerdeman SM: \u003cstrong\u003eA qualitative study on factors influencing the situational and contextual motivation of medical specialists\u003c/strong\u003e. \u003cem\u003eInt J Med Educ\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e11\u003c/strong\u003e:111-119.\u003c/p\u003e\n\u003cp\u003e32.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Ede A, Gorgels W, Reuzel R, Gils van M, Heemskerk S, Gurp van P: \u003cstrong\u003eProfessionalism to connect the student with the curriculum and healthcare society\u003c/strong\u003e. In: \u003cem\u003eAMEE-2019.\u003c/em\u003e Austria; 2019: 1147.\u003c/p\u003e\n\u003cp\u003e33.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;McKenney S, Reeves TC: \u003cstrong\u003eEducational design research: Portraying, conducting, and enhancing productive scholarship\u003c/strong\u003e. \u003cem\u003eMed Educ\u0026nbsp;\u003c/em\u003e2021, \u003cstrong\u003e55\u003c/strong\u003e(1):82-92.\u003c/p\u003e\n\u003cp\u003e34.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Cook DA: \u003cstrong\u003eTwelve tips for evaluating educational programs\u003c/strong\u003e. \u003cem\u003eMed Teach\u0026nbsp;\u003c/em\u003e2010, \u003cstrong\u003e32\u003c/strong\u003e(4):296-301.\u003c/p\u003e\n\u003cp\u003e35.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Edmunds S, Brown G: \u003cstrong\u003eEffective small group learning: AMEE Guide No. 48\u003c/strong\u003e. \u003cem\u003eMed Teach\u0026nbsp;\u003c/em\u003e2010, \u003cstrong\u003e32\u003c/strong\u003e(9):715-726.\u003c/p\u003e\n\u003cp\u003e36.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;MB Miles AH: \u003cstrong\u003eQualitative data analysis: An expanded sourcebook\u003c/strong\u003e: Sage; 1994.\u003c/p\u003e\n\u003cp\u003e37.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Aggie van Huisseling, Danique Keiman, Nina van Liere, Louis Mourisse, Thomas Ohlenforst, Daphne Pleijers, Vennes A: \u003cstrong\u003eWelzijn onder studenten: Radboud Cares\u003c/strong\u003e.\u0026nbsp;Radboud university; 2018.\u003c/p\u003e\n\u003cp\u003e38.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Lyubomirsky S, Sheldon KM, Schkade D: \u003cstrong\u003ePursuing happiness: The architecture of sustainable change\u003c/strong\u003e. \u003cem\u003eRev Gen Psychol\u0026nbsp;\u003c/em\u003e2005, \u003cstrong\u003e9\u003c/strong\u003e(2):111-131.\u003c/p\u003e\n\u003cp\u003e39.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;White CA, Uttl B, Holder MD: \u003cstrong\u003eMeta-analyses of positive psychology interventions: The effects are much smaller than previously reported\u003c/strong\u003e. \u003cem\u003ePlos One\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e14\u003c/strong\u003e(5).\u003c/p\u003e\n\u003cp\u003e40.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Seligman MEP, Steen TA, Park N, Peterson C: \u003cstrong\u003ePositive psychology progress - Empirical validation of interventions\u003c/strong\u003e. \u003cem\u003eAmerican Psychologist\u0026nbsp;\u003c/em\u003e2005, \u003cstrong\u003e60\u003c/strong\u003e(5):410-421.\u003c/p\u003e\n\u003cp\u003e41.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E: \u003cstrong\u003ePositive psychology interventions: a meta-analysis of randomized controlled studies\u003c/strong\u003e. \u003cem\u003eBMC Public Health\u0026nbsp;\u003c/em\u003e2013, \u003cstrong\u003e13\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e42.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tempski P, Martins MA, Paro HBMS: \u003cstrong\u003eTeaching and learning resilience: a new agenda in medical education\u003c/strong\u003e. \u003cem\u003eMed Educ\u0026nbsp;\u003c/em\u003e2012, \u003cstrong\u003e46\u003c/strong\u003e(4):345-346.\u003c/p\u003e\n\u003cp\u003e43.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Calo M, Peiris C, Chipchase L, Blackstock F, Judd B: \u003cstrong\u003eGrit, resilience and mindset in health students\u003c/strong\u003e. \u003cem\u003eClin Teach\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e16\u003c/strong\u003e(4):317-322.\u003c/p\u003e\n\u003cp\u003e44.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Cook DA, Artino AR, Jr.: \u003cstrong\u003eMotivation to learn: an overview of contemporary theories\u003c/strong\u003e. \u003cem\u003eMed Educ\u0026nbsp;\u003c/em\u003e2016, \u003cstrong\u003e50\u003c/strong\u003e(10):997-1014.\u003c/p\u003e\n\u003cp\u003e45.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sin NL, Lyubomirsky S: \u003cstrong\u003eEnhancing Well-Being and Alleviating Depressive Symptoms With Positive Psychology Interventions: A Practice-Friendly Meta-Analysis\u003c/strong\u003e. \u003cem\u003eJournal of Clinical Psychology\u0026nbsp;\u003c/em\u003e2009, \u003cstrong\u003e65\u003c/strong\u003e(5):467-487.\u003c/p\u003e\n\u003cp\u003e46.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Greeson JM, Toohey MJ, Pearce MJ: \u003cstrong\u003eAn adapted, four-week mind-body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care\u003c/strong\u003e. \u003cem\u003eExplore (NY)\u0026nbsp;\u003c/em\u003e2015, \u003cstrong\u003e11\u003c/strong\u003e(3):186-192.\u003c/p\u003e\n\u003cp\u003e47.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dewa CS, Nieuwenhuijsen K, Holmes-Sullivan KJ, Singh AK, Drakakaki G: \u003cstrong\u003eIntroducing plant biology graduate students to a culture of mental well-being\u003c/strong\u003e. \u003cem\u003ePlant Direct\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e4\u003c/strong\u003e(4):e00211.\u003c/p\u003e\n\u003cp\u003e48.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Deci EL, Ryan RM: \u003cstrong\u003eFacilitating Optimal Motivation and Psychological Well-Being Across Life\u0026apos;s Domains\u003c/strong\u003e. \u003cem\u003eCan Psychol\u0026nbsp;\u003c/em\u003e2008, \u003cstrong\u003e49\u003c/strong\u003e(1):14-23.\u003c/p\u003e\n\u003cp\u003e49.