Sara Stewart, BS, and Alina Syros, MPH are first-year medical students at the University of Miami Miller School of Medicine. Jose Perez, MD is a third-year orthopedic surgery resident at the University of Miami.
Medical students and residents experience rigorous requirements in the journey to becoming physicians. Long hours, sleep deprivation, work overload, and emotional stress can contribute to students and residents neglecting their wellbeing to meet the requirements necessary for providing quality patient care. Because of the multitude of responsibilities medical students and residents encounter, wellness often becomes less of a priority. However, studies have shown diet and exercise are key components of wellness and critical factors in maintaining both the physical and cognitive function required to excel in high-demand professions . As such, the sacrifices students and residents in medicine often make may hinder their ability to think clearly and provide adequate care for patients.
Numerous studies have sought to analyze and address wellness among medical students. Kotter et al. conducted a prospective, longitudinal observational study to determine how medical student health changes over the first year and found that 93% of students rated their physical health as “good” at the beginning of the first year . By the end of the first year, this percentage had decreased to 76%. These findings were supported by McKerrow et al. , who found the median overall health score (scale of 1-5) of all medical students was highest at the beginning of M1 (4.71) and lowest at the end of M1 (4.07), with scores in subsequent years never reaching pre-medical school levels. This trend appears to continue into a medical residency, with upwards of 50% of residents reporting burnout . One potential source of burnout among medical residents is a lack of time to focus on physical wellness, which is compounded by high workload and irregular schedules. One isolated study within a residency program reported that no residents (n=110) exercised over 150 minutes per week during inpatient rotations, which could have effects on overall wellness . In addition, lingering feelings of fatigue and unaddressed burnout from medical school have been found to be a risk factor for experiencing burnout in residency .
These studies demonstrate that medical student and resident wellness is a significant issue facing medical trainees. One way to address this problem is by focusing on maintaining a healthy diet and exercising regularly . Existing literature shows us that medical trainees and professionals who incorporate healthy eating and exercise into their daily lives report experiencing less burnout and higher quality of life, whereas a poor diet and a lack of regular physical activity have negative impacts on physical and mental health [8-10]. This article focuses on sharing healthy diets and exercises targeted towards health care professionals and medical students in an effort to improve wellbeing. In doing so, medical providers can be better equipped to meet the high demands required of physicians.
Diet and Nutrition
Maintaining a balanced diet and optimal nutritional habits offers numerous health benefits. Eating a healthy diet including vegetables, fruits, whole grains, and lean protein may prevent adverse physical health outcomes, including cardiovascular disease, type 2 diabetes, and stroke [11-13]. Beyond physical health, proper nutrition can also have positive effects on emotional and mental wellbeing. A systematic review conducted by Lai et al. aimed to discern the connection between dietary patterns and depression in adults . Through a meta-analysis of studies examining a “healthy diet” (fish, whole grain, fruit, and vegetable consumption), the authors found that adults following a “healthy diet” had lower odds of depression than those with poor diets. Further, Conner et al. linked eating fruits and vegetables to increased vitality, flourishing, and motivation . Their clinical intervention assigned young adults to either a diet-as-usual condition or a “fruit and vegetable” intervention, where fruits and vegetables were provided and encouraged for participants. Only participants in the intervention group demonstrated improved psychological well-being at the end of the study. These studies provide support for the role of balanced nutrition in improving mental and emotional health.
In order to ensure medical students and residents have sufficient education regarding nutrition, various medical schools have cultivated nutritional counseling and culinary medicine courses for their students [16 17]. The Perelman School of Medicine and Feinberg School of Medicine have both implemented elective courses where students learn culinary literacy, cooking skills, and nutritional counseling. In response to their elective course, medical students from Perelman felt more confident regarding their knowledge of nutrition and ability to discuss nutrition with patients (p<0.001) . Students also noted they were inclined to introduce healthier eating habits into their daily routine. Similar results were found from Feinberg’s culinary medicine elective, where students reported a significant improvement in their confidence regarding their cooking abilities (p<0.010) and meal preparation skills (p<0.040) . Students also demonstrated increased fruit and vegetable intake after the completion of the course (p=0.040). These data suggest that nutritional-based educational electives have the potential to instill in medical students habits of healthy eating that may persist throughout residency and their future careers.
