Effect of the COVID-19 Pandemic on the Performance of Undergraduate Healthcare Students During Their Internship in Saudi Arabia.

Introduction: The coronavirus disease (COVID-19) is an infectious disease that has rapidly spread on a global scale. The entire world has fought tirelessly to combat this disease, which has had a significant impact on humanity. This study examines the effects of the COVID-19 pandemic on the performance of undergraduate healthcare students during internship, focusing on the leadership, social, and mental aspects. Methodology: A cross-sectional national survey was conducted among Saudi Arabia's undergraduate health care students. From August to December of 2021, non-probability convenient sampling was employed in the study. Online-questionnaire was used to administer the three survey dimensions-mental health, social life, and leadership-as well as the demographic profiles. Correlation coefficients were utilized to establish a meaningful connection between the independent variables and the study's domains. Moreover, the Kruskal-Wallis tests were employed to efficiently compare the medians among the independent groups. Results: Two hundred and forty-one undergraduate healthcare students from a variety of backgrounds participated in this study. Mental health issues such as difficulty relaxing and increased irritability were prominent. From a sociological perspective, the majority of participants expressed a strong desire for more social interaction. Lastly, most participants in the leadership domain revealed satisfaction with their professional relationships. However, 50.7% of respondents expressed dissatisfaction with their incentives. Conclusion: The study concludes that addressing problems in the mental, social, and leadership domains is crucial to enhancing the resilience and overall well-being of undergraduate healthcare students during their internships. Anxiety and stress emerged as the most prevalent factors affecting these students. However, the presence of a positive relationship with their supervisors, as well as the support provided by healthcare organizations, played a vital role in helping them overcome these challenges.

Relationship between emotional intelligence, occupational well-being, and work engagement among Chinese clinical nurses.

PURPOSE: To identify the relationship between emotional intelligence, occupational well-being, and work engagement among Chinese clinical nurses METHODS: This cross-sectional study is based on survey responses provided by 1744 registered nurses from a Chinese hospital. The survey utilized emotional intelligence, occupational well-being, and work engagement scales. RESULTS: A questionnaire was distributed to nurses, and among them, 1744 (99.1 %) filled it in. Work engagement was related to demographic characteristics. The nurses' work engagement score was 28.99±5.46. Correlation analysis showed that work engagement was positively correlated with emotional intelligence (r=0.621-0.826, p<0.01) and occupational well-being (r=0.589-0.788, p<0.01). CONCLUSIONS: The current work engagement of nurses in China is at a medium level. It is influenced by emotional intelligence and occupational well-being.

Symptom Distress Before and After Heart Transplantation - A Longitudinal 5-Year Follow-Up.

INTRODUCTION: Symptom distress after heart transplantation (HTx) is a significant problem causing uncertainty, low self-efficacy, and psychological distress. Few studies have addressed self-reported symptoms. The aim was to explore self-reported symptom distress from time on the waiting list to 5 years after HTx and its association with self-reported psychological well-being, chronic pain, and fatigue in order to identify possible predictors of psychological or transplant specific well-being. METHODS: This multicenter, longitudinal cohort study includes 48 heart recipients (HTRs), 12 women, and 36 men, with a median age of 57 years followed from pretransplant to 5 years post-transplant. Symptom distress was explored by means of four instruments measuring psychological general wellbeing, transplant specific wellbeing, pain, and fatigue. RESULTS: Transplant specific well-being for the whole improved in a stepwise manner during the first 5 years compared to pretransplant. Heart transplant recipients with poor psychological wellbeing were significantly more burdened by symptom distress, in particular sleep problems and fatigue, for up to 5 years after HTx, and their transplant-specific well-being never improved compared to baseline. The prevalence of pain varied from 40% to 60% and explained a significant proportion of the variance in transplant-specific well-being, while psychological general well-being was mainly predicted by overall symptom distress. CONCLUSION: The presence of distressing symptoms explains a significant proportion of poor psychological wellbeing both among HTRs reporting chronic pain and those without pain.

Navigating the depths: exploring seafarers' psychological well-being on board, anchored by the mediating role of resilience and loneliness.

