Procedure

This study used a single-arm design to test the acceptability and preliminary efficacy of LAVENDER in a cohort of third year medical students from September to December 2018. The LAVENDER program was integrated into a mandatory coordinated wellness curriculum (WellMed) for all third-year medical students entering their clerkship year (M3) at the Albert Einstein College of Medicine in New York. LAVENDER consisted of four, 35–40 minute sessions delivered once per month in the fall of students’ clerkship year. One to two trained facilitators taught each session of LAVENDER in a classroom format. There were 5 total facilitators from Northwestern University who delivered the LAVENDER program to the medical students. The facilitators were masters or PhD-level researchers with extensive backgrounds in psychology or public health research, and all had expertise with the LAVENDER program.

Our team consulted with 5 medical students at Northwestern University’s Feinberg School of Medicine to inform adaptation of the intervention content, exercises, and skills to optimize the acceptability and relevance for medical trainees. The medical students were asked to review the existing positive psychology intervention that had previously been delivered to populations coping with health-related stress,²⁷–30 so that they could provide feedback on the skills and offer suggestions of how the intervention could be adapted for medical students.

Based on the feedback from the medical students, we adapted the existing positive emotion skills intervention to address the specific needs and perspectives of medical students. For example, we substituted two of the existing skills taught in the original intervention (personal strengths and attainable goals) with two positive psychological skills that the students considered to be more relevant for coping with the stress of medical training: self-compassion (the tendency to be kind and understanding toward oneself in instances of pain and failure)^34,35 and emotional awareness (understanding the range and functions of emotions, both positive and negative, to promote a balanced perspective of emotions in life and medicine).³⁶ In addition, we adapted the skill of “acts of kindness” to become “compassion toward others” by incorporating content from empathy training and mindful compassion cultivation interventions for medical trainees in our program.³⁷ Finally, we adapted the lesson content, activities, and home practice to incorporate examples that reflected the unique stressors experienced during medical school (e.g., constant sense of being evaluated, working with difficult personalities on teams, feeling isolated on rotations).

The final eight skills taught in LAVENDER are outlined in Table 1, and are presented in the following order: emotional awareness,³⁶ gratitude,³⁸ noticing positive events,³⁹ capitalizing on positive events,⁴⁰ positive reappraisal,⁴¹ mindfulness,⁴² self-compassion,^34,35 and compassion toward others.^37,43–45 These eight skills in the LAVENDER program were integrated into students’ mandatory wellness curriculum and taught over four, monthly sessions in the fall of students’ clerkship year. Each session lasted approximately 35–40 minutes and covered one to three skills. The sessions were delivered in a group format by 1–2 trained facilitators to the entire cohort of medical students in a single large classroom. Students were seated at tables of 7, with monitors at each table that displayed the presentation slides. The sessions consisted of a combination of lecture (delivered to the entire cohort), experiential activities for practicing the skills (e.g., guided meditations, mindful chocolate eating, gratitude Pictionary, “Lemons to Lemonade” reappraisal activity, conducted at their tables of 7), and small group discussions (conducted at their tables of 7). To address the skepticism that medical students may experience regarding positive psychology, the facilitators presented empirical studies in the lectures that provide the scientific evidence base for each of the skills.

LAVENDER Intervention Content.

In addition, we created a mobile-friendly website that includes medical-student specific tutorials, practices, scientific articles, and additional resources to accompany the in-person sessions that the students could use to access the lesson content and practice the skills between the monthly sessions. To address the limited time and demanding work schedules of medical school, we organized the lesson content and home practice on the website by time commitment (e.g., 1-minute to 5-minute tutorials). We included brief videos (3–5 minutes each) and infographics summarizing the intervention content, to offer multiple options for medical students to engage with the skills with minimal time commitment.