View in EDS HTML Full Text PDF Full Text

The Impact of a Novel Outdoor Orientation Program on Incoming Medical Students

Saved in:
Bibliographic Details
Title: The Impact of a Novel Outdoor Orientation Program on Incoming Medical Students
Language: English
Authors: Kercheval, Jacquelyn B. (ORCID 0000-0002-4046-098X), Bernard, Alec (ORCID 0000-0003-1494-1322), Berlin, Hanna, Byl, Nicole, Marois, Boone, Puttagunta, Rahul, Holman, Elizabeth, Bridge, Patrick D.
Source: Journal of Experiential Education. Sep 2022 45(3):276-294.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 19
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: School Orientation, Medical Students, Outdoor Education, Program Effectiveness, Student Attitudes, Student Adjustment, Medical Schools, Student Needs, Camps
Geographic Terms: Michigan (Ann Arbor)
DOI: 10.1177/10538259211048611
ISSN: 1053-8259
2169-009X
Abstract: Background: Undergraduate outdoor orientation programs facilitate students' transition into college. Research has yet to be conducted on the few programs at medical schools, which may have unique benefits given the specific challenges of transitioning to medical school and high rates of burnout among medical students. Purpose: This mixed methods study examines the impact of one medical school's outdoor orientation program on its participants. Methodology/Approach: A survey was administered immediately following the 2018 trip (N = 56 responses). Follow-up focus groups were conducted with a sample of the same participants (N = 18) in 2019. Responses were analyzed using descriptive statistics and thematic analysis. Findings/Conclusions: Participants felt that the program helped ease their transition into medical school, establish a support system, and hone personal development and wellness skills. Many of these effects persisted up to one year later. Implications: These findings are of particular interest to the medical and experiential education communities because many outcomes persisted for at least one year after the original trip and aligned with factors believed to protect against medical student burnout. There is opportunity for additional research as well as expansion of similar programs to other medical schools.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1347419
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwFoS2AtLG33II3ol2nSvIdAAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDEoYuJukzg7l7mga-QIBEICBmxlN3ZwATvmjijjgDGbJubjz5WXg6bw9vlKYJ-UNNWXlaWiU68dC_XkOAMnMDg1MCUJccbtgDoSQkm9N-GriAymavKfGBYVOLXa9j67_taBchWLIO0jdqG94mHCIbLRgZ8Ab5Pv0pahyFYmF9g-dHL46yHPteRGLQN-IXVrMDT4MiCYY_T-Vz8gd7dB9VXko12QDa9DpM2wCvZCr
Text:
  Availability: 1
  Value: <anid>AN0158393537;8l501sep.22;2022Aug09.06:46;v2.2.500</anid> <title id="AN0158393537-1">The Impact of a Novel Outdoor Orientation Program on Incoming Medical Students </title> <p>Background: Undergraduate outdoor orientation programs facilitate students' transition into college. Research has yet to be conducted on the few programs at medical schools, which may have unique benefits given the specific challenges of transitioning to medical school and high rates of burnout among medical students. Purpose: This mixed methods study examines the impact of one medical school's outdoor orientation program on its participants. Methodology/Approach: A survey was administered immediately following the 2018 trip (N = 56 responses). Follow-up focus groups were conducted with a sample of the same participants (N = 18) in 2019. Responses were analyzed using descriptive statistics and thematic analysis. Findings/Conclusions: Participants felt that the program helped ease their transition into medical school, establish a support system, and hone personal development and wellness skills. Many of these effects persisted up to one year later. Implications: These findings are of particular interest to the medical and experiential education communities because many outcomes persisted for at least one year after the original trip and aligned with factors believed to protect against medical student burnout. There is opportunity for additional research as well as expansion of similar programs to other medical schools.</p> <p>Keywords: outdoor orientation programs; medical school; medical student burnout; wellness</p> <p>In the United States, outdoor orientation programs are commonplace at the undergraduate level, with a marked growth in popularity over the last 30–40 years ([<reflink idref="bib5" id="ref1">5</reflink>]). The current body of research on these programs suggests that they positively impact participants' social and emotional development, academic success, and retention in their respective undergraduate programs ([<reflink idref="bib5" id="ref2">5</reflink>]). Despite these positive effects, few such programs exist at medical schools. The transition to medical school shares many challenges with the transition to undergraduate programs, including a move to a new location, an increased level of academic rigor, and a context that often induces significant self-growth and reflection. There are, however, a number of medical school-specific challenges that further complicate that transition. Given the overall efficacy of undergraduate outdoor orientation programs and the additional needs of medical students during their transition, a medical school outdoor orientation program would likely also be impactful. To date, only a handful of medical schools have established such programs, and research about the effects of these programs is limited.</p> <p>Since the first undergraduate outdoor orientation program was created at Dartmouth College in 1935, there are now over 25,000 annual participants in such programs across American and Canadian undergraduate institutions ([<reflink idref="bib5" id="ref3">5</reflink>]). Research demonstrates that such programs bolster participants' self-esteem, leadership skills, and social skills ([<reflink idref="bib5" id="ref4">5</reflink>]), which can result in the emotional, personal, and social growth of participants ([<reflink idref="bib29" id="ref5">29</reflink>]). The formation of social connections and the psychological and developmental growth of participants likely mediate some of the positive effects of these undergraduate programs ([<reflink idref="bib4" id="ref6">4</reflink>]; [<reflink idref="bib5" id="ref7">5</reflink>]).</p> <p>One of the original missions of undergraduate outdoor orientation programs was to smooth the transition from high school to college ([<reflink idref="bib3" id="ref8">3</reflink>]). The progression to medical school shares some features with the undergraduate transition, but it is also associated with several unique challenges. In the early, didactic-heavy years of medical school, the clinical roles of medical students are often poorly defined; this, combined with learning to make decisions that affect team members and patients, adds a new level of complexity to the learning environment ([<reflink idref="bib11" id="ref9">11</reflink>]). Students also must adapt their previously established study habits to the medical school curriculum, and they typically need to adapt again when they transition to the apprenticeship model of learning in the clinical environment later in their training ([<reflink idref="bib28" id="ref10">28</reflink>]). In addition to the differences in the learning environment, the culture of medical school training often feels impersonal compared to students' undergraduate institutions ([<reflink idref="bib19" id="ref11">19</reflink>]).