BACKGROUND: This study investigates seafarers' loneliness as a mediating variable between psychological well-being and resilience, and tests resilience as a mediating variable between psychological well-being and loneliness. It also examines the challenges faced by seafarers on different types of ships and evaluates the mediating roles of resilience and loneliness. MATERIALS AND METHODS: The research uses descriptive data analysis, reliability analysis, correlation analysis, and mediation analysis with bootstrap-based regression models. An online survey was conducted with 471 active Turkish seafarers using a sociodemographic questionnaire and three standardized scales measuring psychological well-being (PW), loneliness at work (LAW), and psychological resilience (PR). Data were collected between 01/07/2023 and 01/09/2023. RESULTS: The findings indicate that ship type is a significant factor in the mediating roles of loneliness at work and psychological resilience. There is a partial mediating role of loneliness at work and resilience in psychological well-being across different ship types. Specifically, loneliness at work partially mediates the relationship between psychological resilience and psychological well-being among seafarers on tanker or bulk carrier vessels, but not on container vessels. CONCLUSIONS: The study concludes with suggestions to address the mental health challenges faced by seafarers, emphasizing the importance of ship type in the mediating roles of loneliness and resilience. Regarding the mediating role of loneliness at work, it has been determined that there is partial mediation between psychological resilience and psychological well-being among seafarers working on tanker or bulk carrier vessels. However, on container vessels, loneliness at work does not mediate the relationship between psychological well-being and psychological resilience. Based on these findings, the authors conclude by offering a range of helpful solutions to address this problem.

Psychological and Academic Adaptation Through Universal Ethnic Studies Classes: Results of a Natural Experiment.

Schools in the United States are increasingly offering ethnic studies classes, which focus on exploring students' ethnic-racial identities (ERI) and critical analysis of systemic racism, to their diverse student bodies, yet scant research exists on their effectiveness for students of different ethnic-racial backgrounds in multiracial classrooms. A policy change to require all high school students in one school district to take an ethnic studies class facilitated a natural experiment for comparing the effects of quasi-random assignment to an ethnic studies class (treatment) relative to a traditional social studies class (control; e.g., U.S. Government, Human Geography). Student surveys and school administrative data were used to compare students' ERI development, well-being, and academic outcomes across ethnic studies and control classes. Participants (N = 535 9th graders; 66.1% ethnic studies) had diverse ethnic-racial (33.5% non-Latine White, 29.5% Black, 21.1% Latine, 10.7% biracial, 2.8% Asian, 2.2% Native American) and gender identities (44.7% female, 7.1% non-binary). Ethnic studies students reported marginally higher ERI exploration and resolution than controls, and sensitivity analyses showed a statistically significant effect on ERI among participants with complete midpoint surveys. Higher resolution was associated with better psychological well-being for all students and higher attendance for White students. Students with low middle school grades (GPA < 2.0) had better high school grades in core subjects when enrolled in ethnic studies than the control class. Overall, the results of this natural experiment provide preliminary support for ethnic studies classes as a method for promoting ERI development, well-being, attendance, and academic achievement for students from diverse ethnic-racial backgrounds.

Living lab modelling as a pilot study assessing the potential psychological health benefits of forest environment for cancer survivors.

OBJECTIVE: To evaluate the physiological and psychological changes in cancer survivors who engage in repeated forest therapy in a living environment. METHODS: This study included stay-based forest therapy for female cancer survivors aged ≥40 years. The program was conducted in two cycles, each spanning 3 weeks and consisting of a 2-night, 3-day stay, followed by daily life integration. The cycles were repeated from July 2, 2022, to August 18, 2022. Participant assessment included standard physical health parameters and a questionnaire on general characteristics, lifestyle habits, stress levels, and health status. RESULTS: Thirty-seven female cancer survivors participated in the forest healing program, 56.8% of whom had a history of breast cancer. The median body mass index (BMI) was 23.80 kg/m2 (range, 21.00-25.60). More than half of the patients reported mild-to-moderate fatigue, chronic pain, and mild-to-moderate depression (81%, 65%, and 73%, respectively). After two cycles of forest therapy, no significant differences were observed in terms of fatigue, pain, or BMI levels. However, significant improvements were found in quality of life measures, particularly the psychological quality of life (mean score 12.54 at baseline vs. 13.48 after cycle 2; P=0.007). Positive improvements were also observed in terms of stress (mean score 17.03 vs. 13.76; P=0.002) and depression (mean score 8.35 vs. 6.11; P=0.002) levels. CONCLUSION: Our forest-healing program demonstrated that nature-based therapies improve the mental health and quality of life of female cancer survivors, suggesting the need for further research on nature-based interventions to better support cancer survivors.