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Kahneman D: \u003cstrong\u003eThinking, Fast and Slow\u003c/strong\u003e. \u003cem\u003eFortune\u0026nbsp;\u003c/em\u003e2015, \u003cstrong\u003e172\u003c/strong\u003e(1):20-20.\u003c/p\u003e\n\u003cp\u003e50.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Zhai Y, Du X: \u003cstrong\u003eAddressing collegiate mental health amid COVID-19 pandemic\u003c/strong\u003e. \u003cem\u003ePsychiatry Res\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e288\u003c/strong\u003e:113003.\u003c/p\u003e\n\u003cp\u003e51.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L, McKyer ELJ, Ahmed HU, Ma P: \u003cstrong\u003eEpidemiology of mental health problems in COVID-19: a review\u003c/strong\u003e. \u003cem\u003eF1000Res\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e9\u003c/strong\u003e:636.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTable 1. Outline of evaluation survey\u003c/p\u003e\n\u003ctable style=\"width:467.55pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 467.55pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003ePanel discussion questions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 467.55pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eWhat are positive elements of the WB program?\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eWhat are negative elements of the WB program?\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eWhat did you learn from the program?\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 467.55pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eIndividual questions: on a Likert scale from 1 to 5/6\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 467.55pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eAt every individual conversation with my teacher-coach, I discuss my subjective wellbeing (never\u0026ndash;always, 1\u0026ndash;5)\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eThe topics of the WB program are useful for my personal development (not at all\u0026ndash;very, 1\u0026ndash;6)\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eI find the teaching methods of the WB program appealing (not at all\u0026ndash;very, 1\u0026ndash;6)\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eI appreciate the amount of attention that is paid to my wellbeing (too little\u0026ndash;too much, 1\u0026ndash;5)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 467.55pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eIndividual open-ended question\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 467.55pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDid your behavior change with regard to maintaining your wellbeing?\u003cbr\u003e\u0026nbsp;If it changed, in what way?\u003cbr\u003e\u0026nbsp;If not, why not?\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTable 2. Design requirements for the first cycle of design and development of a wellbeing program\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 453.1pt;border: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eDesign requirement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 453.1pt;border-color: currentcolor windowtext windowtext;border-style: none solid solid;border-width: medium 1pt 1pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eDevelop a longitudinal wellbeing program for students that stimulates lifelong learning\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eCreate a preventive and proactive program\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eIntegrate the program in the curriculum\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eFocus on improving wellbeing and resilience\u0026nbsp;\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eNormalize stress and setback (every person will face those)\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eProvide back-up plan for coaching/counseling \u0026nbsp; \u0026nbsp;and referral for students with serious mental health issues\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eTable 3. Designed wellbeing program in relation to the professional development program\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 453.1pt;border-color: windowtext currentcolor;border-style: double none solid;border-width: 4.5pt medium 1pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eStructure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:11px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 453.1pt;border-color: currentcolor currentcolor windowtext;border-style: none none double;border-width: medium medium 4.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003ePer academic year:\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e6 individual coaching sessions\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e8 group sessions, 2 hours\u003c/li\u003e\n \u003cli\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: circle;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e30\u0026ndash;60 minutes: group coaching\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e30\u0026ndash;60 minutes educational content on professional development\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e30\u0026ndash;60 minutes focus on a wellbeing topic\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSelf-study and practical assignments\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226.55pt;border-color: currentcolor windowtext currentcolor currentcolor;border-style: none solid none none;border-width: medium 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eProfessional development program\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 226.55pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003eWellbeing program\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226.55pt;border-color: currentcolor windowtext currentcolor currentcolor;border-style: none solid none none;border-width: medium 1pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eBasic skills\u003c/li\u003e\n \u003cli\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: circle;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSelf-reflection, feedback, collaboration, goal-setting, professional responsibilities\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eCritical thinking, life-long learning\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eStudy/career orientation, professional attitude\u003c/li\u003e\n \u003cli\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: circle;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHealthcare developments\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eCurrent affairs\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eGroup coaching\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: circle;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eExchange learning experiences\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eConnection with WB program Skill training in the WB \u0026nbsp;program\u003cspan style=\"font-family:Wingdings;\"\u003e\u003cspan style=\"font-family:Wingdings;\"\u003e\u0026agrave;\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 226.55pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:.5in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSemester 1\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eIntroduction to wellbeing, transition, sleep and exercise, wellbeing and the brain, procrastination and motivation\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSemester 2\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eLearn how to learn, the language of wellbeing, stress explained, performance anxiety\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSemester 3\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003ePersonal leadership, proactivity, motivation, resilience\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSemester 4\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHappiness or stress, positive psychology, prioritize\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSemester 5\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eExpressing feelings (new vocabulary), stress, distress, flow, empowerment\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eSemester 6\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003cul style=\"margin-bottom:0in;list-style-type: disc;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003eHappiness (4 lessons), thinking fast and slow, exercise and sleep\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Radboud University Medical Center Nijmegen The Netherlands","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"wellbeing, undergraduate, longitudinal, proactive","lastPublishedDoi":"10.21203/rs.3.rs-2317703/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2317703/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMany medical students suffer from psychosocial distress and mental health problems, raising concerns about their sustainable employability and subjective wellbeing. Therefore, our faculty decided to design a wellbeing program building on the paradigm that in order to sustainably take care of others and deliver high-quality and safe patient care, (future) health professionals should take care of their own wellbeing first. The aim of our research was to design a theory-informed program on student wellbeing allowing students to acquire skills in this regard. In this paper, we describe the iterative design process and the results of our longitudinal proactive wellbeing program.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted an educational design approach in four phases to construct the program in order to simultaneously gain new insights and develop practical solutions. We implemented the phases of educational design research over the course of two academic years. Phase 1 consisted of a review of the literature and a context and needs analysis in order to draft design principles and requirements. Phase 2 consisted of the cyclical and iterative process of design, construction and interim evaluation and adjustments of the wellbeing program (WB-program). In phase 3, evaluation and reflection, the program was implemented and evaluated. Phase 4 consisted of ongoing maturation and theoretical understanding of the program.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWith our educational design-based approach to construct a WB-program, we were able to design, construct and evaluate an evidence-informed longitudinal proactive wellbeing program for all bachelor of medicine students at our faculty. The most noteworthy result thus far is that students who are exposed to a longitudinal program with recurring attention on improving and maintaining wellbeing learn to value the importance of self-care and wellbeing and develop skills in this regard.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTaken together, our study suggests that it is possible to integrate wellbeing in a core undergraduate curriculum on a large scale. We therefore consider the results of this educational design-based development of our WB-program as a proof of concept for a longitudinal integrated program to support student wellbeing.\u003c/p\u003e","manuscriptTitle":"Investing in student wellbeing: A design-based educational research approach to develop a longitudinal proactive program to improve wellbeing of medical students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-29 23:51:15","doi":"10.21203/rs.3.rs-2317703/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"91302125-5abc-4793-bbbc-92a2690b0c70","owner":[],"postedDate":"November 29th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":17271400,"name":"Educational Philosophy and Theory"}],"tags":[],"updatedAt":"2022-11-29T23:51:15+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-29 23:51:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2317703","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2317703","identity":"rs-2317703","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}