Reflections on a Decade Leading a Medical Student Well-Being Initiative.

One of the earliest longitudinal efforts to improve medical student well-being, and perhaps the only one that has tracked mental health outcomes continuously, is the decade-long medical student well-being initiative at Saint Louis University School of Medicine. In this Invited Commentary, the author describes his experience leading that effort as the associate dean for curriculum to help inform more nascent efforts taking shape across the medical education continuum and in practice.Starting in 2006, a simple model with three components was developed to guide the new well-being initiative: (1) Reduce unnecessary stressors and enhance the learning environment; (2) teach students skills to better manage their stress and provide and encourage them to use a range of psychological and emotional support resources; and (3) create more opportunities for students to find meaning in their work. Over the next 10 years, striking decreases in adverse mental health outcomes were seen with an 85% reduction in the depression rate and a 75% decrease in the anxiety rate in first-year medical students.The author argues that the following factors contributed to the initiative's effectiveness: addressing the problem largely as one stemming from the learning environment, developing a deep understanding of the lived experience of students and avoiding making assumptions about what they need, reducing students' cognitive load, addressing problematic student mind-sets through a modest resilience curriculum, treating students with respect and compassion, and creating greater opportunity for students to find meaning in their work.