Proactive Well-Being Check-Ins for Medical and Health Professions Education Students: A Year- Long Observational Cohort

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Gagliardi, Kimberly L. Blackshear, Jeanine Bandini, Melanie J. Bonner This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8561824/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: A growing body of evidence connects healthcare provider well-being to patient safety, along with barriers to effective help-seeking by clinicians who need it. Improving the culture of safety and well-being is a priority for many academic medical centers, and medical school accreditation standards include attention to learner well-being. Even with increased attention to well-being, barriers exist to help-seeking. Methods: To address existing barriers and gain information about ways to better support our students, we implemented and assessed the feasibility and acceptability of proactive (opt-out) well-being check-ins in a cohort of newly enrolled medical and health professions students. After meetings, students were provided with tailored resources to support their learning and well-being. Results: Overall, the program was acceptable and feasible as well as helpful in identifying strengths and areas for development in our provision of tailored student support. Conclusions: As concerns about burnout and mental health issues among medical students and other clinical learners grow, strategies to decrease barriers and improve effectiveness of interventions are needed. Proactive well-being check-ins are practical and feasible, help facilitate timely access to resources, normalize help-seeking behavior, and promote well-being among medical and health professions education students. Medical education Well-being Early intervention Learning support Behavioral health Figures Figure 1 Background A large body of evidence highlights the relationship between healthcare provider well-being and patient safety, indicating that clinicians who experience improved well-being tend to deliver higher-quality care, while error-prone environments and experiences as second victims may be traumatizing (Tawfik DS, 2018 ) (Tawfik DS S. A., 2019) (Van Gerven E, 2016 ). Noting an association between burnout and threats to patient safety, with implications for staff turnover and costs, hospital and health system administrators recognized an existential threat in terms of cost from burnout even before the COVID-19 pandemic (Han S, 2019 ). With high rates of clinician depression and/or burnout, institutions are faced with the important task of further evaluation and mitigation of root causes (Sen, 2022 ). Burnout is not limited to clinicians in practice, however. Clinical students as members of healthcare teams can exhibit effects of burnout and detrimentally impact teamwork and patient care(Brazeau, 2010 ) (Brazeau C, 2010 ). Medical students and other clinical learners in the healthcare environment have long been recognized to be at risk of burnout and depression but may not seek help due to factors including stigma and lack of awareness of available resources (Dyrbye LN T. M., 2006)(Dyrbye L, 2016 ) (Dyrbye LN, 2015 ). Efforts to incorporate wellness are recommended by accreditation and leading medical organizations; curricula and longitudinal strategies to promote resilience may be beneficial (Wellbeing, 2020 ) (Slavin SJ, 2014 ) (Brazeau, 2010 ). Still, medical educators struggle to understand how to convey important clinical lessons while maintaining attention to learner wellbeing (Rosenbaum, 2024 ). As members of the healthcare team, students can directly affect the quality of care given to their current and future patients with respect to empathy and professional behavior (Thomas MR, 2007 ) (Brazeau C, 2010 ). Risks of unrecognized and unmitigated burnout and depression include threats to patient care, a widening chasm between learners and their supervisors, and attrition from the field (Patel HH, 2025 ). Medical students are at increased risk of burnout with every year of training, and “feeling supported” reduces the risk of burnout and distress (McLuckie A, 2018 ). High rates of depression and suicidal ideation among medical students have been documented, and evidence suggests that students experiencing depression are less likely to disclose and more likely to isolate both due to the nature of depressive disorders and related to stigma and shame (Schwenk TL, 2010 ) (Bynum WE 4th W. T., 2021). Screening medical students for wellness is of interest and has been done using a variety of measures (Haykal KA, 2022 ). Evidence suggests that experiences in clinical training and the environment of care may undermine wellbeing even among students who began their training with optimal mental health and resilience (Brazeau CM, 2014 ). Support using a “one-size fits all” or passive approach may not address all learners’ needs (Ellis AL, 2023 ). Additionally, resources tailored to college students’ needs may not meet the needs of health professions education (HPE) students in the same institution, whose challenging schedules may make accessing usual or existing services impractical. Delays in support or waiting till a learner asks for it can lead to undesirable outcomes including negative impact on learners, diversion of faculty time and resources, and detrimental impact on patients when learners are involved in patient care provision. Burnout, mental health concerns, and disabilities among clinical learners are prevalent, yet access to support services can vary across programs and may only be available as a student enters crisis phase. In general, effective screening for the purpose of primary or secondary prevention relies on the existence of effective mitigation with strategies that are effective and acceptable. High rates of imposter syndrome deter help-seeking seeking (Rice J, 2023 ), which raises the risk of burnout (Dyrbye L, 2016 ), substance use disorder (Jackson ER, 2016 ), and mental illness—especially as nationwide medical and mental health resources are strained (Hale EW, 2023 ). In one study, students were given the opportunity to “opt in” to a 15-minute appointment with a psychologist, with strong participation rates (76.3%) over a 6-year period and most students rating the service “very helpful” or “moderately helpful” (Young C, 2023 ). Assistance that is provided only when requested depends on individuals recognizing their need for help and choosing to seek it; literature on shame in medical students suggests that the very students who would benefit from support may feel least deserving of it – and thus less likely to seek it out (Whelan B, 2021 ). During the 2023–2024 academic year, we created an office of learning environment and well-being within the School of Medicine with a mission to provide centralized and proactive support for all HPE students and with a guiding principle that all students should have equitable and just access to support services regardless of program, advisor, connections, or identity. Our recognizes that students who perceive higher levels of social support and a positive, supportive learning climate are relatively protected from burnout (Dyrbye LN P. D., 2010) and prioritizes three major domains of student support: 1) Health Services; 2) Learning Support (which includes accessibility / disability accommodations as well as tutoring and test preparation); and 3) Community Building. In considering priorities for intervention, our efforts were informed by an existing needs assessment in the context of our own institution’s existing support services (Young C D. K., 