Exploring the influence of leadership styles on psychological well-being and satisfaction of Pilates classes clients.

BACKGROUND: The recent trend of increased indoor activities has significantly influenced daily life, enhancing the popularity of exercises like Pilates. This study explores how Pilates instructors' leadership styles affect class satisfaction and psychological well-being, addressing the research gap concerning the specific impact of leadership within the context of Pilates classes. METHODS: The study surveyed 388 participants from 39 Pilates studios across South Korea, utilizing a questionnaire to assess leadership styles (transformational, transactional, and servant leadership), class satisfaction, and psychological well-being. Using statistical analyses, leadership styles were assessed for their correlation with class satisfaction and psychological well-being. RESULTS: Findings revealed that transformational and transactional leadership styles were positively correlated with class satisfaction and psychological well-being. Specifically, transformational leadership significantly enhanced educational satisfaction and personal growth, while transactional leadership most strongly influenced social satisfaction and the sense of purpose in life. Servant leadership was notably effective in improving physical class satisfaction. The study also highlighted the critical role of class satisfaction in promoting psychological well-being among participants. CONCLUSION: This research underscores the importance of leadership styles in enhancing the Pilates class experience, suggesting that instructors' leadership approaches can significantly impact participants' satisfaction and psychological well-being. The study advocates developing training programs that equip Pilates instructors with the skills to adopt effective leadership styles, fostering a more positive and fulfilling class environment.

Flight-related determinants of health-related quality of life of asylum seekers and refugees in Germany: a longitudinal study based on the German Socio-Economic Panel (SOEP).

BACKGROUND: Germany played a key role as receiving country during the so-called refugee and displacement crisis with about 5 million asylum seekers arriving in the EU between 2014 and 2020. It is well known that asylum seekers and refugees (ASRs) have a high burden of disease and are particularly prone to mental disorders such as trauma, stress-related and affective disorders. Not much is known about the determinants of health-related quality of life (HrQoL) among ASRs, especially in the context of the flight. Therefore, the aim of this study was to analyze the associations between flight-related characteristics and HrQoL of ASRs in Germany. METHODS: The sample of this study was based on five consecutive waves of the Survey of Refugees samples of the German Socio-Economic Panel (n = 8015; 14,314 observations). Mental and physical HrQoL was measured using the mental (MCS) and physical (PCS) component summary scores of the SF-12v2. Associations between flight-related characteristics and HrQoL were examined using multilevel mixed-effects linear regressions. RESULTS: The different countries of birth were associated with varying MCS and PCS scores. The MCS and PCS scores were lower among ASRs with an economic situation below average in their countries of origin. Persecution, discrimination, and poor living conditions as reasons for leaving the county were associated with lower MCS scores. ASRs who were dissatisfied with their own living situation and who were discriminated often due to their origin had both lower MCS and PCS scores. Not feeling welcome in Germany and missing people from one's country of origin were both associated with lower MCS scores. No worries about not being able to stay in Germany or not being able to return to one's country of origin were both associated with higher MCS scores. CONCLUSIONS: The economic situation in the country of origin and the presence of persecution, discrimination, and/or poor living conditions as reason for flight may be pre-flight-related determinants of HrQoL of ASRs in Germany. Possible post-flight-related determinants can be the residence status, the satisfaction with one's living situation, discrimination due to one's origin and a feeling of missing people from one's country of origin. With regard to those determinants, the clarity about the residence status, reducing racial discrimination and the mourning of flight-related circumstances must be ensured.

Burnout and psychological distress among Hispanic nurses across Illinois and New York hospitals: Implications for structural and person-centered solutions.

