Twelve tips for recognizing and supporting medical learners experiencing impostorism.

The resurgence of studies focused on the Impostor Phenomenon (IP) demonstrates a need for greater understanding of the construct as well as strategies to limit the negative conditions that arise from it. To help address this need, the following twelve tips offer perspectives and suggested approaches for educators to assist medical learners with IP during clinical training. A review of the medical literature and the authors' experiences supplies the following information, organized first by etiology and diagnosis followed by management and special considerations. These tips provide insight into the multifaceted aspects of IP and offer suggestions for support at the individual and institutional levels. With proper monitoring and personalized guidance, educators can assist learners in breaking the cycle of negative thoughts and behaviors to achieve confidence in their professional identity and competence in their clinical skills.

Medical students describe their wellness and how to preserve it.

BACKGROUND: Despite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students' perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculum-embedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students. METHODS: Employing a mixed methods analysis of qualitative and longitudinal quantitative data, first- and second-year students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018-2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters. RESULTS: Nearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn't address the medical culture met with skepticism. CONCLUSIONS: Interview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students' identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches.

Impact of Satisfactory/Unsatisfactory Grading on Student Motivation to Learn, Academic Performance, and Well-Being.

Satisfactory/unsatisfactory (S/U) grading is often proposed to ameliorate stress by reducing the competitive nature of letter grading. Though explored considerably in human medical programs, minimal literature focuses on the veterinary school setting. The purpose of this study was to evaluate the impact of S/U grading on veterinary students' motivation to learn, academic performance, and well-being. Cornell University's COVID-19 pandemic response provided a unique opportunity to compare S/U and letter grading on the same population of students during a single pre-clinical foundation course, with the first half being graded S/U (spring semester 2020), returning to letter grades in the second half (fall semester 2020). Students were retroactively surveyed on the effect of S/U vs. letter grading on their overall educational experience and well-being, with 67.8% class participation. The majority of respondents (71.3%) stated that S/U grading had a positive impact on their overall learning experience. More than half (53.8%) perceived that they learned the same amount of information and had the same level of motivation (58.8%), even though most (61.3%) stated that they spent less time preparing for S/U assessments than letter grade assessments. Positive impact factor effects for S/U grading included decreased stress, more time for self-care, improved learning, and increased learning enjoyment. S/U grading did not negatively impact academic performance. In conclusion, this study demonstrates that, in our particular study population and setting, S/U grading conferred well-being and learning experience advantages to students without any reduction in motivation for learning or academic performance.

Financial and caregivers' stressors in Australian law students - a qualitative analysis.

Australian law students exhibit high levels of psychological distress compared to the general population. In 2013, The University of Sydney Law School conducted a survey to examine the level of distress in students, what factors were associated with their distress and what strategies might mitigate student distress. This article reports on the survey's qualitative findings relating to financial stressors and care-giving responsibilities. The findings provide further insights into the context of financial stressors for law students and how they may undermine students' candidacy. The study found that financial stress, work commitments, caring for dependents, illnesses and death in the family can be potential reasons for students suspending studies or withdrawing from their studies altogether. In view of the findings, possible solutions to alleviate stress and support students with their work-study and care-giving concerns are discussed.

Gender differences in substance use and psychiatric distress among medical students: A comprehensive statewide evaluation.

BACKGROUND: Medical student wellness has emerged as an important issue in medical education. The purpose of the present study was to obtain a comprehensive assessment of substance use, psychological distress, and help-seeking among male and female medical students in order to identify targets for continued intervention efforts. METHODS: Medical students from all 9 medical schools in the state of Florida were invited via e-mail and/or announcements to complete an anonymous online questionnaire assessing their well-being. Of 5053 matriculating medical students, 1137 (57.1% female) responded to the questionnaire. Descriptive statistics, t tests, and chi-square analyses were computed using SPSS 20. RESULTS: Over 70% of students acknowledged binge drinking, with men reporting higher frequency than women (χ2 = 13.90, P = .003), and 22.7% (n = 201) reported marijuana use during medical school, with higher rates (χ2 = 9.50, P = .02) among men (27.0%, n = 99) than women (18.9%, n = 93). A significant minority of students reported nonmedical use of prescription stimulants and prescription opioids. In addition, 3.3% of male students (n = 12) compared with 0.6% of female students (n = 3) reported problematic drug use. Further, almost 2/3 of respondents reported decreased psychological health since beginning medical school, with women noting greater reductions (χ2 = 12.39, P = .05) and higher levels of stress (χ2 = 16.30, P = .003). Over 10% of students (n = 102) endorsed "thoughts of committing suicide" during medical school, and 70.1% felt they would benefit from mental healthcare (79.3% of women vs. 59.6% of men; χ2 = 41.94, P < .001), although only 39.8% accessed help. CONCLUSIONS: Despite efforts to address medical student wellness, students continue to report concerning levels of psychological distress, suicidal ideation, and substance use. More work is needed to effectively address medical student mental health and well-being.