In addition to nutrition, physical activity has positive benefits on both physical and mental health. For example, physical activity is a protective factor against many chronic diseases such as cardiovascular disease, type 2 diabetes, and osteoporosis [18 19]. Beyond physical health, exercise has also been shown to improve mental health. LeBouthillier et al. conducted a randomized control trial to determine the effect of exercise on anxiety and found that both aerobic exercise and resistance training were effective at decreasing symptoms of anxiety . The resounding evidence regarding the link between exercise and physical/mental wellbeing underscores the central role of physical activity in maintaining a medical trainee’s wellness.
Barriers to regular exercise routines are currently being addressed at both the medical student and resident physician level. Bitonte and Desanto proposed that exercise should be a mandatory curriculum requirement for able-bodied medical students as a preventive measure for mental illness and burnout . They state that because medical students suffer from higher rates of mental illness than the general population, mandatory exercise should be implemented to be maximally effective in preventing mental illness and burnout while enforcing the importance of activity. While this may not be a feasible solution for all medical schools, exercise as an elective curricular component could be explored as an adjunctive modality to improving student wellness.
Similarly to medical students, resident physicians attribute the lack of dedicated time as the main barrier to exercise [22 23]. In response, the Mayo Clinic established an incentivized, team-based exercise program for residents . Participants of the program demonstrated higher physical activity compared to non-participants (p<0.001). Participating residents also rated their quality of life (Scale: 1-100) significantly higher than non-participants (75 versus 68, respectively; p<0.001). Creating incentivized exercise plans with dedicated time for physical activity may encourage medical trainees to become more active and help improve their quality of life.
Medical students and residents face stress and burnout from a variety of factors, including long work hours, sleep deprivation, and social isolation, at the expense of physical and mental wellbeing. Proper nutrition and regular physical activity are two components of a healthy lifestyle that have the potential to substantially improve medical student and resident wellness. Establishing healthy habits and practices during one’s formative years in medical training is essential in ensuring a successful, lifelong career as a healthcare provider.
1. Karr S. Avoiding physician burnout through physical, emotional, and spiritual energy. Curr Opin Cardiol 2019;34(1):94-97 doi: 10.1097/HCO.0000000000000574.
2. Kotter T, Tautphaus Y, Obst KU, Voltmer E, Scherer M. Health-promoting factors in the freshman year of medical school: a longitudinal study. Med Educ 2016;50(6):646-56 doi: 10.1111/medu.12987.
3. McKerrow I, Carney PA, Caretta-Weyer H, Furnari M, Miller Juve A. Trends in medical students' stress, physical, and emotional health throughout training. Med Educ Online 2020;25(1):1709278 doi: 10.1080/10872981.2019.1709278.
4. Low ZX, Yeo KA, Sharma VK, et al. Prevalence of Burnout in Medical and Surgical Residents: A Meta-Analysis. Int J Environ Res Public Health 2019;16(9) doi: 10.3390/ijerph16091479.
5. Williams AS, Williams CD, Cronk NJ, Kruse RL, Ringdahl EN, Koopman RJ. Understanding the exercise habits of residents and attending physicians: a mixed methodology study. Fam Med 2015;47(2):118-23
6. Chaukos D, Chad-Friedman E, Mehta DH, et al. Risk and Resilience Factors Associated with Resident Burnout. Acad Psychiatry 2017;41(2):189-94 doi: 10.1007/s40596-016-0628-6.