BACKGROUND: Despite high levels of burnout and psychological distress among nurses, few studies have evaluated these outcomes among Hispanic nurses. PURPOSE: To evaluate the differences in job-related and psychological well-being outcomes for Hispanic and non-Hispanic White nurses and the association of nurse work environments. METHODS: Cross-sectional analysis of the 2021 RN4CAST-New York-Illinois nurse survey. Multilevel logistic regression models examined the association between nurse ethnicity and job-related outcomes and psychological well-being. DISCUSSION: Our sample included 798 (10.7%) Hispanic and 6,642 (89.3%) non-Hispanic White nurses in 249 hospitals. In unadjusted models, Hispanic ethnicity was associated with higher odds of burnout (odds ratio (OR) 1.21, 95% confidence interval (CI): 1.03-1.42), which diminished when considering the work environment (OR 1.16, 95% CI: 1.01-1.35) and nurse characteristics (i.e., age) (OR 1.01, 95% CI: 0.83-1.21). CONCLUSION: Equity-driven solutions to support the well-being of Hispanic nurses should consider a focus on the needs of young Hispanic nurses and include increased support in work environments.

The mediating role of psychological well-being on the effect of fear of future violent events at work on nurses' intention to migration.

AIM: To evaluate the effect of the fear of violence of nurses working in Turkey on their intention to migrate and to examine the mediating role of psychological well-being on this effect. BACKGROUND: Many countries are concerned about nurses' fear of violence and their intention to migrate. The fear of violence at work may influence nurses' intention to migrate. Additionally, psychological well-being may impact this process. However, the impact of the fear of violence at work on the intention to migrate, as well as the moderating effect of psychological well-being in a nursing context, is not well understood. METHODS: We conducted this cross-sectional study on a sample of 221 nurses from two public hospitals. We collected survey data between November 2022 and January 2023 using three scales. We analyzed the data using SPSS, AMOS, and HAYES. We followed the STROBE statement guidelines for cross-sectional studies. RESULTS: Nurses reported a moderate intention to migrate and a moderate to high level of fear of violence and psychological well-being. Fear of violence is positively associated with the intention to migrate. Mediation analyses indicated that the association between fear of violence and intention to migration was mediated by psychological well-being. DISCUSSION AND CONCLUSION: The fear among nurses of being exposed to violence increases their intention to migrate. However, high psychological well-being can reduce this intention. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing managers, policymakers, and decision-makers need to take serious precautions against the fear of violence in the future and make necessary improvements for nurses who witness violence. To achieve this, it can begin by paying attention to the high psychological well-being of each nurse.

The Ambiguous Cue Task: Measurement reliability of an experimental paradigm for the assessment of interpretation bias and associations with mental health.

Interpretation biases in the processing of ambiguous affective information are assumed to play an important role in the onset and maintenance of emotional disorders. Reports of low reliability for experimental measures of cognitive biases have called into question previous findings on the association of these measures with markers of mental health and demonstrated the need to systematically evaluate measurement reliability for measures of cognitive biases. We evaluated reliability and correlations with self-report measures of mental health for interpretation bias scores derived from the Ambiguous Cue Task (ACT), an experimental paradigm for the assessment of approach-avoidance behavior towards ambiguous affective stimuli. For a non-clinical sample, the measurement of an interpretation bias with the ACT showed high internal consistency (rSB = .91 - .96, N = 354) and acceptable 2-week test-retest correlations (rPearson = .61 - .65, n = 109). Correlations between the ACT interpretation bias scores and mental health-related self-report measures of personality and well-being were generally small (r ≤ |.11|) and statistically not significant when correcting for multiple comparisons. These findings suggest that in non-clinical populations, individual differences in the interpretation of ambiguous affective information as assessed with the ACT do not show a clear association with self-report markers of mental health. However, in allowing for a highly reliable measurement of interpretation bias, the ACT provides a valuable tool for studies considering potentially small effect sizes in non-clinical populations by studying bigger samples as well as for work on clinical populations, for which potentially greater effects can be expected.

The relationship between night shift work, sleep patterns, psychological well-being, and mental health among Jordanian healthcare workers.