</p> <p>Importantly, many of these distinct challenges of the transition to medical school are believed to contribute to the widespread burnout experienced by medical students. Students must learn to navigate an increased workload, greater work–family conflict, and the hierarchical culture of medicine, all of which are antecedents of burnout in medical students ([<reflink idref="bib16" id="ref12">16</reflink>]). One study estimates the prevalence of medical student burnout at 45–71% ([<reflink idref="bib18" id="ref13">18</reflink>]), and, according to [<reflink idref="bib12" id="ref14">12</reflink>], 35–45% and 26–38% of medical students report high emotional exhaustion and high depersonalization, respectively. The potential complications of trainee burnout include erosion of personal and professional development, an increase in serious thoughts of dropping out of medical school, and higher risk of alcohol abuse and suicidal ideation ([<reflink idref="bib12" id="ref15">12</reflink>]). Of note, medical students do not begin their training with high levels of burnout; in fact, [<reflink idref="bib9" id="ref16">9</reflink>] demonstrated that matriculating medical students have <emph>lower</emph> rates of burnout than other age-similar college graduates. This suggests that something unique to the medical school environment might be contributing to the burnout epidemic.</p> <p>The literature describes a number of factors that may reduce burnout in medical students, including the culture of the learning environment and institution (e.g., perceived support), expectations of what it means to be a medical student (e.g., workload), and person-specific traits (e.g., mental health) ([<reflink idref="bib13" id="ref17">13</reflink>]; [<reflink idref="bib16" id="ref18">16</reflink>]; [<reflink idref="bib26" id="ref19">26</reflink>]). Although the best strategies for promoting those factors are still being studied ([<reflink idref="bib12" id="ref20">12</reflink>]), some of the outcomes associated with undergraduate outdoor orientation programs could decrease burnout if considered in a medical school orientation context. By design, many such programs leverage the challenges associated with outdoor recreation to promote the psychological and developmental growth of participants ([<reflink idref="bib24" id="ref21">24</reflink>]), and they are associated with development of increased participant resilience ([<reflink idref="bib17" id="ref22">17</reflink>]; [<reflink idref="bib24" id="ref23">24</reflink>]). Resilience directly decreases the risk of burnout and also appears to be associated with better coping mechanisms for managing burnout when present ([<reflink idref="bib16" id="ref24">16</reflink>]). The risk of medical student burnout is also lower in students who report a stronger sense of peer support ([<reflink idref="bib13" id="ref25">13</reflink>]; [<reflink idref="bib16" id="ref26">16</reflink>]; [<reflink idref="bib26" id="ref27">26</reflink>]), and the formation of social support systems is one major outcome of undergraduate outdoor orientation programs ([<reflink idref="bib3" id="ref28">3</reflink>]; Bell & Holmes, 2011; [<reflink idref="bib15" id="ref29">15</reflink>]). It is certainly plausible that outdoor orientation programming at the medical school level might therefore be associated with protection against burnout.</p> <p>Anecdotally, it is understood that most medical schools provide some type of orientation programming, but the research on this is very limited. With the possible exception of the White Coat Ceremony, these orientations are neither standardized nor well-studied across institutions ([<reflink idref="bib14" id="ref30">14</reflink>]; [<reflink idref="bib27" id="ref31">27</reflink>]). To our knowledge, [<reflink idref="bib14" id="ref32">14</reflink>] are the only researchers who have attempted to systematically evaluate existing medical school orientation practices. They noted the dearth of empirical research on the subject, which they supplemented by surveying 11 Canadian medical schools. Although certain aspects of orientation seemed to be shared across these institutions, including a focus on encouraging students' adoption of a physician identity, a White Coat Ceremony, and an introduction to the institution and profession at large, the authors found many areas of divergence, describing a "contestation of both what orientation should involve and what it should not" ([<reflink idref="bib14" id="ref33">14</reflink>]). The other scarce literature that exists describes case reports at specific institutions. For example, the Foundations of the Profession course at Vanderbilt University School of Medicine is offered to all incoming medical students, and almost all participants feel that it contributes to their professional development and learning ([<reflink idref="bib1" id="ref34">1</reflink>]). However, its focus is more specifically on exposing students to the moral and service aspects of medicine rather than the cultural, social, and practical components of the orientations described by [<reflink idref="bib14" id="ref35">14</reflink>]. As another example, orientation programs for two Bachelor of Medicine, Bachelor of Surgery (MBBS) programs in India also appear to be effective ([<reflink idref="bib2" id="ref36">2</reflink>]; [<reflink idref="bib20" id="ref37">20</reflink>]), but MBBS degrees are acquired directly following secondary school so may be more analogous to undergraduate programs in the United States.</p> <p>Although most medical schools do appear to have an orientation of some sort, the presence of <emph>outdoor</emph> orientation programming is much less widespread. The work described in this manuscript focuses on one such program, the Creating Adventurous and Mindful Physicians (CAMP) program at the University of Michigan Medical School (UMMS). In addition to CAMP, the authors are only aware of four other well-established medical school outdoor orientation programs: the Stanford Wilderness Education Active Orientation Trip (SWEAT) at Stanford School of Medicine, the Physicians & Surgeons Outdoor Orientation Program (P-SOOP) at Columbia University College of Physicians and Surgeons, Pre-Op at the University of California San Diego Medical School, and the First-year Educational Adventure Trip (FEAT) at Harvard Medical School. There is limited literature to date describing the effects of these programs on medical student participants.</p> <p>In part to address the medical school-specific adjustment and burnout challenges previously discussed, the CAMP program was formally established in 2018, following a successful pilot backpacking trip in 2017. The program has continued annually, and participation is offered to all incoming medical students. It is free of charge, gear is provided to any students who need it, and no prior backpacking or wilderness experience is necessary to participate. Approximately 2/3 of the incoming medical school class, or roughly 100 students, now participate each year, along with about 20 upperclassmen guides.