Sources of medical student stress.

BACKGROUND: Key elements in the clinical practice of prevention, health and wellness are best cultivated in medical professionals during undergraduate medical training. This study explores students' self-assessed stress relative to gender, academic expectations, and level of medical training to guide development of targeted wellness interventions. METHODS: In early 2012, undergraduate (M1-M4) students in four Southeastern U.S. allopathic medical schools were surveyed about health-related attitudes and behaviors. RESULTS: A total of 575 students returned completed questionnaires. Students in the preclinical years (M1-M2), especially females, reported significantly higher stress levels. Academic expectations and satisfaction were also significantly implicated. DISCUSSION: These findings highlight the general areas of potential concern regarding stressors associated with medical training. Future research should guide programmatic efforts to enhance students' overall health and wellness vis-à -vis curriculum, skills training, and support services.

Characterizing Asian American medical students' experiences with microaggression and the impact on their well-being.

PURPOSE: This mixed-methods study quantified and characterized incidents of microaggressions experienced by Asian American medical students. The authors report on their impact and suggest improvements to create a more equitable and supportive learning environment. METHOD: Quantitative and qualitative data were collected from 305 participants who self-identified as Asian American or Pacific Islander. An online, anonymous survey was sent to US medical students through the Asian Pacific American Medical Student Association (APAMSA). Questions explored incidence, characteristics of, and response to microaggressions. We conducted four focus groups to further characterize students' experiences. Data were organized and coded, and thematic analysis was used to identify core themes. RESULTS: Racial microaggressions were prevalent among Asian American medical students. Nearly 70% (n = 213) of survey respondents reported experiencing at least one incident during their medical training to date. The most common perpetrators were patients (n = 151, 70.9%) and fellow medical students (n = 126, 59.2%), followed by professors (n = 90, 42.3%). The most prevalent themes included being perceived as a perpetual foreigner, the assumption of timidness, and ascription of the model minority myth. Students rarely reported the incident and usually did not respond immediately due to fear of retaliation, uncertainties about the experience or how to respond appropriately, and perception that they would bear the burden of advocacy alone. Experiences with microaggressions led to feelings of frustration and burnout and had a negative impact on mental health. Recommendations were made to improve the anonymous reporting systems in medical schools, and to increase diversity and inclusion in medical education and leadership. CONCLUSIONS: Asian American medical students face high exposure to racial microaggressions during their medical education that adversely impact their mental health. Changes are needed in medical training to create a more equitable and inclusive learning environment.

6-Week student wellness program improves psychological wellbeing of students.

Objective: Employing a waitlist control design, the current study examined the effectiveness of a shortened version of a newly developed wellness program. Participants/Methods: Twenty-four students were randomly assigned to an experimental wellness (EW) group or a waitlist control (WLC) group. The 6-week wellness program focused on specific wellness topics (i.e., relaxation and mindfulness, yoga, gratitude and self-compassion, emotion regulation, goal setting and time management, and nutrition and movement). Both mental health and wellbeing outcomes were examined pre-post group. Results/Conclusions: Findings revealed that the EW group reported significantly improved overall psychological wellbeing, optimism, self-compassion, and satisfaction with life following the program relative to baseline, but the WLC group did not.

Peer mentoring in pharmacy programs: Recommendations for implementation based on a review of available literature.