This study examines the associations between working night shifts and various outcomes, including sleep patterns, healthcare workers' sleep quality, and physical, mental, and social well-being. A descriptive cross-sectional study was conducted, where the findings revealed that night shift healthcare workers experienced poor sleep quality and pattern. In addition, night shift healthcare workers were more likely to express their intent to leave, the impact of work on their social lives, and a low level of job satisfaction. Healthcare workers showed moderate anxiety and mild depression levels. Lower job satisfaction correlated with higher anxiety and depression levels among healthcare workers, while the negative impact of working hours on social life was associated with increased anxiety and depression. Organizations should consider establishing comprehensive wellness initiatives covering work-life balance, stress management strategies, and mental health resources.

The mediation model of social status on the link between parental attachment, aggressive behavior, and psychological well-being: Evidence from two studies in Vietnamese adolescents and young adults.

Little is known about how insecure attachment affects aggressive behavior and well-being among Vietnamese youth. Using structural equation modeling, we investigate the mediating role of subjective social status (SSS) on the paths from insecure attachment to overt aggressive behavior (OAB) and psychological well-being (PW) in a sample of 1753 Vietnamese adolescents (Mage = 16.136, SD = 0.784) and test whether the results will be replicated in another sample of 601 Vietnamese young adults (Mage = 19.93, SD = 1.35). Participants complete a survey comprising demographic information, attachment styles, SSS, OAB, and PW questionnaires. Our main findings include: (a) anxious attachment positively related to OAB in both samples, (b) anxious attachment was only negatively associated with adolescents' PW, (c) avoidant attachment was positively correlated to OAB in adolescents but negatively correlated in young adults, and (d) avoidant attachment was negatively related to PW in both samples. In addition, (e) in adolescents, the mediation role of SSS was significant in all paths, but (f) SSS only mediated the link from avoidant attachment to PW of young adults. The present study suggests that aggressive behavior might not be associated with social status or attachment in the same way in adolescents compared to young adult Vietnamese samples.

The Effects of Gender-Affirming Hormone Therapy on Quality of Life: The Importance of Research on Youth.

Gender-affirming hormone therapy (GAHT) plays a significant role in the medical care of transgender individuals, helping to align their physical characteristics with their gender identity. While numerous studies have investigated the impact of GAHT on adults, research focusing on its effects on the quality of life (QoL) of transgender youth is limited. In this opinion paper, we aim to address selected challenges associated with gender-affirming medical care, such as (1) the necessity for evidence-based youth gender-affirming medical care, (2) the urge to explore different approaches to gender-affirming medical care diversely in transgender youth research, and (3) understanding the challenges of the detransition process (which refers to stopping or reversing gender-affirming medical or surgical treatments), as well as suggest possible solutions for meaningful progress. Notably, the available evidence underlines a positive impact of GAHT on various aspects of QoL of transgender youth, such as mental health and social functioning, by alleviating gender dysphoria, improving body satisfaction, and facilitating appearance congruence (the degree to which an individual's physical appearance represents their gender identity). However, challenges related to methodological limitations, as well as ethical considerations, and several sociocultural factors highlight the need for further research to better understand the long-term effects of GAHT on the QoL of transgender youth. Ethical considerations, such as ensuring informed consent and weighing potential benefits against risks, are pivotal in guiding healthcare decisions. Additionally, navigating these ethical responsibilities amid sociocultural contexts is crucial for providing inclusive and respectful care to transgender youth. Addressing these research gaps is, therefore, crucial to developing successful healthcare programmes, raising awareness, and promoting the holistic well-being of transgender youth through comprehensive and affirming care.

