Physicians regularly counsel patients on essential healthy lifestyle habits: eat at least five servings of vegetables, get 30 minutes of exercise, and sleep at least eight hours each day. However, this can be easier said than done especially for medical students who are trying to balance their obligations to learning and practicing patient care with self-care. In a survey published by the Southern Medical Journal, two Internal Medicine faculty members and a Carver College of Medicine medical student examined the habits of medical students and the challenges these students face when forming this part of their professional identity.
Annee M.L. Rempel, a fourth-year CCOM student; Patrick B. Barlow, PhD, clinical professor in General Internal Medicine; and Lauris C. Kaldjian, MD, PhD, professor in General Internal Medicine and Richard M Caplan Chair in Biomedical Ethics and Medical Humanities, gathered data from 351 CCOM students in Fall 2019. The online survey, “Medical Education and Ethics of Self-Care: A Survey of Medical Students Regarding Professional Challenges and Expectations for Living Healthy Lifestyles,” was cross-sectional and anonymous.
The survey’s results suggested most medical students believe physicians have a responsibility to try to live a healthy lifestyle and are more confident to counsel patients if they practice healthy behaviors themselves. But the majority of medical students also believe the medical school workload results in less healthy habits when it comes to exercise, sleep, and nutrition.
In response to the results, Rempel, Barlow, and Kaldjian concluded that students need learning environments and ethical frameworks that promote both self-care and altruistic service as part of their professional identity formation. Throughout CCOM, there have been a number of recent initiatives and programs designed to promote student health. Last year, Sarah L. Averill, MD, clinical assistant professor of Radiology, and Gerard Clancy, MD, professor of Psychiatry and Associate Dean of External Affairs, created a third- and fourth-year elective class centered on different aspects of wellness such as burnout, stress, financial practices, parenting, and hobbies. Barlow designed a survey to look at the course’s effectiveness. Barlow is also a part of a Continuous Quality Improvement team in the Office of Consultation and Research in Medical Education evaluating the steps CCOM is making to support student wellness.
The recently published survey is a part of Rempel’s Humanities Distinction Track (HDT) project, which explored a physician’s professional responsibility to encourage and practice healthy lifestyles. Rempel initially became interested in exploring physician wellness after having conversations with her classmates and looking into the work of Erica Frank, MD, MPH, at the University of British Columbia.
“I then began to ask myself: if physicians are indeed more effective when they themselves are able to embody health, do we not have an obligation to our patients and to our medical profession to be healthy? Should we not be given the space during training to better balance our personal health needs with the requirements of our medical education?” Rempel said.
Rempel reached out to Kaldjian to explore the ethical implications of these questions.
“Dr. Kaldjian went above and beyond to sit down and flesh out our ideas and questions as they relate to how medical students think about and engage with their own health,” Rempel said. “I’ve never before experienced the level of support and mentorship in an academic endeavor as I have now with Dr. Kaldjian.”
Kaldjian looped in Barlow to help with the statistical aspect of the survey, and the team began collecting data and running tests.
“One of the things that first drew me to CCOM for medical school was its robust humanities program,” Rempel said. “I knew I wanted to do an HDT project, and after a number of conversations with Dr. Kaldjian and the development of our survey tool, it became quite clear that this project would be at the cornerstone.”
As another part of her HDT project, Rempel embarked on a self-supported bike tour from Maine to Iowa City with her mother and CCOM alum, Jean Linder. Rempel and Linder made stops along the 936-mile route to interview physicians about their definitions of healthy and how they balance self-care and patient care. “Many of their responses helped guide how I thought about asking questions of medical students regarding this balance,” Rempel said.
Rempel was interviewed last year about this project and the resulting artwork she produced last year by Medicine Iowa. Some of her artwork can be viewed on her website.