2023). Institutional data from a HPE student well-being survey in spring 2022, a portion of which is published, demonstrated a high degree (~ 50%) of anxiety and/or depression symptoms among medical and HPE students (Bynum WE 4th, 2024). Additionally, 33% of students reported challenges accessing behavioral health care. Consistent with other findings, shame and intersectional marginalized identities were associated with higher rates of distress and reluctance to seek help (Streed CG, 2024 ) (Ogunyemi D, 2025 ). The 2022 findings in the context of broader evidence in clinical learning environments served as a stimulus for the current project. Building on our prior success in programs we have piloted for clinical learners using an “opt-out” method with higher participation and satisfaction rates, we designed a program to offer tailored support to all incoming medical and health professional students on an “opt out” basis(Bonner MJ, 2019) (Gagliardi, 2019). Methods The primary objective of this observational study was to evaluate the feasibility of proactive well-being check-ins in the cohort of first-year HPE students at an academic medical center with respect to a) completion rates of two validated scales to assess well-being and learning strategies and b) participation rates in prospectively scheduled “opt-out” meetings with a licensed clinical social worker, designated as the well-being navigator. Secondary outcomes include student self-report of satisfaction with and utilization of support services and the program’s usefulness. The protocol was conceptualized in accordance with the Helsinki Declaration, reviewed by the Duke University Health System Institutional Review Board (IRB) and determined to be exempt (Pro00118181). Setting and Participants: The intervention was conducted at an interprofessional school of medicine with approximately 1200 total clinically facing medical and HPE students in six programs including Doctor of Physical Therapy (DPT); Master of Biomedical Sciences (MBS); Medical Doctorate (MD); Pathologists’ Assistant; Physician Assistant (PA); and Occupational Therapy Doctorate (OTD). Each program involves a degree of patient-facing responsibility, with graduated levels of responsibility and complexity over time. All students are assigned a program-specific faculty advisor. Some programs utilize formal advisory groups with designated leaders (e.g., “advisory deans”) while others provide advising via individual faculty members. All incoming (first-year) students in 2024 were asked to complete questionnaires and were scheduled for individual meetings with the well-being navigator. Questionnaire data were collected during orientation or early in the fall semester before meetings with the well-being navigator. Individual, 30-minute meetings were scheduled proactively (on an “opt-out” basis) with the well-being navigator. To facilitate scheduling, HPE program directors or their designees provided access to their first-year curricular schedules to facilitate meeting scheduling during times free from mandatory learning activities. Once scheduled, students were provided with a calendar invitation that included the time and virtual (Zoom) location of the meeting as well as the link to the two standardized assessment tools. Students were instructed to complete the screenings before the meetings. Students who did not present for the meeting were contacted by the well-being navigator and offered a second appointment at a time that did not interfere with required scheduled coursework. Students who did not present for the rescheduled meeting were considered to have truly “opted out” of the meeting but remained eligible for self-directed connection with the well-being navigator. Each meeting utilized a structured process in eliciting student concerns and reviewing the validated measures completed in advance (Appendix). The meeting focused on identifying student strengths and challenges and developing a personalized plan for student-specific support resources. Following the meeting, the well-being navigator provided the student with a meeting summary that included detailed instructions on accessing recommended support services. For reasons of confidentiality, information was provided only in de-identified aggregate to program directors. Status of individual student participation completed versus opted out) was not revealed to program directors or advisors. All meetings were completed within 2 months of orientation. A follow-up survey was sent to students one year later to assess student perceptions of primary outcome measures of feasibility and acceptability. If students provided consent, the well-being navigator provided information updates to student advisors for purposes of continuity and enhanced support. The well-being navigator met weekly with leaders of the School of Medicine’s office of learning environment and well-being to share progress and emerging themes. Measures: The following measures were administered in advance of individual zoom meetings: Counseling Center Assessment of Psychological Symptoms (CCAPS) Screener . The CCAPS Screener is a 36-item questionnaire housed in a web-based secure platform separate from electronic medical record systems or educational assessment systems. The CCAPS is validated in undergraduate counseling settings to identify potentially problematic psychological symptoms including 1) depression; 2) generalized anxiety; 3) social anxiety; 4) academic distress; 5) eating concerns; 6) frustration; 7) family distress; and 8) alcohol use (Center for Collegiate Mental Health, n.d.). The CCAPS includes a question about thoughts of self-harm within the previous 2 weeks, and same-day outreach was offered to any student for whom the answer was anything other than “No/never.” Learning and Study Strategies Inventory (LASSI) . The LASSI is a 10-scale, 60-item assessment of students’ awareness regarding and use of learning and study strategies related to skill, will and self-regulation components of strategic learning (LASSI: Learning and Study Strategies Inventory, 3rd Edition, n.d.). Outcome Measures: Feasibility : Percent show rate was calculated using the total number of incoming HPE students as the denominator. Acceptability : Student perception of the program was assessed during the first semester of their second year via an anonymous survey with questions asking about ease/acceptability, whether referrals were made to support services, accessibility of support services, comfort reaching out to the well-being navigator, self-knowledge as a result of the process, and recommendation for the future of the project (Supplemental Appendix). Service Referrals On a deidentified spreadsheet, the well-being navigator tracked number, type and urgency of referrals for services including on- and off-campus medical or behavioral healthcare, accessibility consultation, tutoring, learning support, and other services deemed relevant during the course of individual student meetings. Results A total of 402 students were eligible for proactive case management services, and 351 (87%) completed their meetings. The CCAPS questionnaire was completed by 363 (91%) students, and the LASSI was completed by 283 (71%) students. In a one-year follow-up survey, 80% of respondents (N = 98) rated meetings to be “very” or “somewhat” easy to complete and indicated they would feel “very” or “somewhat” comfortable reaching out to the well-being navigator for future concerns. During meetings, 147 (42%) students reported previous diagnosis with and/or treatment for behavioral health concerns. Specific intervention was recommended for 112 (32%) students, with more than one intervention recommended for many. Of those 112 students, 47 were referred to the campus counseling center; 33 to community mental health/psychiatry; 18 to student health; 48 to other medical specialists; 9 to dieticians; 46 for learning consultation; 21 for consideration of disability accommodations; and 12 for neuropsychological assessments (see Fig. 1). Twenty of the 112 (18%) student referrals were moderate to high in priority. In addition to the high proportion (81%) of students who expressed an interest in continuing contact with our office, student satisfaction with availability of mental health resources increased by 12% during the first semester of the program. Discussion The transition into HPE programs, known for demanding and accelerating curricular and clinical expectations, can pose a risk of distress for all students, irrespective of their prior preparation and academic background. Time demands, fantasies of invulnerability and shame can contribute to a scenario by which students do not seek out or receive support to promote their success and well-being. We created a system of centralized, specialized support for HPE students, separate and distinct from advising support and course evaluation, with a goal of early identification and intervention. Findings support this approach as both feasible and acceptable and with potential to yield important data to promote early and tailored intervention. Though individual meetings with students in and of themselves have the potential to provide benefit, the use of validated metrics added specificity to referrals made to educational, health-related, and behavioral support services while providing data to inform future programming. The proactive approach normalized the fact that individual students – including the brightest of HPE students – can benefit from specific types of individualized support. Approximately one-third of students were referred to additional support services based on findings from proactive well-being check-ins. Attrition from HPE programs is a rare event, and we were thus unable directly to assess the effect of the proactive well-being check-ins on program completion. Data collected during the study period have informed educational outreach designed to combat bias and stigma in institutional, departmental, and program settings. HPE students are susceptible to the same maladies as their age-matched peers in other occupations despite narratives that suggest clinical care providers and learners may be resilient to behavioral and medical concerns (Fahs, 2025 ). For example, more than one-third of students scored in the moderate to high range on the CCAPS for symptoms of anxiety and depression, and 42% of students disclosed they had been diagnosed with and/or treated for a psychiatric disorder. Normalization of help-seeking and early connection with the well-being navigator facilitated development of rapport and trust. Notably, 80% of students who participated in the initial meeting expressed interest in ongoing contact with the well-being navigator, who remained available for direct (by the student) and indirect (by concerned faculty or staff) referral for assistance navigating available resources. A similar percentage of students who responded to the one-year follow-up survey recommended continuing the program. Future iterations of the project will benefit from intentional attention to best methods of incorporating students’ advisors into the process while maintaining adherence to boundaries set forth by FERPA and HIPAA. Proactive meetings helped the leadership team assess program-wide stressors, enabling targeted interventions to improve well-being (e.g., scheduled wellness activities around high-stake exams). The personalized student support approach, including open office hours, wellness workshops, and regular communications, was positively received and applicable to students across the health profession education programs. Up-front costs of the program include time, personnel, and licensure of the validated measures. There are limitations to note. As with any project in the educational and health professions domain, factors beyond the direct control of the project team likely influenced learner perception not only of their own well-being but also of the support available to them. Additionally, during the timeframe of the project, changes were underway in the clinical practice environment including emphasis on continuous data-driven programmatic improvement, curricular innovations emphasizing patients first, and restorative approaches to conflict resolution. We offered the program to all incoming medical and HPE students and thus do not have a comparison cohort. Given the importance of protecting the educational and health-related privacy of all individuals involved, program-specific and identity-related analyses were not conducted. Finally, as with all self-report data, our findings may inaccurately estimate actual levels of distress in our cohort of students. Conclusions Proactive engagement and well-being check-ins serve as practical and feasible ways to provide early and timely access to resources, normalize help-seeking behavior, and promote well-being among HPE students. As concerns about burnout and mental health issues among medical students and other clinical learners grow, the approach we describe is an effective method to orient students into HPE educational programs while evaluating and providing support for their individual and unique needs. Abbreviations CCAPS Counseling Center Assessment of Psychological Symptoms Screener HPE Health professions education LASSI Learning and Study Strategies Inventory Declarations Ethics approval and consent to participate Study procedures were conceptualized and implemented in compliance with the Helsinki Declaration and were reviewed and deemed exempt by the Duke University Health system Institutional Review Board (Reference Number: Pro00118181-INIT-1.0). Consent for publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to confidentiality of individual participant data and conditions of IRB review and exemption. Competing interests None of the authors has competing interests to declare. Dr. Gagliardi serves as the Associate Director for the Train New Trainers Primary Care Fellowships, an educational program for primary care clinicians designed to facilitate better recognition, diagnosis and treatment of behavioral health conditions in primary care. Funding Funding for the project was provided by The Duke Endowment (Grant 7231-SP). Authors' contributions Authors JPG and MJB conceptualized the project, secured funding from The Duke Endowment, analyzed data, drafted and edited the manuscript. Author KLB conducted the majority of the proactively scheduled well-being check-ins in fall 2024, contributed to data collection and data analysis, and provided edits to the manuscript. Author JB conducts well-being check-ins, contributed to data collection and data analysis, and provided edits to the manuscript. Acknolwedgments Not applicable. References Tawfik DS. P. J. (2018). Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clinic Proceedings , 1571–1580. Tawfik DS. S. A. (2019). Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis. Ann Intern Med, 555–67. Van Gerven E. V. E. (2016). Increased Risk of Burnout for Physicians and Nurses Involved in a Patient Safety Incident. Med Care, 937–43. Han S. S. T. (2019). Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med, 784–90. Sen S. Is It Burnout or Depression? Expanding Efforts to Improve Physician Well-Being. N Engl J Med. 2022;387(18):1629–30. Brazeau C, S. R. Relationships between burnout, empathy, and professionalism climate. Acad Med. 2010;85(10suppl):533–6. Brazeau C. The Surest Way to Prevent Burnout in Medical School and Beyond. Acad Med. 2010;85(4):569–70. Dyrbye LN, T. M. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73. Dyrbye L. S. T. (2016). A narrative review on burnout experienced by medical students and residents. Med Educ, 132–49. Dyrbye LN, E. A. The Impact of Stigma and Personal Experiences on the Help-Seeking Behaviors of Medical Students With Burnout. Acad Med. 2015;90(7):961–9. Wellbeing GC. UME Wellness Programming and Strategies for Evaluating Wellness Programs: A National Review. Retrieved from Association of American Medical Colleges; 2020. . Slavin SJ, S. D. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014;89(4):573–7. Rosenbaum L. (2024). Being Well while Doing Well - Distinguishing Necessary from Unnecessary Discomfort in Training. New England Journal of Medicine , 390*6): 568–572. Thomas MR, D. L. How do distress and well-being relate to medical student empathy? A multicenter study. Ann Intern Med. 2007;22(2):177–83. Patel HH, L. E. Leaning into Necessary Discomforts: Striving for Clinical Excellence While Maintaining Wellness. ATS Scholar. 2025;6(4):420–31. McLuckie A, M. K. The relationship between psychological distress and perception of emotional support in medical students and residents and implications for educational institutions. Acad Psychiatry. 2018;42(1):41–7. Schwenk TL, D. L. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181–90. Bynum WE 4th, W. T. In the shadow of shame: A phenomenological exporation of the nature of shame experiences in medical students. Acad Med. 2021;96(11S):S23–30. Haykal KA, P. L. Medical student wellness assessment beyond anxiety and depression: A scoping review. PLoS ONE. 2022;17(10):e0276894. Brazeau CM, S. T. Distress among matriculating medical students relative to the general population. Acad Med. 2014;89(11):1520–5. Ellis AL. P. M. (2023). Interprofessional Perceptions of Diversity, Equity, Inclusion, Cultural Competence, and Humility Among Students and Faculty: A Mixed-Methods Study. J Allied Health, 89–96. Rice J. R.-W. B.-L. (2023). Impostor syndrome among minority medical students who are underrepresented in medicine. J Natl Med Assoc, 191–8. Jackson ER. S. T. (2016). Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students. Acad Med, 1251–6. Hale EW, D. R. Supporting the future of medicine: Student mental health services in medical school. Front Health Serv. 2023;3:1032317. Young C. J. M. (2023). Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program. Acad Med, 782–7. Whelan B, H. S. Shame in medical clerkship: You just feel like dirt under someone's shoe. Perspect Med Educ. 2021;10(5):265–71. Dyrbye LN, P. D. Factors associated with resilience to and recovery from burnout: A prospective, multi-institutional study of US medical students. Med Educ. 2010;44(10):1016–26. Young C, D. K. Applying Kern's Model to the Development and Evaluation of Medical Student Well-Being Programs. J Gen Intern Med. 2023;38(13):3047–50. Bynum WE 4th, D. T. Development and initial validation of the Shame Frequency Questionnaire in Medical Students. Acad Med. 2024;99(7):756–63. Streed CG, N. M. Academic Physician and Trainee Occupational Well-Being by Sexual and Gender Minority Status. JAMA Netw Open. 2024;7(11):e2443937. Ogunyemi D, H. H. Risk factors associated with professional consequences in a cohort of black physicians. J Natl Med Assoc. 2025;S0027–9684(25):00335–9. Epub ahead of print. Bonner MJ. S. S. (2019, March). Use of the LASSI as a tool to evaluate learning growth in pre-health professional students. Duke AHEAD Education Day . Durham, NC. Gagliardi J. (2019, March 1). Resident-initiated quality improvement: Wellness strategies including prospectively-scheduled opt-out emotional wellbeing checks. Annual Meeting of the American Association of Directors of Psychiatry Residency Training . San Diego, CA. Center for Collegiate Mental Health . (n.d.). Retrieved from CCAPS-Screen: https://ccmh.psu.edu/ccaps-screen LASSI. : Learning and Study Strategies Inventory, 3rd Edition . (n.d.). Retrieved from https://www.hhpublishing.com/ap/_assessments/LASSI-3rd-Edition.html Fahs LE. The myth of physician invulnerability. Med Sci Educ. 2025. https://doi.org/10.1007/s40670-025-02443-3 . Additional Declarations No competing interests reported. Supplementary Files SupplementalAppendix.pdf Appendix.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 10 Mar, 2026 Editor assigned by journal 28 Jan, 2026 Editor invited by journal 16 Jan, 2026 Submission checks completed at journal 13 Jan, 2026 First submitted to journal 13 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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A., 2019) (Van Gerven E, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Noting an association between burnout and threats to patient safety, with implications for staff turnover and costs, hospital and health system administrators recognized an existential threat in terms of cost from burnout even before the COVID-19 pandemic (Han S, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). With high rates of clinician depression and/or burnout, institutions are faced with the important task of further evaluation and mitigation of root causes (Sen, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Burnout is not limited to clinicians in practice, however. Clinical students as members of healthcare teams can exhibit effects of burnout and detrimentally impact teamwork and patient care(Brazeau, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) (Brazeau C, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMedical students and other clinical learners in the healthcare environment have long been recognized to be at risk of burnout and depression but may not seek help due to factors including stigma and lack of awareness of available resources (Dyrbye LN T. M., 2006)(Dyrbye L, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) (Dyrbye LN, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Efforts to incorporate wellness are recommended by accreditation and leading medical organizations; curricula and longitudinal strategies to promote resilience may be beneficial (Wellbeing, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (Slavin SJ, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) (Brazeau, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Still, medical educators struggle to understand how to convey important clinical lessons while maintaining attention to learner wellbeing (Rosenbaum, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs members of the healthcare team, students can directly affect the quality of care given to their current and future patients with respect to empathy and professional behavior (Thomas MR, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) (Brazeau C, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Risks of unrecognized and unmitigated burnout and depression include threats to patient care, a widening chasm between learners and their supervisors, and attrition from the field (Patel HH, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMedical students are at increased risk of burnout with every year of training, and \u0026ldquo;feeling supported\u0026rdquo; reduces the risk of burnout and distress (McLuckie A, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). High rates of depression and suicidal ideation among medical students have been documented, and evidence suggests that students experiencing depression