BACKGROUND: Stress experienced by pharmacy students is on the rise and is negatively impacting student success. Pharmacy accreditation standards encourage schools to promote student success and well-being. Peer to peer student support is a largely under-investigated strategy to address this. The objective of this manuscript is to conduct a literature review on the development of peer mentoring programs for pharmacy students and describe best practices for successful implementation into pharmacy programs. METHODS: This literature review identified studies using major databases, including PubMed, Embase, International Pharmaceutical Abstracts, and Education Resources Information Center. Search terms included [(peer mentor*) AND pharmacy]. Any study that involved peer assessment, peer tutoring, or peer learning within a course, faculty mentors only, non-pharmacy students, and/or did not implement a mentor-mentee relationship, was excluded. RESULTS: Three studies met the criteria for inclusion. Mentorship programs varied with regard to duration, mentor recruitment, participant incentives, and overall structure. Various methods of analyses were employed. Despite major differences between the included studies, three themes were identified regarding development of peer mentoring programs: participation, support, and pairing. Active engagement led to higher perceived benefit and both mentors and mentees found the programs beneficial, agreed to recommend the programs to others, and provided positive feedback. IMPLICATIONS: Successful mentoring programs should aim to incorporate the following characteristics to some degree: mandatory participation by mentor and mentee as well as support for mentors with training and faculty oversight. Peer mentoring programs have a positive impact on participants. More studies are needed to assess the effects of peer mentoring in pharmacy programs. This is the first known review of peer mentoring within pharmacy programs and identifies a gap in knowledge in this area. There is a paucity of data surrounding peer mentoring in pharmacy and its potential value as a tool to improve student well-being.

Wellness Activities, Stress, and Academic Performance in Medical Students.

INTRODUCTION: Medical student wellness has a range of effects from academic performance to tragic mortality. Many factors correlate with academic performance, including study environments, faculty support, research participation, and student attitude. Its relationship with student stress and wellness demonstrates mixed results. This study hopes to help clarify these results and will also assess the interplay of these factors in relation to the pre-clerkship and clerkship phases of medical school. METHODS: This retrospective descriptive study was conducted using a de-identified database from 2017 to 2023, provided per an Institutional Review Board (IRB) protocol. The subjects were the students of the classes of 2021-2027 at the Kirk Kerkorian School of Medicine at UNLV. The database included performance data including semester, clinical subject, and USMLE Step 1 and Step 2 exam scores. Other data included variables relating to self-perceived stress and time spent in wellness activities before medical school and at the end of the pre-clerkship and clerkship phases of medical school. The effects of these variables were calculated with bivariate correlations and independent samples T-tests using cut-off points calculated from the class means of those variables. A total of 361 medical students were included in the study. RESULTS: Students with high wellness time had lower stress levels in both the pre-clerkship and clerkship phases of medical school (5.83 vs. 7.3 p < 0.001* and 5.74 vs. 8.49 p < 0.001*, respectively). Students with low stress levels in the pre-clerkship phase scored 5.81 points higher on the Step 1 exam (p = 0.013*). Clerkship phase stress levels were significantly negatively correlated with all clinical subject exams except for pediatrics. Stress levels in the pre-clerkship and clerkship phases had similar relationships with the second and third semester and Step 2 exams, respectively, although not statistically significant. Wellness activity time did not have a significant relationship with academic performance. CONCLUSION: Stress levels had significant negative relationships with many medical school exams. Although wellness activity time did not have a direct relationship with academic performance, its relationship with stress levels can allude to an indirect effect on academic performance. This, along with fending off burnout and stress, are reasons why medical student wellness should be a priority for medical schools, faculty, and their students.

The Effects of a Guided Mindful Walk on Mental Health in University Students.

College campuses in the United States are experiencing high levels of mental distress without adequate psychological resources to address the need. In addition, the majority of university students do not meet the physical activity guidelines for mental and physical health. Effective and time efficient resources are needed to address poor mental health and low physical activity among university students on college campuses. Mindful walking may be a promising solution. The purpose was to 1) measure change in mental health and 2) estimate physical activity from participation in a guided mindful walk in a diverse student sample. Students participated in a mindful walking route which included seven stops (0.85 miles) during the Spring 2022 semester. Undergraduate students (n = 44) were mean ± SD age 20.9 ± 3.8 years and 68% female. Validated surveys were given pre- and post-participation measuring mental health constructs of state mindfulness (Toronto Mindfulness Scale; TMS), state anxiety (visual analogue scale), and state stress (Short Stress State Questionnaire; SSSQ). Physical activity was estimated via steps on a Yamax pedometer worn at the hip. After the guided mindful walk, total state mindfulness score significantly improved (mean ± SD) (pre: 27.5 ± 8.2, post: 32.8 ± 9.5; p < 0.001); state anxiety significantly decreased (pre: 3.7 ± 2.4, post: 2.4 ± 2; p < 0.0001) and total state stress score was reduced (pre: 66.1 ± 10.7, post: 63.4 ± 8.3; p = 0.03). Physical activity averaged 1,726 ± 159 steps. Completion of a guided mindful walk can reduce anxiety and stress, while increasing mindfulness among university students.