</p> <p>In brief, CAMP is a 3-day, 2-night outdoor orientation trip whose curriculum is based on undergraduate outdoor orientation programs and adapted to address the specific challenges of medical school matriculation. Incoming students are divided into groups of 10–12, and each group is led by 2–3 upperclassmen medical students. The trip includes team-building activities, discussions about wellness and medicine, mindfulness training, and backpacking skill lessons. Group leaders facilitate conversations about the demands of medical school, including a space where participants can anonymously share anxieties about their upcoming matriculation as well as both formal and informal opportunities to exchange strategies for maintaining wellness with one another. Analogies are drawn between the challenges of a backpacking trip and the difficulties of medical school, and participants are encouraged to brainstorm how to transfer skills they learn during CAMP to the postmatriculation medical school environment. On the final night of CAMP, participants write a letter to themselves, which is mailed back to them by their CAMP leaders six months after the trip. The experience culminates in all groups coming together for a farewell barbeque that is attended by medical school staff and faculty, who are given the opportunity to welcome the new students into their community. Table 1 provides a list of several curricular elements with associated aims.</p> <p>Graph</p> <p>Table 1. Select Curricular Elements of the University of Michigan Medical School's Creating Adventurous and Mindful Physicians Outdoor Orientation Program.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left">Curricular Element</th><th align="center">Brief Description</th><th align="center">Aims</th></tr></thead><tbody><tr><td>Full value contract</td><td>Contract established and agreed upon by participants describing goals for themselves, each other, and the program in line with their values.</td><td><list list-type="Bullet"><list-item><p>Encourage collaboration between participants</p></list-item><list-item><p>Set the stage for reflective goal-setting in medical school</p></list-item></list></td></tr><tr><td>Fears in a hat</td><td>Participants anonymously write down their fears about medical school. All fears are placed in a hat and are revealed one-by-one, read aloud, and discussed by the group.</td><td><list list-type="Bullet"><list-item><p>Encourage vulnerability</p></list-item><list-item><p>Emphasize the shared experience of participants</p></list-item><list-item><p>Reduce "imposter syndrome"</p></list-item></list></td></tr><tr><td>Fill my cup</td><td>Participants share gratitude with their peers for specific actions or characteristics.</td><td><list list-type="Bullet"><list-item><p>Solidify participant bonding and build community</p></list-item></list></td></tr><tr><td>Cherry pit minutes</td><td>Guided, short, reflective exercises interspersed throughout the trip.</td><td><list list-type="Bullet"><list-item><p>Introduce concepts of meditation and reflection, as well as ways to infuse these practices into daily life post-trip</p></list-item></list></td></tr><tr><td>Letter to future self</td><td>Participants independently write a note to their future selves (prompts are provided for those interested). This note is mailed to each participant 6-9 months into their first year.</td><td><list list-type="Bullet"><list-item><p>Enable goal-setting and anchoring of student values</p></list-item><list-item><p>Promote reflection</p></list-item></list></td></tr><tr><td>Closing barbecue</td><td>All groups come together with faculty from the medical school for additional team-building and connection.</td><td><list list-type="Bullet"><list-item><p>Facilitate faculty-student and between-group relationships to limit clique formation and conclude the program</p></list-item></list></td></tr></tbody></table> </ephtml> </p> <p>An assessment of the 2017 pilot CAMP trip ([<reflink idref="bib7" id="ref38">7</reflink>]) is the first study of which the authors are aware that describes outdoor orientation programming at the medical school level. Findings from the pilot trip were largely positive, suggesting that students' sense of belonging, readiness to start medical school, and emotional fortitude were either reaffirmed or increased during the program ([<reflink idref="bib7" id="ref39">7</reflink>]). In contrast to the informal, 16-person pilot backpacking trip assessed by [<reflink idref="bib7" id="ref40">7</reflink>], this current work offers a more in-depth, longitudinal analysis of the first formal, 66-participant CAMP trip. The purpose of this manuscript is to describe participants' impressions of a formal medical school outdoor orientation program, and to frame the findings in the context of the larger body of literature associated with the transition to medical school and outdoor orientation programs at the undergraduate level. We will also offer some insight about the implementation of such a program at other medical schools.</p> <hd id="AN0158393537-2">Methods</hd> <p>This mixed methods study was approved by the Institutional Review Board at the University of Michigan, Ann Arbor. We collected two distinct sources of data on the 2018 CAMP participants, all of whom were incoming medical students at the time of the 2018 CAMP trip: (<reflink idref="bib1" id="ref41">1</reflink>) a survey administered via Qualtrics (Provo, UT) immediately following the trip in August 2018, and (<reflink idref="bib2" id="ref42">2</reflink>) focus groups conducted in June 2019 with a subset of the same trip's participants. The post-trip survey was emailed to all 66 participants following the trip, and <emph>N</emph> = 56 responded. It was composed of three Likert-scale questions and five free-text questions (see endnote #1). The Likert-scale questions were analyzed using SPSS version 25 (Armonk, NY). A thematic analysis was conducted to analyze the participants' free-text responses to the question, "What have you learned from CAMP that you can apply during medical school?" The other four questions were excluded from the thematic analysis because they primarily focused on areas of improvement for future trips and were therefore irrelevant to our research question.</p> <p>In order to more thoroughly understand the impact that CAMP had on its participants, focus groups were held about one year following the trip (June 2019), and themes were elicited from the focus groups via another thematic analysis. Focus groups were chosen to collect these data because they facilitate discussion and debate among participants in order to explore their perspectives ([<reflink idref="bib25" id="ref43">25</reflink>]). Participants were recruited for the focus groups via email. All <emph>N</emph> = 66 CAMP 2018 participants were invited to participate, and a total of <emph>N</emph> = 18 students consented and were included in the focus groups. A focus group guide was developed by three members of the research team and was piloted with the other members of the team, all of whom had participated in the CAMP program in 2017 so were familiar with the program's structure. The guide was edited to reflect their feedback. Three separate focus groups were conducted. Each was led by two members of the research team and lasted approximately 60 min. The post-trip survey and focus group guide are available online as supplemental material.</p> <p>We began the focus groups by introducing the purpose of the study and obtaining consent to record. After introductions, we elicited participants' general associations with CAMP, and then specifically asked about the program's effects on community-building, relationships with classmates, the transition to medical school, and outdoor knowledge and skills. We also asked how CAMP affected students' ability to face challenges during medical school, why they would or would not recommend the program to other incoming students, and how CAMP impacted the way they felt about medical school in general. Finally, we briefly described how, in school-wide annual assessments, the program has not yet been associated with a quantitative decrease in burnout over time, and we asked participants why they thought this might be.