are less likely to disclose and more likely to isolate both due to the nature of depressive disorders and related to stigma and shame (Schwenk TL, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) (Bynum WE 4th W. T., 2021). Screening medical students for wellness is of interest and has been done using a variety of measures (Haykal KA, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvidence suggests that experiences in clinical training and the environment of care may undermine wellbeing even among students who began their training with optimal mental health and resilience (Brazeau CM, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Support using a \u0026ldquo;one-size fits all\u0026rdquo; or passive approach may not address all learners\u0026rsquo; needs (Ellis AL, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Additionally, resources tailored to college students\u0026rsquo; needs may not meet the needs of health professions education (HPE) students in the same institution, whose challenging schedules may make accessing usual or existing services impractical. Delays in support or waiting till a learner asks for it can lead to undesirable outcomes including negative impact on learners, diversion of faculty time and resources, and detrimental impact on patients when learners are involved in patient care provision.\u003c/p\u003e \u003cp\u003eBurnout, mental health concerns, and disabilities among clinical learners are prevalent, yet access to support services can vary across programs and may only be available as a student enters crisis phase. In general, effective screening for the purpose of primary or secondary prevention relies on the existence of effective mitigation with strategies that are effective and acceptable. High rates of imposter syndrome deter help-seeking seeking (Rice J, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which raises the risk of burnout (Dyrbye L, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), substance use disorder (Jackson ER, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), and mental illness\u0026mdash;especially as nationwide medical and mental health resources are strained (Hale EW, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn one study, students were given the opportunity to \u0026ldquo;opt in\u0026rdquo; to a 15-minute appointment with a psychologist, with strong participation rates (76.3%) over a 6-year period and most students rating the service \u0026ldquo;very helpful\u0026rdquo; or \u0026ldquo;moderately helpful\u0026rdquo; (Young C, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Assistance that is provided only when requested depends on individuals recognizing their need for help and choosing to seek it; literature on shame in medical students suggests that the very students who would benefit from support may feel least deserving of it \u0026ndash; and thus less likely to seek it out (Whelan B, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDuring the 2023\u0026ndash;2024 academic year, we created an office of learning environment and well-being within the School of Medicine with a mission to provide centralized and proactive support for all HPE students and with a guiding principle that all students should have equitable and just access to support services regardless of program, advisor, connections, or identity. Our recognizes that students who perceive higher levels of social support and a positive, supportive learning climate are relatively protected from burnout (Dyrbye LN P. D., 2010) and prioritizes three major domains of student support: 1) Health Services; 2) Learning Support (which includes accessibility / disability accommodations as well as tutoring and test preparation); and 3) Community Building.\u003c/p\u003e \u003cp\u003eIn considering priorities for intervention, our efforts were informed by an existing needs assessment in the context of our own institution\u0026rsquo;s existing support services (Young C D. K., 2023). Institutional data from a HPE student well-being survey in spring 2022, a portion of which is published, demonstrated a high degree (~\u0026thinsp;50%) of anxiety and/or depression symptoms among medical and HPE students (Bynum WE 4th, 2024). Additionally, 33% of students reported challenges accessing behavioral health care. Consistent with other findings, shame and intersectional marginalized identities were associated with higher rates of distress and reluctance to seek help (Streed CG, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (Ogunyemi D, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The 2022 findings in the context of broader evidence in clinical learning environments served as a stimulus for the current project. Building on our prior success in programs we have piloted for clinical learners using an \u0026ldquo;opt-out\u0026rdquo; method with higher participation and satisfaction rates, we designed a program to offer tailored support to all incoming medical and health professional students on an \u0026ldquo;opt out\u0026rdquo; basis(Bonner MJ, 2019) (Gagliardi, 2019).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe primary objective of this observational study was to evaluate the feasibility of proactive well-being check-ins in the cohort of first-year HPE students at an academic medical center with respect to a) completion rates of two validated scales to assess well-being and learning strategies and b) participation rates in prospectively scheduled \u0026ldquo;opt-out\u0026rdquo; meetings with a licensed clinical social worker, designated as the well-being navigator. Secondary outcomes include student self-report of satisfaction with and utilization of support services and the program\u0026rsquo;s usefulness. The protocol was conceptualized in accordance with the Helsinki Declaration, reviewed by the Duke University Health System Institutional Review Board (IRB) and determined to be exempt (Pro00118181).\u003c/p\u003e \u003cp\u003eSetting and Participants:\u003c/p\u003e \u003cp\u003eThe intervention was conducted at an interprofessional school of medicine with approximately 1200 total clinically facing medical and HPE students in six programs including Doctor of Physical Therapy (DPT); Master of Biomedical Sciences (MBS); Medical Doctorate (MD); Pathologists\u0026rsquo; Assistant; Physician Assistant (PA); and Occupational Therapy Doctorate (OTD). Each program involves a degree of patient-facing responsibility, with graduated levels of responsibility and complexity over time. All students are assigned a program-specific faculty advisor. Some programs utilize formal advisory groups with designated leaders (e.g., \u0026ldquo;advisory deans\u0026rdquo;) while others provide advising via individual faculty members.\u003c/p\u003e \u003cp\u003eAll incoming (first-year) students in 2024 were asked to complete questionnaires and were scheduled for individual meetings with the well-being navigator. Questionnaire data were collected during orientation or early in the fall semester before meetings with the well-being navigator.\u003c/p\u003e \u003cp\u003eIndividual, 30-minute meetings were scheduled proactively (on an \u0026ldquo;opt-out\u0026rdquo; basis) with the well-being navigator. To facilitate scheduling, HPE program directors or their designees provided access to their first-year curricular schedules to facilitate meeting scheduling during times free from mandatory learning activities.