7. Hopkins L, Morgan H, Buery-Joyner SD, et al. To the Point: a prescription for well-being in medical education. Am J Obstet Gynecol 2019;221(6):542-48 doi: 10.1016/j.ajog.2019.05.012.
8. Dyrbye LN, Satele D, Shanafelt TD. Healthy Exercise Habits Are Associated With Lower Risk of Burnout and Higher Quality of Life Among U.S. Medical Students. Acad Med 2017;92(7):1006-11 doi: 10.1097/ACM.0000000000001540.
9. Fargen KM, Spiotta AM, Turner RD, Patel S. The Importance of Exercise in the Well-Rounded Physician: Dialogue for the Inclusion of a Physical Fitness Program in Neurosurgery Resident Training. World Neurosurg 2016;90:380-84 doi: 10.1016/j.wneu.2016.03.024.
10. Shanafelt TD, Oreskovich MR, Dyrbye LN, et al. Avoiding burnout: the personal health habits and wellness practices of US surgeons. Ann Surg 2012;255(4):625-33 doi: 10.1097/SLA.0b013e31824b2fa0.
11. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;140(11):e596-e646 doi: 10.1161/CIR.0000000000000678.
12. Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res 2017;120(3):472-95 doi: 10.1161/CIRCRESAHA.116.308398.
13. Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean diet and diabetes: prevention and treatment. Nutrients 2014;6(4):1406-23 doi: 10.3390/nu6041406.
14. Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr 2014;99(1):181-97 doi: 10.3945/ajcn.113.069880.
15. Conner TS, Brookie KL, Carr AC, Mainvil LA, Vissers MC. Let them eat fruit! The effect of fruit and vegetable consumption on psychological well-being in young adults: A randomized controlled trial. PLoS One 2017;12(2):e0171206 doi: 10.1371/journal.pone.0171206.
16. Rothman JM, Bilici N, Mergler B, et al. A Culinary Medicine Elective for Clinically Experienced Medical Students: A Pilot Study. J Altern Complement Med 2020;26(7):636-44 doi: 10.1089/acm.2020.0063.
17. Schlair S, Hanley K, Gillespie C, et al. How medical students' behaviors and attitudes affect the impact of a brief curriculum on nutrition counseling. J Nutr Educ Behav 2012;44(6):653-7 doi: 10.1016/j.jneb.2011.08.006.
18. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012;2(2):1143-211 doi: 10.1002/cphy.c110025.
19. Lavie CJ, Ozemek C, Carbone S, Katzmarzyk PT, Blair SN. Sedentary Behavior, Exercise, and Cardiovascular Health. Circ Res 2019;124(5):799-815 doi: 10.1161/CIRCRESAHA.118.312669.
20. LeBouthillier DM, Asmundson GJG. The efficacy of aerobic exercise and resistance training as transdiagnostic interventions for anxiety-related disorders and constructs: A randomized controlled trial. J Anxiety Disord 2017;52:43-52 doi: 10.1016/j.janxdis.2017.09.005.
21. Bitonte RA, DeSanto DJ, 2nd. Mandatory physical exercise for the prevention of mental illness in medical students. Ment Illn 2014;6(2):5549 doi: 10.4081/mi.2014.5549.
22. Daneshvar F, Weinreich M, Daneshvar D, et al. Cardiorespiratory Fitness in Internal Medicine Residents: Are Future Physicians Becoming Deconditioned? J Grad Med Educ 2017;9(1):97-101 doi: 10.4300/JGME-D-15-00720.1.
23. Milner JD, DeFroda SF, Cruz AI, Jr. Fitness habits and barriers to exercise during residency training. Orthop Rev (Pavia) 2020;12(3):8507 doi: 10.4081/or.2020.8507.
24. Weight CJ, Sellon JL, Lessard-Anderson CR, Shanafelt TD, Olsen KD, Laskowski ER. Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program. Mayo Clin Proc 2013;88(12):1435-42 doi: 10.1016/j.mayocp.2013.09.010.