</p> <p>The two thematic analyses conducted in this study both adopted a conventional, inductive approach. Thematic analysis allows the researcher to identify key themes in the data in a systematic way without constraining the analysis to a set of predetermined theories ([<reflink idref="bib8" id="ref44">8</reflink>]; [<reflink idref="bib10" id="ref45">10</reflink>]). Given the dearth of previous research on medical school outdoor orientation programs, the inherent flexibility of thematic analysis was important ([<reflink idref="bib8" id="ref46">8</reflink>]). The raw data were reviewed multiple times prior to beginning the coding process. Line-by-line coding was conducted in Microsoft Word and Excel (Redmond, WA) by two independent coders. These codes were modified through discussion and reconciliation of differences as necessary as the reviewers progressed through the raw data until intercoder agreement was achieved. The final set of codes was reviewed, and common codes were grouped together into categories. Each code was assigned to only one category. Finally, the categories were assessed and grouped into a set of broader themes. As this inductive approach is inherently subjective, both thematic analyses were then discussed with additional members of the team to discuss any potential biases and outliers, which were reconciled until the entire team agreed on a consensus that best reflected the underlying data.</p> <hd id="AN0158393537-3">Results</hd> <p></p> <hd id="AN0158393537-4">Post-trip Survey (August 2018): Quantitative Results</hd> <p>A total of <emph>N</emph> = 56 (85%) CAMP participants responded to each of the three quantitative questions in the post-trip survey. The first question was analyzed using the "net promoter" methodology developed by [<reflink idref="bib21" id="ref47">21</reflink>]. Using a 10-point Likert scale, participants were asked, "How likely is it that you would recommend CAMP to a friend who is about to start medical school?" In the net promoter methodology, scores of 0–6 are considered "Detractors," scores of 7–8 "Passives," and scores of 9–10 "Promoters." The overall net promoter score is then calculated by subtracting the number of Detractors from the number of Promoters. The mean (±S.D.) response was 9.63 (±0.095), and the net promoter overall score was 91% (Figure 1).</p> <p>Graph: Figure 1. Net promoter framework applied to responses from the 2018 post-CAMP survey question, "How likely is it that you would recommend CAMP to a friend who is about to start medical school?"</p> <p>The second quantitative question asked participants to respond to the statement, "I feel more prepared to start classes than I did before attending CAMP." Answer choices ranged from Strongly Disagree (<reflink idref="bib1" id="ref48">1</reflink>) to Strongly Agree (<reflink idref="bib5" id="ref49">5</reflink>). The mean (±S.D.) response was 4.14 (±0.085). Eighty-three percent of the students agreed or strongly agreed that they feel more prepared to start classes than before attending CAMP (Figure 2).</p> <p>Graph: Figure 2. Likert responses to the 2018 post-CAMP survey question: "I feel more prepared to start classes than I did before attending CAMP."</p> <hd id="AN0158393537-5">Post-trip Survey (August 2018): Thematic Analysis</hd> <p>Thematic analysis was used to analyze the <emph>N</emph> = 56 responses to the free-text-response question, "What have you learned from CAMP that you can apply during medical school?" Four themes and 14 subthemes were derived from the data (Table 2).</p> <p>Graph</p> <p>Table 2. Themes and Subthemes Derived From a Thematic Analysis of the 2018 Post-CAMP Survey Question, "What Have You Learned From CAMP That You Can Apply During Medical School?"</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left">Themes</th><th align="center">Subthemes</th><th align="center">Example Quotes</th></tr></thead><tbody><tr><td rowspan="3">Fears</td><td>Asking for help</td><td>"It's always okay to ask for help, and help will always be there for me."</td></tr><tr><td>Shared fears/anxieties with peers</td><td>"I am not alone, and many of my classmates share my fears and anxieties.""Knowing that everyone else has similar fears and also wants to connect was really helpful."</td></tr><tr><td>Vulnerability</td><td>"People will reciprocate when you are open and vulnerable with them. I never could have anticipated exactly how well it would go and how easy it was to shed any sort of worries about the people we would meet."</td></tr><tr><td rowspan="4">Relationships</td><td>Conversations</td><td>"It was amazing how open our entire group was, and I believe that really changed the dynamic and made everyone comfortable talking about uncomfortable things."</td></tr><tr><td>New connections</td><td>"CAMP created a unique dynamic that I believe allowed us to be more vulnerable with each other... I believe it will be easier to reach out again during the school year, allowing for deeper connections with any of our classmates."</td></tr><tr><td>Quality of classmates</td><td>"I learned how amazing my class is, and I'm so ready to spend the next four years with them. This class is truly amazing."</td></tr><tr><td>Supportive community</td><td>"My classmates are truly willing to support and help me if I reach out to them. The M2 leaders [second-year medical students] in my group are also willing to help."</td></tr><tr><td rowspan="5">New skills</td><td>Communication skills</td><td>"We communicated well to create a shelter under which we could cook and eat our food. These skills (adaptability and communication/teamwork) will come in handy during medical school."</td></tr><tr><td>Resilience/perseverance</td><td>"[CAMP taught me] perseverance and that friends will support you and relate when you are struggling!"</td></tr><tr><td>Role of the group/team</td><td>"Collaboration and drawing from the skills/experiences of my other classmates was important in CAMP, and will be especially important in med school."</td></tr><tr><td>Social skills</td><td>"[I learned] teamwork, communication, and cooperation.""[I learned] teamwork, patience, and open-mindedness."</td></tr><tr><td>Wellness</td><td>"[I learned] to just breathe and remember the big picture when the stresses feel overwhelming.""You shouldn't give up your hobbies in medical school."</td></tr><tr><td rowspan="2">CAMP and medical school</td><td>Applications of CAMP to medical school</td><td>"Hiking teaches a lot about perseverance, and that will also be required in medical school as well.""My guides taught me a lot about how to be flexible during medical school when it came to studying."</td></tr><tr><td>Relationship with upperclassmen/leaders</td><td>"CAMP helped me find out more about the Michigan-specific med school experience (from leaders).""Upperclassmen are so kind and helpful; reach out to them!"</td></tr></tbody></table> </ephtml> </p> <p>1 CAMP = Creating Adventurous and Mindful Physicians Outdoor Orientation Program.</p> <p>Graph</p> <p>Table 3. Themes and Subthemes Derived From a Thematic Analysis of Focus Groups Conducted in June 2019.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left">Themes</th><th align="center">Subthemes</th><th align="center">Example Quotes</th></tr></thead><tbody><tr><td rowspan="6">Developing a support system</td><td>Forming a friendly team environment</td><td>"CAMP facilitated conversations, and activities helped form relationships."