Reimagining Wellness Curricula: Lessons from the Data and the Frontlines

 

Reimagining Wellness Curricula: Lessons from the Data and the Frontlines

John E Delzell Jr MD MSPH MBA FAAFP

Residency is a crucible. It is where idealism meets reality, where the long hours and emotional toll of clinical training can either forge resilience or fuel burnout. Over the past decade, wellness curricula have emerged as a hopeful antidote to the rising tide of physician distress. But are they working? Two key studies—Coutinho et al’s 2025 longitudinal analysis and Raj’s 2016 systematic review—offer sobering insights and a call to recalibrate our approach.

What the Data Tells Us

Coutinho and colleagues (1) conducted a national longitudinal study (using the CERA protocol) linking wellness curricula in family medicine residency programs to burnout three years post-graduation. Their findings? No significant association between the presence or type of wellness curricula and reduced burnout in early career physicians. That’s a tough pill to swallow, especially given the time and resources invested in these initiatives.

Raj’s systematic review (2) echoes this complexity. While interventions like mindfulness and stress management show promise, the evidence base is thin—limited by small sample sizes, single-site studies, and inconsistent definitions of “well-being”. Autonomy, competence-building, and social connectedness emerged as key predictors of resident well-being, but translating these into curricular components remains elusive.

Beyond Bubble Baths and Burnout Bingo

Let’s be honest: some wellness efforts feel performative. A yoga session here, a gratitude journal there—well-intentioned, but often disconnected from the structural realities of residency. What residents crave isn’t just self-care tips; it’s systemic change. They want protected time, psychological safety, and leadership that models vulnerability and balance.

Coutinho’s study found that working fewer than 60 hours per week during PGY-1 was associated with lower burnout. That’s not a wellness module—it’s a workload adjustment. It suggests that the most impactful “curriculum” might be embedded in scheduling, staffing, and culture, not just in didactics.

Building a Curriculum That Matters

So where do we go from here? First, we need to redefine what wellness curricula actually mean. It’s not just about teaching coping strategies—it’s about embedding well-being into the DNA of training programs. That includes:

- Longitudinal design: One-off workshops don’t cut it. Wellness must be woven throughout the entire residency experience. The curriculum must be CORE to the residency training model.

- Faculty champions: Programs need leaders who advocate for well-being and model it authentically. Leaders must be the Program Directors and APDs and not just a wellness “Champion”. If your program needs a single champion, it is not serious about resident well-being.

- Safe spaces for disclosure: Residents must feel empowered to share struggles without fear of stigma or retaliation. Some of these spaces must be outside of their program and peers. Best if including other specialties

- Feedback loops: Curricula should be dynamic, shaped by resident input and evolving needs.

Raj’s review highlights the importance of autonomy and competence-building. That means giving residents meaningful roles in shaping their learning environment, not just asking them to meditate between consults. Institutions must have a wellness council that is resident-led.

The Missing Piece: Measurement

One of the biggest barriers to progress is the lack of standardized metrics. How do we define and measure “well-being”? Raj calls for a clear definition and validated scale—a crucial step if we want to compare interventions and track outcomes over time.

Without robust data, we risk chasing wellness trends without knowing what actually works. It’s time to move beyond anecdote and toward evidence-informed design. This includes robust studies of curricular models and longitudinal RCTs comparing models.

Culture Eats Curriculum for Breakfast

Ultimately, wellness isn’t a syllabus—it’s a culture. Programs that prioritize psychological safety, mentorship, and humane workloads will outperform those that rely solely on curricular fixes. Residents don’t just learn from lectures; they absorb the ethos of their environment.

If a program teaches mindfulness but punishes vulnerability, the curriculum is moot. If it offers resilience training but ignores toxic hierarchies, it’s window dressing. True wellness requires alignment between values, behaviors, and systems.

A Call to Action

The takeaway from these studies isn’t that wellness curricula are futile—it’s that they must evolve. We need to shift from checkbox interventions to transformative experiences. That means:

- Integrating wellness into core competencies

- Evaluating curricula with rigorous, longitudinal data

- Centering resident voices in design and delivery

- Addressing structural drivers of burnout, not just symptoms

Residency will always be demanding. But it doesn’t have to be depleting. With intentional design, courageous leadership, and a commitment to culture change, we can build training environments that nurture both clinical excellence and human flourishing.

 

References

(1) Anastasia J. Coutinho, MD, MHS; Amanda K. H. Weidner, MPH; Peter F. Cronholm, MD, MSCE.  A National Longitudinal Study of Wellness Curricula in US Family Medicine Residency Programs and Association With Early Career Physician Burnout.  J Grad Med Educ 2025; 17 (3): 320–329. https://doi.org/10.4300/JGME-D-24-00515.1

(2) Kristin S. Raj.  Well-Being in Residency: A Systematic Review.  J Grad Med Educ 2016; 8 (5): 674–684. https://doi.org/10.4300/JGME-D-15-00764.1