Curricular Strategies and Evaluation Practices for Medical Student Wellness: A National Survey of U.S. Medical Schools

Abstract

Introduction Medical student well-being is critical for learning and patient care, yet national data on wellness strategies remain limited. Existing literature consists mainly of single-institution reports with minimal consolidated data. Multi-institutional studies have identified gaps including non-rigorous evaluation and insufficient structural approaches. No large-scale national survey has been conducted since 2019, before transformative changes including USMLE Step 1 pass/fail conversion, the COVID-19 pandemic, and advances in digital health tools. This national survey provides updated data to assess current strategies, barriers, and opportunities for improvement across U.S. medical education.

Objectives: To characterize wellness strategies at U.S. medical schools nationally, emphasizing structural approaches and evaluation practices.

Methods: From July–October 2025, we surveyed all accredited U.S. medical schools (n=159) using a web-based instrument adapted from prior literature and piloted for response process validity. Items queried curricular strategies, wellness assessments, program evaluation, organizational structure, and student involvement.

Results: Of 159 schools, 104 (65%) responded, representing all U.S. regions. Most schools demonstrated organizational commitment with dedicated wellness staff positions (77%, 61/79), wellness committees (95%, 75/79), and student representation on committees (90%, 74/82). Formal wellness curricula existed at 62% (55/89), most commonly in orientation (83%, 55/66) and less often integrated into coursework (64%, 42/66). Structured learning communities were reported by 88% (73/83). Clinical rotation interventions included mistreatment prevention policies (91%, 74/81) and protected time off (72%, 58/81). Faculty training for supporting student wellness was offered by 46% (38/72). Primary implementation barriers were curricular overcrowding (82%, 63/77) and logistical difficulties (69%, 53/77). Most schools (55%, 42/77) assess wellness, predominantly using AAMC national surveys (90%, 38/42); established instruments for burnout (16%), depression (14%), and anxiety (13%) were uncommon. Only 20% (15/76) collected demographic data alongside wellness metrics—a critical gap for identifying disparities. Half (51%, 39/76) evaluate program effectiveness, primarily through AAMC survey rather than pre-/post-intervention assessments (21%) or longitudinal tracking (26%) with established tools. Evaluation barriers included limited staffing/time (54%) and poor student participation (44%).

Discussion: This national survey reveals widespread wellness curricula and organizational infrastructure but significant evaluation gaps. While mistreatment policies are common, wellness promotion in daily education requires strengthening, including faculty development. Critically, few programs collect demographic data—essential for identifying disparities and advancing equity in wellness initiatives. Assessment practices rely heavily on AAMC surveys with limited wellness-specific data. Programs should adopt brief established measures for longitudinal, iterative assessment alongside demographic data to identify at-risk populations, track disparities, and ensure equitable wellness support. These findings provide a national baseline for evidence-based wellness program development.

Target audience: Faculty, staff, and student representatives in medical education involved in student affairs, well-being, curriculum development, and student support services. Takeaways are applicable to parallel stakeholders in other health-professions programs.