</td></tr><tr><td>Developing a support system</td><td>"Huge overlap between CAMP and my core community in medical school.""CAMP gave me a strong support system."</td></tr><tr><td>Making friends</td><td>"My best friends are from CAMP.""CAMP was a good stepping stone to friendships."</td></tr><tr><td>Promotes meaningful connections</td><td>"CAMP increased my ability to be vulnerable with friends."</td></tr><tr><td>Building community within CAMP</td><td>"CAMP has given me friends and community."</td></tr><tr><td>Positive experience</td><td>"CAMP gave me positive views of Michigan.""It would be nice to come back to CAMP."</td></tr><tr><td rowspan="3">Building community outside of CAMP</td><td>Connected incoming first-year students to each other</td><td>"CAMP brought people of the same values together, but I also became friends with people I wouldn't have otherwise."</td></tr><tr><td>Connected incoming first-year students to greater medical school community</td><td>"CAMP feels like part of the Michigan community.""Administration seemed accessible at the barbeque."</td></tr><tr><td>Building community (general)</td><td>"CAMP attracts people who are afraid of not meeting anyone.""I could talk to anyone in my class if I were struggling."</td></tr><tr><td rowspan="5">Transition to medical school</td><td>Improves transition to medical school</td><td>"CAMP helped promote collaboration early in the year.""I felt more optimistic and excited to transition in."</td></tr><tr><td>Builds student confidence</td><td>"CAMP pushed me out of my comfort zone.""Making it through an outdoor experience upped my confidence."</td></tr><tr><td>Draws applicants to UMMS</td><td>"CAMP was my main reason for coming here as a non-Michigander."</td></tr><tr><td>Desirable pre-orientation experience</td><td>"It was nice to have a few stress-free days before starting school.""I appreciated that people took activities and team bonding seriously."</td></tr><tr><td>Challenging transition</td><td>"Some classmates regretted not going on CAMP.""CAMP made the transition harder for those who didn't go on CAMP."</td></tr><tr><td rowspan="2">Learning wilderness-related skills</td><td>Connection with outdoors</td><td>"CAMP opened my mind to going outdoors.""I enjoyed exploring Michigan."</td></tr><tr><td>Camping skills</td><td>"Learning new skills was motivating."</td></tr><tr><td rowspan="3">Learning emotional resilience-related skills</td><td>Tangible mindfulness and wellness skills</td><td>"CAMP was a reminder to be intentional about my actions.""I learned mindfulness tricks."</td></tr><tr><td>Encourages self-reflection</td><td>"I used the 'letter to myself' as motivation during stressful [medical school] sequences.""CAMP was a strong reminder that what I'm feeling inside isn't necessary what's reflected externally."</td></tr><tr><td>Ascribes value to life outside of medicine</td><td>"It was really nice to see that other people care about the outdoors.""CAMP created a dialogue about wellness and mental health."</td></tr><tr><td rowspan="2">Sustainability after CAMP</td><td>Limitations in preventing burnout</td><td>"The skills needed to deal with the challenges of med school can't be learned on a 3-day trip.""Burnout is secondary to the pace of the medical school curriculum."</td></tr><tr><td>Impact not sustained throughout first year</td><td>"CAMP helps start friendships but can't sustain or transform them.""I would love to have a follow-up event open to the whole school."</td></tr><tr><td rowspan="2">Trip-specific changes</td><td>CAMP outdoor experience too limited</td><td>"CAMP did not increase my backpacking skills.""I would like more wilderness medicine training on CAMP."</td></tr><tr><td>CAMP outdoor experience too challenging</td><td>"The quick hiking speed can make it feel physically challenging.""Expectations for distances weren't clear to non-backpackers."</td></tr></tbody></table> </ephtml> </p> <p>2 CAMP = Creating Adventurous and Mindful Physicians Outdoor Orientation Program.</p> <p>Many participants described concepts related to fears and anxieties in their responses. Specifically, they commented that CAMP reminded them of the importance of asking for help when needed. They also noted that some of the trip's activities enabled them to embrace vulnerability, which resulted in a realization that many of their peers shared similar anxieties about starting medical school. Many students described a sentiment similar to that of this participant:</p> <p>"The biggest thing I took away from CAMP is that I am not alone and that many of my classmates share my fears and anxieties and are more than willing to be there for each other if we are ever overwhelmed or struggling. In other words, it's always okay to ask for help, and help will always be there for me."</p> <p>Some participants noted that their natural tendency is to not be immediately vulnerable with a new group of people. However, they felt that the setting of CAMP helped "to push myself out of my comfort zone more, especially when it comes to being vulnerable with my classmates and open about my failures, fears, and insecurities." Not only did a recognition of shared anxieties help with community-building, but it also contributed to participants' ability to be emotionally present on the trip: "I never could have anticipated exactly how well it would go and how easy it was to shed any sort of worries about the people we would meet, and simply be in the moment."</p> <p>The formation of new relationships with classmates was another prevailing theme that emerged in many responses. One participant noted that "there were talks that we had on the trip that I haven't been able to have with fellow students since we started [medical school]," and another felt that the depth of these connections will make it "easier to reach [out] again during the school year, allowing for deeper connections with any of our classmates." Many participants described a setting that enabled them to improve their communication skills and then use those skills to form connections, culminating in very positive sentiments about their new classmates: "I learned how amazing my class is, and I'm so ready to spend the next four years with them. This class is truly amazing."</p> <p>Participants also described a wide variety of skills that they had learned on the trip and planned to use in medical school, with resilience and wellness being two of the more salient skills. The trip showed one student "that I'm capable of handling and getting through a situation even if I think I can't do it," and another noted "that sometimes the journey will be challenging, but you need to keep going and build relationships along the way that will help lift you up." Wellness-related topics such as patience, open-mindedness, mindfulness, and different forms of self-care were also explicitly mentioned as takeaways from the trip. Finally, the relationships formed with upperclassmen and some of the medical school-specific knowledge that was transmitted through those relationships was very helpful for participants as they transitioned into medical school.</p> <hd id="AN0158393537-6">Focus Groups (June 2019): Thematic Analysis</hd> <p>Seven themes emerged from the focus groups (Table 3). Broadly, participants described how CAMP helped them to establish a support system and community, eased their transition to medical school, and gave them tools to improve wellness and resilience.