Evaluation of a Pilot Wellness Elective for Master of Public Health Students during the COVID-19 Pandemic.

BACKGROUND: Graduate student wellbeing is a public health issue in the United States. The COVID-19 outbreak exacerbated the mental health burden on graduate students worldwide. Culture of Wellness (PH 104) is a 2-week wellbeing elective course that teaches evidence-based wellbeing strategies for graduate students at a university in the United States. Our study aimed to evaluate the impact of this pilot wellbeing elective on Master of Public Health students' mental health and wellness during the COVID-19 pandemic. METHODS: Participants included 22 Master of Public Health students from the class of 2021 at a university in the United States. We provided a pre-course survey to students that assessed their perception of their own personal wellbeing, their knowledge about various wellbeing strategies, and their confidence in applying 13 wellbeing strategies before taking the course. Post-course students completed the same survey following course completion, as well as a matching evaluation and a five-month follow up survey. RESULTS: Of the 13 strategies taught, students reported significant improvements in their ability to apply 10 strategies. There was a significant increase in self-reported emotional and physical wellbeing, as well as a significant decrease in burnout. Five months post-course, more than three quarters of respondents used strategies taught in the course on a weekly basis or more. LIMITATIONS: This pilot study is limited by its small sample size, which may restrict the generalizability of the findings. CONCLUSIONS: The PH 104 Culture of Wellness course was effective in improving graduate students' wellbeing and confidence in applying wellbeing strategies.

The Effects of Positive Psychological Factors on the Mental Wellbeing of Medical Students.

Objective A well-established association exists between academic performance and levels of depression and anxiety among medical students. However, the effects of positive psychological factors on symptoms of depression and anxiety and academic performance have not been adequately studied. This study explores the relationship between the above variables and identifies positive psychological factors that can promote medical student wellbeing. Methods Medical students were surveyed at four time points during their first two years of medical education using Qualtrics. The surveys used a five-point Likert scale to assess students' levels of loneliness, religiosity, engaged living, life fulfillment, resilience, psychological wellbeing, and symptoms of depression and anxiety. Academic performance was measured using students' Comprehensive Basic Science Examination scores. Linear mixed effect models with maximum likelihood estimation were used to investigate the relationship between positive psychological factors and scores on depression and anxiety as well as the relationship between demographic and psychological factors and exam scores. Results Seventy-two students completed the study. A significant positive correlation was observed between loneliness and symptoms of depression and anxiety, while the same symptoms had significant negative correlations with engaged living. None of the positive psychological factors were significantly predictive of exam scores. Conclusion Our findings suggest that medical students who develop meaningful relationships and live engaged lives are less likely to develop symptoms of depression and anxiety. Our study lays the groundwork for future research focusing on identifying and implementing pre-clinical curriculum changes aiming to improve medical students' mental health.

Development and testing of the university student resilience scale.

Objective: University students exist in unpredictable, challenging circumstances. This heightens social anxiety, which can manifest in lack of identity formation, consumption of alcohol, and suicide ideation. To better understand the psychological motivators in the student experience, this study develops and tests a contemporary 10-item university student resilience scale. Participants: Respondents (N = 270) were 18-24 in university, previously had some university experience, or held a university degree. Methods: Scale variables are tested through network analysis, then exploratory and confirmatory factor analysis to identify interrelationships and dimensions in university student perception of resilience. Results: University students are most resilient by relying on friends and family, seeing adversity as a learning opportunity, and helping themselves by helping others. The most highly correlated measures are "positive attitude" and "open mind" while "faith in a higher power" holds a negative relationship with "being responsible for my own problems." Regression analysis indicates a strong will, not giving up, and maintaining an open mind are predictors of resilience. A 3-factor structural model captures the latent dimensions "Infinite Possibilities," "Like a Rock" and "Surrounded by Love." Conclusion: This scale offers practical application for university counselors and administrators creating protocols for students requiring support in developing resilient outcomes. The most powerful factor in this model indicates an "open mind while helping others" creates the greatest effect in resilient behavior. Opportunities for resilience can be incorporated as a benefit of social justice training and education. It will allow students to learn about identities other than their own as well as develop the ability to empathize based on lived experiences.

Student wellness: Interest and program ideas & pilot of a student wellness program.