\u003c/p\u003e \u003cp\u003eOnce scheduled, students were provided with a calendar invitation that included the time and virtual (Zoom) location of the meeting as well as the link to the two standardized assessment tools. Students were instructed to complete the screenings before the meetings. Students who did not present for the meeting were contacted by the well-being navigator and offered a second appointment at a time that did not interfere with required scheduled coursework. Students who did not present for the rescheduled meeting were considered to have truly \u0026ldquo;opted out\u0026rdquo; of the meeting but remained eligible for self-directed connection with the well-being navigator.\u003c/p\u003e \u003cp\u003eEach meeting utilized a structured process in eliciting student concerns and reviewing the validated measures completed in advance (Appendix). The meeting focused on identifying student strengths and challenges and developing a personalized plan for student-specific support resources. Following the meeting, the well-being navigator provided the student with a meeting summary that included detailed instructions on accessing recommended support services. For reasons of confidentiality, information was provided only in de-identified aggregate to program directors. Status of individual student participation completed versus opted out) was not revealed to program directors or advisors. All meetings were completed within 2 months of orientation. A follow-up survey was sent to students one year later to assess student perceptions of primary outcome measures of feasibility and acceptability.\u003c/p\u003e \u003cp\u003eIf students provided consent, the well-being navigator provided information updates to student advisors for purposes of continuity and enhanced support. The well-being navigator met weekly with leaders of the School of Medicine\u0026rsquo;s office of learning environment and well-being to share progress and emerging themes.\u003c/p\u003e \u003cp\u003eMeasures:\u003c/p\u003e \u003cp\u003eThe following measures were administered in advance of individual zoom meetings:\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCounseling Center Assessment of Psychological Symptoms (CCAPS) Screener\u003c/span\u003e. The CCAPS Screener is a 36-item questionnaire housed in a web-based secure platform separate from electronic medical record systems or educational assessment systems. The CCAPS is validated in undergraduate counseling settings to identify potentially problematic psychological symptoms including 1) depression; 2) generalized anxiety; 3) social anxiety; 4) academic distress; 5) eating concerns; 6) frustration; 7) family distress; and 8) alcohol use (Center for Collegiate Mental Health, n.d.). The CCAPS includes a question about thoughts of self-harm within the previous 2 weeks, and same-day outreach was offered to any student for whom the answer was anything other than \u0026ldquo;No/never.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLearning and Study Strategies Inventory (LASSI)\u003c/span\u003e. The LASSI is a 10-scale, 60-item assessment of students\u0026rsquo; awareness regarding and use of learning and study strategies related to skill, will and self-regulation components of strategic learning (LASSI: Learning and Study Strategies Inventory, 3rd Edition, n.d.).\u003c/p\u003e \u003cp\u003eOutcome Measures:\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eFeasibility\u003c/span\u003e: Percent show rate was calculated using the total number of incoming HPE students as the denominator.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAcceptability\u003c/span\u003e: Student perception of the program was assessed during the first semester of their second year via an anonymous survey with questions asking about ease/acceptability, whether referrals were made to support services, accessibility of support services, comfort reaching out to the well-being navigator, self-knowledge as a result of the process, and recommendation for the future of the project (Supplemental Appendix).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eService Referrals\u003c/span\u003e On a deidentified spreadsheet, the well-being navigator tracked number, type and urgency of referrals for services including on- and off-campus medical or behavioral healthcare, accessibility consultation, tutoring, learning support, and other services deemed relevant during the course of individual student meetings.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 402 students were eligible for proactive case management services, and 351 (87%) completed their meetings. The CCAPS questionnaire was completed by 363 (91%) students, and the LASSI was completed by 283 (71%) students. In a one-year follow-up survey, 80% of respondents (N\u0026thinsp;=\u0026thinsp;98) rated meetings to be \u0026ldquo;very\u0026rdquo; or \u0026ldquo;somewhat\u0026rdquo; easy to complete and indicated they would feel \u0026ldquo;very\u0026rdquo; or \u0026ldquo;somewhat\u0026rdquo; comfortable reaching out to the well-being navigator for future concerns.\u003c/p\u003e \u003cp\u003eDuring meetings, 147 (42%) students reported previous diagnosis with and/or treatment for behavioral health concerns. Specific intervention was recommended for 112 (32%) students, with more than one intervention recommended for many. Of those 112 students, 47 were referred to the campus counseling center; 33 to community mental health/psychiatry; 18 to student health; 48 to other medical specialists; 9 to dieticians; 46 for learning consultation; 21 for consideration of disability accommodations; and 12 for neuropsychological assessments (see Fig.\u0026nbsp;1). Twenty of the 112 (18%) student referrals were moderate to high in priority. In addition to the high proportion (81%) of students who expressed an interest in continuing contact with our office, student satisfaction with availability of mental health resources increased by 12% during the first semester of the program.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe transition into HPE programs, known for demanding and accelerating curricular and clinical expectations, can pose a risk of distress for all students, irrespective of their prior preparation and academic background. Time demands, fantasies of invulnerability and shame can contribute to a scenario by which students do not seek out or receive support to promote their success and well-being. We created a system of centralized, specialized support for HPE students, separate and distinct from advising support and course evaluation, with a goal of early identification and intervention. Findings support this approach as both feasible and acceptable and with potential to yield important data to promote early and tailored intervention.\u003c/p\u003e \u003cp\u003eThough individual meetings with students in and of themselves have the potential to provide benefit, the use of validated metrics added specificity to referrals made to educational, health-related, and behavioral support services while providing data to inform future programming. The proactive approach normalized the fact that individual students \u0026ndash; including the brightest of HPE students \u0026ndash; can benefit from specific types of individualized support. Approximately one-third of students were referred to additional support services based on findings from proactive well-being check-ins. Attrition from HPE programs is a rare event, and we were thus unable directly to assess the effect of the proactive well-being check-ins on program completion.