</p> <p>Many students described the ways in which CAMP helped them to develop a support system. Participants commented not only on the <emph>quantity </emph>of friendships established during CAMP, but also on the ease of forming friendships ("allowed for quicker bonding," "CAMP facilitated quicker formation of friend groups") and on the <emph>quality </emph>of those friendships. Indeed, quality of friendships was cited by many participants, with multiple students noting that their "best" or "closest" friends were made on CAMP, that "no more small talk [was] needed" because of CAMP, and that "overcoming adversity promoted bonding."</p> <p>In addition to developing a support system with other CAMP participants, the focus groups revealed that CAMP helped establish a community more broadly within the medical school. Participants felt that CAMP helped connect first-year medical students to one another and to the greater medical school community at large, including the administration. One participant noted that because of CAMP, they feel "connected to other CAMPers who aren't close friends," and another was "shocked to hear that other classes didn't have the same collaboration" (of note, this cohort of students was the first to be offered participation in the formal CAMP program). One student also commented that the relationship between CAMP and the community is bidirectional, noting that CAMP also "contributes to the community."</p> <p>Assisting with the transition to school is one of the shared goals of all outdoor orientation programs ([<reflink idref="bib3" id="ref50">3</reflink>]), and CAMP is no exception. Because of CAMP, students "felt more optimistic and excited to transition in" and noted that CAMP "validated [the] school's message of valuing wellness initially." Participants also noted that CAMP is an independent draw for the medical school itself ("main reason for coming here as a non-Michigander"), in addition to building student confidence and decreasing anxiety. Many participants addressed this decrease in anxiety, noting that CAMP "made school less intimidating" and that it "helped to see others' vulnerability and weaknesses." Importantly, however, some participants noted that, depending on the situation, CAMP may have fostered the formation of exclusive groups, making the transition more difficult for those who found themselves in the "out-group."</p> <p>Wilderness-related knowledge and skills were also discussed multiple times throughout the focus groups. Participants noted that the connection with the outdoors and the pushing of one's comfort zone were important aspects of the trip. Although some felt that "CAMP is hard for inexperienced campers," there was a shared understanding that "CAMP is about bringing people together of different abilities." Even a year after the trip itself, focus group participants listed a number of specific skills that they learned on the trip and that the "opportunity to learn" was a highlight.</p> <p>In addition to the wilderness-specific skills, another theme that emerged was the fact that CAMP facilitates the development of skills related to emotional resilience. Participants described the acquisition of tangible mindfulness and wellness skills, the fact that CAMP encourages self-reflection, and how they learned to ascribe value to life outside of medicine. Participants felt that CAMP "created a dialogue about wellness and mental health," and that one strength of the program is that it "encourages but doesn't force wellness." The letter to oneself was brought up multiple times during the focus groups, and participants appreciated the self-support system that it fostered, noting that they "used the letter as motivation during stressful situations." Participants also highlighted mindfulness skills, social skills, and intentionality as important takeaways from CAMP.</p> <p>One of the other themes that arose was that of sustainability of these effects after CAMP is over. Importantly, many of the comments that underlie this theme and the theme of trip-specific changes were made in response to the focus group question about why a separate, school-wide survey did not find a statistically significant relationship between CAMP participation and burnout reduction, in spite of the community-building, support system, and resilience skills that participants described. Participants expressed a sentiment that the challenges experienced on CAMP are not always analogous to those experienced during medical school, and that participation in the trip cannot change the inevitable stressors of school (e.g., "a great CAMP trip doesn't decrease the amount of schoolwork"). There was also a sentiment that the definition of "burnout" depends on the person, and an outdoor orientation program does not necessarily equate to burnout prevention for everyone. Finally, integration within the broader medical school community could also theoretically help protect against burnout, but participants noted that integration with other class years was fairly dependent on the CAMP group and whether participants and their upperclassmen group leaders maintained a relationship following the trip. This theme also captured a variety of participant suggestions about how CAMP can be improved moving forward, in which many expressed a shared desire to have additional CAMP-related events throughout the school year. Although CAMP seems to facilitate integration with upperclassmen during the short transition into medical school, the incorporation of longitudinal events may promote more sustainable integration with other classes and with the medical school administration.</p> <hd id="AN0158393537-7">Discussion</hd> <p>Both the quantitative and qualitative results of this study suggest that CAMP was perceived to have a largely positive impact on participants, and a number of those positive themes emerged again one year following the trip. Specifically, CAMP helped ease participants' transition to medical school and contributed to the establishment of a support system within their new community. The program also empowered students to hone wellness and resilience skills; this theme was described both immediately and one year after the trip. These findings align with the undergraduate-specific literature, which also describes the community-building, personal growth, and improved transition into school that result from such programs ([<reflink idref="bib5" id="ref51">5</reflink>]). This study builds on the work of [<reflink idref="bib7" id="ref52">7</reflink>] by describing the impact of a <emph>formal </emph>outdoor orientation program for incoming medical students and assessing the long-term effects.</p> <p>Importantly, the themes that arose from this study are uniquely suited to combat the risk of burnout associated with the medical school transition. Several studies have found that burnout in medical students is correlated with the lack of a nurturing network of peers ([<reflink idref="bib13" id="ref53">13</reflink>]; [<reflink idref="bib16" id="ref54">16</reflink>]; [<reflink idref="bib26" id="ref55">26</reflink>]). The development of a peer support system through CAMP, both immediately and one year following the trip, may help protect against the development of burnout. Medical students are also likely to feel overwhelmed by the content and quantity of learning material during their transition ([<reflink idref="bib11" id="ref56">11</reflink>]), and the vertical integration and sense of connectedness with the administration fostered by CAMP may provide students with tools and resources to navigate these changes, particularly early on in the transition. Finally, the decrease in self-efficacy that plagues many medical students during their first year of medical school ([<reflink idref="bib22" id="ref57">22</reflink>]) may contribute to the loss of resilience that is felt to contribute to burnout ([<reflink idref="bib16" id="ref58">16</reflink>]). Although this study did not explicitly assess self-efficacy, CAMP participants described the mindfulness skills that they gained from the trip, as well as the fact that CAMP helped them realize that their peers are also struggling with medical school-related anxieties. These results suggest that the trip normalized asking for help and reaching out to others, a behavior that historically was frowned upon in medicine but is slowly becoming accepted as an important component of burnout prevention ([<reflink idref="bib23" id="ref59">23</reflink>]).