Objective: To increase our knowledge related to student wellness programs, the current studies examined interest in wellness and wellness programs among university students and piloted a newly developed wellness program targeting students in higher education. Participants/Methods: In Study 1, 93 undergraduate students answered questions related to their wellness and mental health (e.g. psychological wellbeing, satisfaction with life, optimism, and stress) and to wellness programs (e.g. interest, barriers, duration, and topics). In Study 2, 13 undergraduate and graduate students participated in a 9-week pilot wellness program focused on specific wellness topics (e.g. relaxation, yoga, gratitude and self-compassion, and emotion regulation). Results/Conclusions: Study 1 results support a strong interest in wellness and wellness programs among undergraduate students. Study 2 results suggest that students who participated in an on-campus wellness program reported higher levels of overall psychological wellbeing and optimism and lower levels of mental health issues relative to baseline.

Teaching Health Literacy and Digital Literacy Together at University Level: The FLOURISH Module.

Many universities have wellness programs to promote overall health and well-being. Using students' own personal data as part of improving their own wellness would seem to be a natural fit given that most university students are already data and information literate. In this work, we aim to show how the interplay between health literacy and data literacy can be used and taught together. The method we use is the development and delivery of the FLOURISH module, an accredited, online-only but extra-curricular course that delivers practical tips in the areas that impact students' everyday wellness including sleep, nutrition, work habits, procrastination, relationships with others, physical activity, positive psychology, critical thinking, and more. For most of these topics, students gather personal data related to the topic and submit an analysis of their data for assessment thus demonstrating how students can use their personal data for their benefit. More than 350 students have taken the module and an analysis of the use of online resources, as well as feedback on the module experience, are presented. The contributions of this article are to further endorse the need for health literacy and digital literacy for students, and we demonstrate that these can be taught together making each literacy more appealing to the digital natives of Generation Z who make up the majority of students. The implications for public health research and practice are that two student literacies, health and digital, are not independent and for our students, they should be taught together.

Factors associated with stress impacting academic success among post-secondary students: A systematic review.

Objective: To synthesize peer-reviewed primary research exploring factors associated with perceived stress impacting post-secondary students' academic success. Methods: A systematic review identified research conducted in North America, Europe, and Australia in the last ten years across 12 databases. Results: Of the 6,214 references screened, 14 English articles published between 2011 and 2018 were deemed relevant. Subsequent analysis characterized articles by study design, location, population, factors with a statistically significant relationship with both perceived stress and academic success, and future research directions. Findings reveal a complex relationship among overlapping factors associated with perceived stress on academic success at both the intrapersonal (eg, academic, demographic, psychological, attitudinal, and behavioral characteristics) and interpersonal levels (eg, social capital). Conclusions: Further research should measure the association of the identified factors to inform areas where resources could be targeted within post-secondary institutions to prevent stress from unduly impacting students' educational outcomes.

Nourish: A pilot program to support self-Efficacy, learning, and wellness during USMLE step 1 preparation.

PURPOSE: Medical trainees experience significant exam-related stress, such as preparing for the USA Licensing Medical Examination Step 1, which often negatively affects emotional health. Nourish, a novel Step 1 support program, was designed to foster improved self-efficacy and well-being during the process of studying for and taking the exam. Nourish was piloted at Oregon Health & Science University between December 2018 and February 2019. METHODS: Program elements were guided by Self-Efficacy Theory and included community building, wellness support, peer tutoring and social persuasion. Program evaluation included pre- and post-program surveys. Participation was optional and included 46 of 154 students (30%) with 40 of the 46 students (87%) completing pre and post evaluations. The pre-survey was given during the Nourish orientation in December prior to the Step 1 study period, and the post-survey was given in early February when most students had taken their exam but none had received their scores. RESULTS: While summary self-efficacy scores increased between baseline and post program (24.9 vs 27.7, p < 0.001), summary emotional health scores worsened (8.15 vs 8.75, p = 0.03). Summary scores for physical health also dropped but this difference was not statistically significant. Summary perceived stress scores increased from 15.5 at baseline to 23.7 post program (p < 0.001). All students who routinely participated in Nourish passed their USMLE Step 1 exam. One student who participated only in the orientation session did not pass. CONCLUSION: Nourish appeared to improve self-efficacy, even though students reported being stressed with low emotional health. The program appeared to help students align task demands with their own personal resources and set reasonable expectations and strategies to pass the exam. Medical schools should consider similar peer- and faculty mentor-based wellness and tutoring programs to support medical students while they work to achieve academic success.