\u003c/p\u003e \u003cp\u003eData collected during the study period have informed educational outreach designed to combat bias and stigma in institutional, departmental, and program settings. HPE students are susceptible to the same maladies as their age-matched peers in other occupations despite narratives that suggest clinical care providers and learners may be resilient to behavioral and medical concerns (Fahs, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). For example, more than one-third of students scored in the moderate to high range on the CCAPS for symptoms of anxiety and depression, and 42% of students disclosed they had been diagnosed with and/or treated for a psychiatric disorder.\u003c/p\u003e \u003cp\u003eNormalization of help-seeking and early connection with the well-being navigator facilitated development of rapport and trust. Notably, 80% of students who participated in the initial meeting expressed interest in ongoing contact with the well-being navigator, who remained available for direct (by the student) and indirect (by concerned faculty or staff) referral for assistance navigating available resources. A similar percentage of students who responded to the one-year follow-up survey recommended continuing the program.\u003c/p\u003e \u003cp\u003eFuture iterations of the project will benefit from intentional attention to best methods of incorporating students\u0026rsquo; advisors into the process while maintaining adherence to boundaries set forth by FERPA and HIPAA.\u003c/p\u003e \u003cp\u003eProactive meetings helped the leadership team assess program-wide stressors, enabling targeted interventions to improve well-being (e.g., scheduled wellness activities around high-stake exams). The personalized student support approach, including open office hours, wellness workshops, and regular communications, was positively received and applicable to students across the health profession education programs. Up-front costs of the program include time, personnel, and licensure of the validated measures.\u003c/p\u003e \u003cp\u003eThere are limitations to note. As with any project in the educational and health professions domain, factors beyond the direct control of the project team likely influenced learner perception not only of their own well-being but also of the support available to them. Additionally, during the timeframe of the project, changes were underway in the clinical practice environment including emphasis on continuous data-driven programmatic improvement, curricular innovations emphasizing patients first, and restorative approaches to conflict resolution. We offered the program to all incoming medical and HPE students and thus do not have a comparison cohort. Given the importance of protecting the educational and health-related privacy of all individuals involved, program-specific and identity-related analyses were not conducted. Finally, as with all self-report data, our findings may inaccurately estimate actual levels of distress in our cohort of students.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eProactive engagement and well-being check-ins serve as practical and feasible ways to provide early and timely access to resources, normalize help-seeking behavior, and promote well-being among HPE students. As concerns about burnout and mental health issues among medical students and other clinical learners grow, the approach we describe is an effective method to orient students into HPE educational programs while evaluating and providing support for their individual and unique needs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCAPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCounseling Center Assessment of Psychological Symptoms Screener\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHPE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth professions education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLASSI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLearning and Study Strategies Inventory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy procedures\u0026nbsp;were conceptualized and implemented in compliance with the Helsinki Declaration and were reviewed and deemed exempt by the Duke University Health system Institutional Review Board (Reference Number: Pro00118181-INIT-1.0).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to confidentiality of individual participant data and conditions of IRB review and exemption.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors has competing interests to declare.\u003c/p\u003e\n\u003cp\u003eDr. Gagliardi serves as the Associate Director for the Train New Trainers Primary Care Fellowships, an educational program for primary care clinicians designed to facilitate better recognition, diagnosis and treatment of behavioral health conditions in primary care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for the project was provided by The Duke Endowment (Grant 7231-SP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors JPG and MJB conceptualized the project, secured funding from The Duke Endowment, analyzed data, drafted and edited the manuscript. \u0026nbsp;Author KLB conducted the majority of the proactively scheduled well-being check-ins in fall 2024, contributed to data collection and data analysis, and provided edits to the manuscript. \u0026nbsp;Author JB conducts well-being check-ins, contributed to data collection and data analysis, and provided edits to the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknolwedgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTawfik DS. P. J. (2018). Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. \u003cem\u003eMayo Clinic Proceedings\u003c/em\u003e, 1571\u0026ndash;1580.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTawfik DS. S. A. (2019). Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis. Ann Intern Med, 555\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Gerven E. V. E. (2016). Increased Risk of Burnout for Physicians and Nurses Involved in a Patient Safety Incident. Med Care, 937\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan S. S. T. (2019). Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med, 784\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSen S. Is It Burnout or Depression? Expanding Efforts to Improve Physician Well-Being. N Engl J Med. 2022;387(18):1629\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrazeau C, S. R. Relationships between burnout, empathy, and professionalism climate. Acad Med. 2010;85(10suppl):533\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrazeau C. The Surest Way to Prevent Burnout in Medical School and Beyond. Acad Med. 2010;85(4):569\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyrbye LN, T. M. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyrbye L. S. T. (2016). A narrative review on burnout experienced by medical students and residents. Med Educ, 132\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyrbye LN, E. A. The Impact of Stigma and Personal Experiences on the Help-Seeking Behaviors of Medical Students With Burnout. Acad Med. 2015;90(7):961\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWellbeing GC. UME Wellness Programming and Strategies for Evaluating Wellness Programs: A National Review. Retrieved from Association of American Medical Colleges; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.aamc.org/media/56246/download?attachment\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSlavin SJ, S. D. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014;89(4):573\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenbaum L. (2024). Being Well while Doing Well - Distinguishing Necessary from Unnecessary Discomfort in Training. \u003cem\u003eNew England Journal of Medicine\u003c/em\u003e, 390*6): 568\u0026ndash;572.