</p> <p>Given these promising findings and the burnout epidemic among medical students, there exist ample opportunities for continued research on this topic. As the first study on a formal medical school outdoor orientation program (supplementing [<reflink idref="bib7" id="ref60">7</reflink>]'s findings on the pilot program), we took an inductive approach to thematic analysis and opted to describe themes in general rather than the specific relationship between CAMP and burnout. Future research could certainly explore this relationship more explicitly, and because the prevalence of burnout appears to increase as medical students progress into more advanced years of their training ([<reflink idref="bib12" id="ref61">12</reflink>]), future research could also attempt to elucidate whether the positive effects of outdoor orientation programs early in training persist into later years. Finally, this is a single-institution study with small sample sizes. Although the similarities between our findings and the undergraduate-specific literature suggest that there may be shared principles, research on other medical school outdoor orientation programs will help further validate our findings.</p> <p>There are a number of key takeaways that should be considered by other medical schools that are contemplating developing their own outdoor orientation program. Participants perceived that CAMP facilitated wellness skills, a sense of community, and a support system during the transition to medical school. This was a powerful outcome given the short nature of the intervention. Although participant feedback was largely positive, as evidenced by the overall net promoter score of 91%, there were two concerns mentioned: whether the trip's positive effects would persist during the subsequent years of medical school, and how to prevent the formation of an in-group/out-group dynamic, particularly among students who did not attend the trip.</p> <p>To address the first concern, the authors recommend that any future medical school outdoor orientation programs also consider adding longitudinal follow-up experiences throughout medical school. Given the unique challenges of medical school and the series of transitions that occur throughout training (e.g., shifting from didactics into the hospital, clinic, or operating room), similar outdoor interventions may be useful at other key transition points. For example, one such experience might consist of a guided hike with reflection activities at each major medical school transition point. We would recommend the inclusion of upperclassmen guides as well as alumni of the trip from other class years in these longitudinal experiences to facilitate continued interclass connection after the orientation program.</p> <p>To address the second primary concern, peer medical schools should attempt to mitigate the development of an in-group/out-group dynamic by implementing thoughtful integration activities with the entire incoming class. For example, during the next CAMP trip, we plan to host a post-trip barbecue to which all incoming students, regardless of participation in CAMP, are invited. Peer medical schools should also actively consider the potential benefits and drawbacks of making a future outdoor orientation program mandatory for all medical students. Expanding enrollment in the program to as many incoming students as possible could promote stronger community-building while preventing the formation of exclusive "out-groups" of students who did not participate. However, an important limitation to mandating wilderness trips is that they are most accessible to students without physical disabilities. This could be addressed in part by the utilization of adaptive recreation equipment, or the trip could be planned such that campsites are accessible by vehicle to allow participants who are unable to hike to drive in as needed. Leaders would need to be intentional about facilitating team bonding activities in this setting to ensure that any participants with disabilities feel fully welcomed into the team. Focusing on both diversity and inclusion of potential participants should be a core objective for any institution considering implementing an outdoor orientation program.</p> <hd id="AN0158393537-8">Conclusion</hd> <p>The CAMP program at the University of Michigan Medical School is one of just a small number of outdoor orientation programs that exist at the medical school level and is the first, to our knowledge, to be systematically studied. The body of literature on undergraduate outdoor orientation programs suggests that they have both immediate and enduring effects ([<reflink idref="bib5" id="ref62">5</reflink>]; [<reflink idref="bib15" id="ref63">15</reflink>]), and our study indicates that programs at the medical school level may have similar effects on community-building, personal growth, and resilience. The potential efficacy of medical school outdoor orientation programs is particularly promising given the unique challenges associated with the transition to medical school ([<reflink idref="bib11" id="ref64">11</reflink>]), the high rates of burnout among medical students ([<reflink idref="bib18" id="ref65">18</reflink>]), and the lack of uniform orientation programming across institutions ([<reflink idref="bib14" id="ref66">14</reflink>]). Despite the potentially severe consequences of medical student burnout ([<reflink idref="bib12" id="ref67">12</reflink>]), the medical education community remains divided on how to best tackle this important concern ([<reflink idref="bib12" id="ref68">12</reflink>]). The burnout literature demonstrates that having a strong support system and an individual sense of resilience help prevent burnout in medical students ([<reflink idref="bib16" id="ref69">16</reflink>]; [<reflink idref="bib26" id="ref70">26</reflink>]), and these were two of the key perceived effects of CAMP described by participants. The medical education community should therefore strongly consider adapting outdoor orientation programs to the medical school level to ease the challenging transition into medical school and help combat the growing epidemic of medical student burnout.</p> <hd id="AN0158393537-9">Supplemental Material</hd> <p>sj-docx-1-jee-10.1177_10538259211048611.docx</p> <p>sj-docx-1-jee-10.1177_10538259211048611 - Supplemental material for The Impact of a Novel Outdoor Orientation Program on Incoming Medical Students</p> <p></p> <p>Supplemental material, sj-docx-1-jee-10.1177_10538259211048611 for The Impact of a Novel Outdoor Orientation Program on Incoming Medical Students by Jacquelyn B. Kercheval, Alec Bernard, Hanna Berlin, Nicole Byl, Boone Marois, Rahul Puttagunta, Elizabeth Holman and Patrick D. Bridge in Journal of Experiential Education</p> <p></p> <hd id="AN0158393537-10">Acknowledgments</hd> <p>The author(s) would like to thank the M-Home program and the administration at the University of Michigan Medical School for their support for CAMP.