Work-Related Quality of Life among Physicians in Poland: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Working in a healthcare setting is associated with high levels of stress and burnout syndrome. Work-related quality of life (WRQoL) remains insufficiently evaluated among physicians. The aim of this study is to assess the WRQoL among physicians of interventional, non-interventional, and diagnostic specialties in Poland. MATERIALS AND METHODS: Standardized and anonymous WRQoL questionnaires have been filled in by 257 physicians working in Silesia, Poland. After the removal of missing data, 246 individuals were stratified in terms of specialties into the appropriate categories, including interventional, non-interventional, and diagnostics. These categories were compared using the following subscales: general well-being (GWB), home-work interface (HWI), job and career satisfaction (JCS), control at work (CAW), working conditions (WCS), and stress at work (SAW). RESULTS: Out of 246 individuals, 132 were women (53.7%) and 112 (45.5%) were men. There were no differences in terms of WRQoL scores (p = 0.220) and subscales GWB (p = 0.148), HWI (p = 0.368), JCS (p = 0.117), CAW (p = 0.224), WCS (p = 0.609), SAW (p = 0.472) between interventional, non-interventional, and diagnostic specialties. The group of young doctors (age ≤ 30 years) had higher JCS scores than the older ones (mean score [SD], 22.7 [3.98] vs. 21 [4.6]; p = 0.013). Physicians who were not working in hospital had higher WRQoL score than respondents working in hospital (p = 0.061), with significant differences in terms of GWB (mean score [SD], 20.3 [4.93] vs. 22.8 [3.2], p = 0.014), HWI (mean score [SD], 9.1 [=2.65] vs. 10.6 [2.73], p = 0.011), and WCS (mean score [SD], 9.5 [2.61] vs. 10.8 [2.54], p = 0.035). CONCLUSION: There were no differences considering overall WRQoL between analyzed groups stratified according to specialty. However, we disclosed a significant association between the respondent's WRQoL and age as well as place of work.

Self-employed people with chronic health conditions: Business maintenance and well-being.

Chronic health conditions (CHCs) involve physical, psychological, and social challenges and can have a significant negative impact on work ability, which can then affect performance and job satisfaction. However, the various effects of CHCs on business operations and maintenance among self-employed workers are understudied. This study examined four common CHCs that are characterised by persistent symptoms and can prompt major life changes: respiratory disease, heart conditions, inflammatory bowel disease, and cancer survivorship. Groups were compared regarding the CHC's impact on business maintenance (declining in income and activity, and slowing business growth), and well-being. A sample of 294 self-employed workers with these CHCs completed questionnaires about how their conditions affect their businesses, physical symptoms, and well-being. The four CHCs had substantial negative effects on business maintenance. Differences were found in reported changes in income, activity, and growth between individuals with inflammatory bowel disease and cancer. No differences in well-being occurred among self-employed people with different CHCs. In the overall sample, work absences and slowing business growth were negatively associated with well-being. Although the groups differed in the severity of symptoms, threat to life, and treatment regimen, the CHCs had similar effects on most business maintenance factors and well-being. Moreover, the results indicate that the inability to maintain a business can negatively affect well-being.

A Nation-Wide Survey of Program Directors at a Large Health Care Organization: Prevalence and Perceptions of Resident Wellness Activities.

Background: This study evaluated wellness programs in a large hospital network to determine residency program directors' (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness' influence on decision-making across organizational levels. Methods: In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration's ability to prioritize wellness, funding sources, and perceptions of resident wellness' impact on decision-making. Results: Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived that fellow colleagues in their institution linked wellness to markers of institutional success to a greater extent than other available options (ie, Accreditation Council for Graduate Medical Education [ACGME] requirements, budgetary concerns, resident input, core faculty priorities, and education quality). Financial well-being was perceived as least connected to wellness. Perceptions of wellness were rated across 3 organizational levels: program, institution, and organization. Across all levels, ACGME requirements (31.0%-32.8%) and budgetary/financial concerns (21.9%-37.0%) were perceived as having the most significant influence on overall decision-making, whereas resident wellness was rated lower in influence (8.0%-12.2%). Most programs allowed residents to attend mental health appointments without using paid time off (87.9%) and while on duty (83.1%). Conclusion: The frequency of wellness activities varied greatly across programs. PDs reported challenges making resident self-care and personal development a priority and perceived resident wellness as having limited importance to decision-making at higher levels.

A Qualitative Follow-Up to a Survey of Program Directors on Wellness Programming at a Large Healthcare Organization: Interviews of High- and Low-Exemplar Programs.