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas MR, D. L. How do distress and well-being relate to medical student empathy? A multicenter study. Ann Intern Med. 2007;22(2):177\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel HH, L. E. Leaning into Necessary Discomforts: Striving for Clinical Excellence While Maintaining Wellness. ATS Scholar. 2025;6(4):420\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLuckie A, M. K. The relationship between psychological distress and perception of emotional support in medical students and residents and implications for educational institutions. Acad Psychiatry. 2018;42(1):41\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwenk TL, D. L. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBynum WE 4th, W. T. In the shadow of shame: A phenomenological exporation of the nature of shame experiences in medical students. Acad Med. 2021;96(11S):S23\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaykal KA, P. L. Medical student wellness assessment beyond anxiety and depression: A scoping review. PLoS ONE. 2022;17(10):e0276894.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrazeau CM, S. T. Distress among matriculating medical students relative to the general population. Acad Med. 2014;89(11):1520\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEllis AL. P. M. (2023). Interprofessional Perceptions of Diversity, Equity, Inclusion, Cultural Competence, and Humility Among Students and Faculty: A Mixed-Methods Study. J Allied Health, 89\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRice J. R.-W. B.-L. (2023). Impostor syndrome among minority medical students who are underrepresented in medicine. J Natl Med Assoc, 191\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson ER. S. T. (2016). Burnout and Alcohol Abuse/Dependence Among U.S. Medical Students. Acad Med, 1251\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHale EW, D. R. Supporting the future of medicine: Student mental health services in medical school. Front Health Serv. 2023;3:1032317.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung C. J. M. (2023). Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program. Acad Med, 782\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhelan B, H. S. Shame in medical clerkship: You just feel like dirt under someone's shoe. Perspect Med Educ. 2021;10(5):265\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDyrbye LN, P. D. Factors associated with resilience to and recovery from burnout: A prospective, multi-institutional study of US medical students. Med Educ. 2010;44(10):1016\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoung C, D. K. Applying Kern's Model to the Development and Evaluation of Medical Student Well-Being Programs. J Gen Intern Med. 2023;38(13):3047\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBynum WE 4th, D. T. Development and initial validation of the Shame Frequency Questionnaire in Medical Students. Acad Med. 2024;99(7):756\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStreed CG, N. M. Academic Physician and Trainee Occupational Well-Being by Sexual and Gender Minority Status. JAMA Netw Open. 2024;7(11):e2443937.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgunyemi D, H. H. Risk factors associated with professional consequences in a cohort of black physicians. J Natl Med Assoc. 2025;S0027\u0026ndash;9684(25):00335\u0026ndash;9. Epub ahead of print.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonner MJ. S. S. (2019, March). Use of the LASSI as a tool to evaluate learning growth in pre-health professional students. \u003cem\u003eDuke AHEAD Education Day\u003c/em\u003e. Durham, NC.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGagliardi J. (2019, March 1). Resident-initiated quality improvement: Wellness strategies including prospectively-scheduled opt-out emotional wellbeing checks. \u003cem\u003eAnnual Meeting of the American Association of Directors of Psychiatry Residency Training\u003c/em\u003e. San Diego, CA.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eCenter for Collegiate Mental Health\u003c/em\u003e. (n.d.). Retrieved from CCAPS-Screen: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ccmh.psu.edu/ccaps-screen\u003c/span\u003e\u003cspan address=\"https://ccmh.psu.edu/ccaps-screen\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLASSI. : \u003cem\u003eLearning and Study Strategies Inventory, 3rd Edition\u003c/em\u003e. (n.d.). Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hhpublishing.com/ap/_assessments/LASSI-3rd-Edition.html\u003c/span\u003e\u003cspan address=\"https://www.hhpublishing.com/ap/_assessments/LASSI-3rd-Edition.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFahs LE. The myth of physician invulnerability. Med Sci Educ. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40670-025-02443-3\u003c/span\u003e\u003cspan address=\"10.1007/s40670-025-02443-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical education, Well-being , Early intervention , Learning support , Behavioral health","lastPublishedDoi":"10.21203/rs.3.rs-8561824/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8561824/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: A growing body of evidence connects healthcare provider well-being to patient safety, along with barriers to effective help-seeking by clinicians who need it. Improving the culture of safety and well-being is a priority for many academic medical centers, and medical school accreditation standards include attention to learner well-being. Even with increased attention to well-being, barriers exist to help-seeking.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: To address existing barriers and gain information about ways to better support our students, we implemented and assessed the feasibility and acceptability of proactive (opt-out) well-being check-ins in a cohort of newly enrolled medical and health professions students. After meetings, students were provided with tailored resources to support their learning and well-being.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Overall, the program was acceptable and feasible as well as helpful in identifying strengths and areas for development in our provision of tailored student support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: As concerns about burnout and mental health issues among medical students and other clinical learners grow, strategies to decrease barriers and improve effectiveness of interventions are needed. Proactive well-being check-ins are practical and feasible, help facilitate timely access to resources, normalize help-seeking behavior, and promote well-being among medical and health professions education students.\u003c/p\u003e","manuscriptTitle":"Proactive Well-Being Check-Ins for Medical and Health Professions Education Students: A Year- Long Observational Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 17:43:09","doi":"10.21203/rs.3.rs-8561824/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-10T14:07:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-29T04:24:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-16T05:06:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-13T13:31:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-13T13:19:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3da16b28-912a-48ae-abbf-ea028bf7ccb3","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T17:43:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 17:43:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8561824","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8561824","identity":"rs-8561824","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}