Enhanced Stress-Resilience Training (ESRT) for Graduate-Entry Medical Students: A Mixed-Method Investigation

Abstract Background Medical students face demanding academic requirements, fierce competition, self-doubt and financial concerns contributing to high rates of depression, anxiety, stress, sleep problems and burnout, highlighting a need for effective interventions. We explored a promising intervention known as Enhanced Stress-Resilience Training (ESRT), a modified form of mindfulness training adapted for clinicians, that was applied to medical students for the first time. Methods A randomised controlled trial was conducted to examine the effectiveness of ESRT for graduate-entry medical students (N = 98). Group (ESRT, active control) by time (pre-intervention, post-intervention, 6-month follow-up assessment) analyses of variance (ANOVAs) were conducted on psychological flexibility, resilience and stress reactivity. Student experience and perception of ESRT were investigated via exit evaluations (n = 25), one-on-one semi-structured interviews (n = 12), and end-of-study focus groups (n = 11) which underwent reflexive thematic analysis. Results ESRT users demonstrated increased psychological flexibility scores at post-intervention (p = .001, d = 0.62) and six-months follow-up (p = < .001, d = 0.96), and these findings were confirmed in intention-to-treat analysis. Those with low baseline resilience who underwent ESRT displayed increased resilience (p = < .001, d = 1.86) and decreased stress reactivity (p = < .001, d = 1.58) at the six-month follow-up. Reflexive thematic analysis revealed a strong demand for ESRT, which improved capacity for coping. Feedback from ESRT participants demonstrated overwhelmingly positive experiences and a demand for integrating ESRT into the medical curriculum. Conclusions ESRT is an effective intervention for enhancing psychological flexibility, while also increasing resilience and decreasing stress reactivity in the most vulnerable students. While students felt subjectively better across multiple domains, engagement in ESRT was challenged by time constraints and conflicting priorities. To overcome these barriers, we advocate for further implementation efforts which would benefit from institutional support to integrate ESRT into the formal medical curriculum.