Background: The current research used a qualitative approach to understand which factors facilitate and hinder wellness programming in residency programs. Methods: Program directors identified from a previous quantitative study as having residency programs with notably more or less resident wellness programming than others (ie, high- and low-exemplars, respectively) were contacted. In total, semi-structured interviews were conducted over Zoom with 7 low-exemplars and 9 high-exemplars. Results: The results of this qualitative examination suggest common themes across the 2 exemplar groups, such as wanting more resources for resident wellness with fewer barriers to implementation, viewing wellness as purpose-driven, and seeing wellness as a shared responsibility. There were also critical distinctions between the exemplar groups. Those high in wellness programming expressed more of an emphasis on connections among residents in the program and between the faculty and residents. In contrast, those low in wellness programming described more barriers, such as staffing problems (ie, turnover and lack of faculty wellness) and a lack of integration between the varying levels involved in graduate medical education (GME) operations (ie, between GME programs and sponsoring hospitals, and between GME facilities and the larger health care organization). Conclusion: This study provides insight into program directors' experiences with wellness programming at a large health care organization. The results could point to potential next steps for investigating how the medical education community can improve resident wellness programming.

The Impact of a 4-Domain Wellness-Initiative Curriculum on Internal Medicine Resident Physicians.

Background: There is a trend toward fostering well-being, or the state of being happy and healthy, within the medical community. Historically, resident physicians have faced high rates of distress during training. A structured well-being curriculum in residency programs may shift residents' mindsets from survival and resilience to one centered on purpose, engagement, and joy. Methods: An original well-being curriculum was administered to residents in person at a single institution every 5 weeks for approximately 10 well-being workshops, totaling around 20 hours of curriculum exposure during every academic year. The well-being curriculum was divided into 4 domains: cognitive distortions and problematic mindsets, mindfulness and meditation, creative outlets, and self-compassion.Residents exposed to at least 1 year of the well-being curriculum were asked to answer an anonymous survey. Four questions were asked for each of the 4 domains. The first and second questions asked how familiar they were with the topic before and after the workshops on a scale of 1-5 of familiarity. The third and fourth questions asked how much the knowledge acquired influenced their professional and personal life on a scale of 1-5 of influence. Results: Before curriculum exposure, the average for moderate or higher levels of knowledge across all domains was 22.7%, which improved to 77.3% after curriculum completion. Overall, 58.6% of participants felt the knowledge of the domains was moderately or extremely influential in their professional lives and 83.6% in their personal lives. There were no significant differences between post-graduate year 2 and post-graduate year 3 residents for any domains examined before and after the wellness workshops. Conclusion: A 4-domain well-being curriculum practiced in a group setting positively impacted participating residents in their personal and professional lives. Further studies need to be performed on a larger scale to assess if the curriculum fits the needs of the broader medical community.

A Multi-Wave Study of Factors Associated With Resident Engagement, Depression, Burnout, and Stay Intent.

Background: Many studies have documented the epidemic of mental ill-being among resident physicians, but fewer have focused on mental well-being or on guiding intervention design to make progress toward positive change in residency programs to support resident thriving. Informed by the job demands-resources model (JD-R) and positive psychology, the current study examines 4 potential predictors of residents' ill-being (burnout, depression) and well-being (engagement, stay intent) that are malleable and thus capable of change through intervention: psychological capital (PsyCap), supervising physicians' autonomy-supportive leadership style (ASL), social support, and meaningful work. Methods: Three waves of data were collected between November 2017 and September 2018 at a large hospital system in the United States. Due to participant response rates, we were unable to conduct a planned longitudinal analysis. Therefore, for each wave, Bayesian regression analyses were used to examine cross-sectional relationships between the 4 predictors and each outcome. Results: Although findings varied across the study's 3 waves, the outcomes were largely as expected. With only 1 exception (depressive symptoms in Wave 2), meaningful work significantly predicted all outcome variables in the expected direction across all 3 waves. PsyCap significantly predicted burnout, depressive symptoms, and engagement in the expected direction across all 3 waves. ASL significantly predicted engagement in the expected direction across all 3 waves, as well as depressive symptoms and stay intent in 2 waves, and burnout in 1 wave. Social support significantly negatively predicted depressive symptoms in all 3 waves and burnout in 1 wave. Conclusion: Applying the JD-R framework and a positive psychology lens can open new pathways for developing programming to support resident thriving. Meaningful work, PsyCap, ASL, and social support all significantly predicted 1 or more outcomes related to resident thriving (burnout, depression, engagement, stay intent) across all 3 waves. Thus, this study provides theoretical and practical implications for future intervention studies and designing current programming for resident thriving.