Beyond burnout: a four-year survey of osteopathic medical student mental health and the implications for the development of wellness and mental health programs.

CONTEXT: The mental health crisis in medicine cannot be explained by burnout alone. Physicians are not immune to this crisis and are known to have higher rates of suicide and depression than the general population. A high prevalence of mental health symptoms has been observed in early medical training. OBJECTIVES: This study was completed to characterize medical students' mental well-being and provide guidance for timely intervention. METHODS: An annual prospective, voluntary, anonymous, cross-sectional survey of medical students was completed over a 4-year period in medical school from 2016 to 2019. The survey was created based on standardized psychiatric screening tools assessing symptoms of depression, anxiety, burnout, and sleep problems. In each of those years, 1,257 (2016), 1,254 (2017), 1,221 (2018), and 1,220 (2019) enrolled students, respectively, were invited to participate. Data on students' mental health were analyzed in relation to their year of school separately for each survey year utilizing SAS 9.4. RESULTS: A total of 973 students in 2016, 889 students in 2017, 547 students in 2018, and 606 students in 2019 participated in the study. For depression and burnout subscales, an increase in symptom scores were observed every survey year (2016, 2017, 2018, and 2019) by the second or third year of medical school with a clinically significant effect size. Persistently high levels of anxiety were observed throughout medical school, with significant increases after the first year noted in the 2016 and 2017 surveys, but not in the 2018 or 2019 surveys. Similarly, significant changes in sleep disturbance were found in the 2016 and 2017 surveys, but not in 2018 or 2019. CONCLUSIONS: Symptoms of burnout, depression, and anxiety were observed throughout all four years of medical school, with increases starting after the first year. Early intervention is needed to support students' mental health and increase access to care and resources.

A student-driven mindfulness curriculum for first-year osteopathic medical students: a pilot study.

CONTEXT: Medical education is stressful and can adversely affect the health and well-being of students. Although mindfulness-based interventions (MBIs) have been successfully utilized in other settings, little is known about the use of student-led interventions in undergraduate medical education. OBJECTIVES: The objectives of this study are to assess student satisfaction with four student-selected and student-led mindfulness activities incorporated into mandatory small-group sessions, the immediate impact of these activities on student stress levels, and student use of these activities outside the mindfulness sessions. METHODS: First-year osteopathic medical students voluntarily participated in weekly student-selected and student-led mindfulness activities once a week for 8 consecutive weeks during regularly scheduled class time. Activities included yoga postures, the 4-7-8 breathing technique, progressive muscle relaxation (PMR), and values affirmation. Each activity was completed twice during the 8 weeks. After each session, students could anonymously complete an electronic survey assessing participation, change in stress level, satisfaction with the activity, and mindfulness activities practiced outside the session. Survey questions included dichotomous, Likert-like, and multiple-choice responses. A chi-square test was utilized to analyze student responses from each week about the decrease in stress level, and satisfaction with the mindfulness activity, and student use of the activities outside the classroom. Wilcoxon rank sum tests were utilized to determine associations between outcomes, and a logistic regression model was utilized to determine relationships between the change in stress levels and other outcomes. RESULTS: Of the 154 first-year medical students initially enrolled in the 2021-2022 academic year, 14 (9.1 %) to 94 (61.0 %) actively participated in the weekly mindfulness activities. Students indicated that the 4-7-8 breathing technique was the activity most practiced outside the mindfulness sessions (32.3 %, 43/133 total responses) across all weeks. The mindfulness activity with the highest percentage of reported decrease in stress level was the yoga postures in week 5 (94.8 %, 36/38), and both weeks of the yoga activities had the highest reported student satisfaction (95.7 %, 90/94 for week 1; 92.1 %, 35/38 for week 5). For students who answered the change in stress level question, the stress level decrease was related to participation in the weekly activity for weeks 1 through 7 (all p<0.03). For students who participated in mindfulness sessions, the odds of reporting a reduction in the stress level were 16.6 times (95 % CI, 6.8-47.2; p<0.001) that of students who did not participate. For those satisfied with the activities, the odds of reporting a reduction in stress level were 6.7 (95 % CI, 3.3-13.9; p<0.001). CONCLUSIONS: Results suggested that the student-selected and student-led mindfulness activities may successfully reduce medical student stress in students who actively participate. However, additional research is needed to determine how to optimize mindfulness curricula implementation.