</p> <ref id="AN0158393537-11"> <title> References </title> <blist> <bibl id="bib1" idref="ref34" type="bt">1</bibl> <bibtext> Allos B. M., Yakes E. A., Fleming A., Cutrer W. B., Pilla M., Clair W., Fowler M., Miller B. (2018). Framing medicine as a moral practice: An introductory medical school course. Academic Medicine, 93(9), 1310–1314. https://doi.org/10.1097/acm.0000000000002301</bibtext> </blist> <blist> <bibl id="bib2" idref="ref36" type="bt">2</bibl> <bibtext> Bandaru A. K. (2019). Analysis of orientation program for first year MBBS students to acclimatize to medical institution. International Journal of Scientific Research, 8(11), 22–23. https://doi.org/10.36106/ijsr%2F5001060</bibtext> </blist> <blist> <bibl id="bib3" idref="ref8" type="bt">3</bibl> <bibtext> Bell B. J. (2006). Wilderness orientation: Exploring the relationship between college preorientation programs and social support. Journal of Experiential Education, 29(2), 145–167. https://doi.org/10.1177%2F105382590602900206</bibtext> </blist> <blist> <bibl id="bib4" idref="ref6" type="bt">4</bibl> <bibtext> Bell B. J. (2012). Assessing the effectiveness of an adventure-based first-year experience class. Journal of Collect Student Development, 53(2), 347–355. https://doi.org/10.1353/csd.2012.0031</bibtext> </blist> <blist> <bibl id="bib5" idref="ref1" type="bt">5</bibl> <bibtext> Bell B. J., Gass M. A., Nafziger C. S., Starbuck J. D. (2014). The state of knowledge of outdoor orientation programs: Current practices, research, and theory. Journal of Experiential Education, 37(1), 31–45. https://doi.org/10.1177/1053825913518891</bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext> Bell B. J., Holmes M. R. (2011). Important factors leading to outdoor orientation program outcomes: A qualitative exploration of survey results. Journal of Outdoor Recreation, Education, and Leadership, 3(1), 26–39. https://doi.org/10.7768/1948-5123.1075</bibtext> </blist> <blist> <bibl id="bib7" idref="ref38" type="bt">7</bibl> <bibtext> Bernard A., Kercheval J. B., Blaty A. D., Burrows H. (2018). Creating adventurous and mindful physicians: Expanding wilderness orientation programs to medical school. Michigan Journal of Medicine, 3(1), 57–63. https://doi.org/10.3998/mjm.13761231.0003.109</bibtext> </blist> <blist> <bibl id="bib8" idref="ref44" type="bt">8</bibl> <bibtext> Braun V., Clarke V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa</bibtext> </blist> <blist> <bibl id="bib9" idref="ref16" type="bt">9</bibl> <bibtext> Brazeau C. M. L. R., Shanafelt T., Durning S. J., Massie F. S., Eacker A., Moutier C., Satele D. V., Sloan J. A., Dyrbye L. N. (2014). Distress among matriculating medical students relative to the general population. Academic Medicine, 89(11), 1520–1525. https://doi.org/10.1097/acm.0000000000000482</bibtext> </blist> <blist> <bibtext> Castleberry A., Nolen A. (2018). Thematic analysis of qualitative research data: Is it as easy as it sounds? Currents in Pharmacy Teaching and Learning, 10(6), 807–815. https://doi.org/10.1016/j.cptl.2018.03.019</bibtext> </blist> <blist> <bibtext> Cooke M., Irby D. M., O'Brien B. C., Shulman L. S. (2010). Educating physicians: A call for reform of medical school and residency. Jossey-Bass.</bibtext> </blist> <blist> <bibtext> Dyrbye L., Shanafelt T. (2016). A narrative review on burnout experienced by medical students and residents. Medical Education, 50(1), 132–149. https://doi.org/10.1111/medu.12927</bibtext> </blist> <blist> <bibtext> Dyrbye L. N., Power D. V., Massie F. S., Eacker A., Harper W., Thomas M. R., Szydlo D. W., Sloan J. A., Shanafelt T. D. (2010). Factors associated with resilience to and recovery from burnout: A prospective, multi-institutional study of US medical students. Medical Education, 44(10), 1016–1026. https://doi.org/10.1111/j.1365-2923.2010.03754.x</bibtext> </blist> <blist> <bibtext> Ellaway R. H., Cooper G., Al-Idrissi T., Dubé T., Graves L. (2014). Discourses of student orientation to medical education programs. Medical Education Online, 19(1). https://doi.org/10.3402/meo.v19.23714</bibtext> </blist> <blist> <bibtext> Gass M. A., Garvey D. E., Sugerman D. A. (2003). The long-term effects of a first-year student wilderness orientation program. Journal of Experiential Education, 26(1), 34–40. https://doi.org/10.1177%2F105382590302600106</bibtext> </blist> <blist> <bibtext> Hariharan T. S., Griffin B. (2019). A review of the factors related to burnout at the early-career stage of medicine. Medical Teacher, 41(12), 1380–1391. https://doi.org/10.1080/0142159x.2019.1641189</bibtext> </blist> <blist> <bibtext> Hill E., Posey T., Gomez E., Shapiro S. L. (2018). Student readiness: Examining the impact of a university outdoor orientation program. Journal of Outdoor Recreation, Orientation, and Leadership, 10(2), 109–123. https://doi.org/10.18666/JOREL-2018-V10-I2-7184</bibtext> </blist> <blist> <bibtext> Ishak W., Nikravesh R., Lederer S., Perry R., Ogunyemi D., Bernstein C. (2013). Burnout in medical students: A systematic review. Clinical Teacher, 10(4), 242–245. https://doi.org/10.1111/tct.12014</bibtext> </blist> <blist> <bibtext> Osterberg L., Gilbert J., Lotan R. (2014). From high school to medical school: The importance of community in education. Medical Science Educator, 24(3), 353–356. https://doi.org/10.1007/s40670-014-0060-z</bibtext> </blist> <blist> <bibtext> Patel J., Akhani P. (2017). A study of perception of first-year MBBS students toward orientation program and foundation course at entry level. National Journal of Physiology, Pharmacy and Pharmacology, 7(9), 920–923.</bibtext> </blist> <blist> <bibtext> Reichheld F. F. (2003). The one number you need to grow. Harvard Business Review, 81(12), 46–54. <ulink href="http://hbr.org/2003/12/the-one-number-you-need-to-grow/ar/1">http://hbr.org/2003/12/the-one-number-you-need-to-grow/ar/1</ulink></bibtext> </blist> <blist> <bibtext> Rosenthal J. L. (2012). Motives and methods: Motivation, learning approaches, and academic achievement of students during first year transition to medical school. University of Southern California dissertations and theses. <ulink href="http://digitallibrary.usc.edu/cdm/ref/collection/p15799coll3/id/66075">http://digitallibrary.usc.edu/cdm/ref/collection/p15799coll3/id/66075</ulink>.</bibtext> </blist> <blist> <bibtext> Shanafelt T. D., Schein E., Minor L. B., Trockel M., Schein P., Kirch D. (2019). Healing the professional culture of medicine. Mayo Clinic Proceedings, 94(8), 1556–1566. https://doi.org/10.1016/j.mayocp.2019.03.026</bibtext> </blist> <blist> <bibtext> Shellman A., Hill E. (2017). Flourishing through resilience: The impact of a college outdoor education program. The Journal of Park and Recreation Administration, 35(4), 59–68. https://doi.org/10.18666/JPRA-2017-V35-I4-7779</bibtext> </blist> <blist> <bibtext> Stalmeijer R. E., Mcnaughton N., Van Mook W. N. (2014). Using focus groups in medical education research: AMEE Guide No. 91. Medical Teacher, 36(11), 923–939. https://doi.org/10.3109/0142159x.2014.917165</bibtext> </blist> <blist> <bibtext> Tackett S., Wright S., Lubin R., Li J., Pan H. (2017). International study of medical school learning environments and their relationship with student well-being and empathy. Medical Education, 51(3), 280–289. https://doi.org/10.1111/medu.13120</bibtext> </blist> <blist> <bibtext> van Buuren A., Yaseen W., Veinot P., Mylopoulos M., Law M. (2021). Later is too late: Exploring student experiences of diversity and inclusion in medical school orientation. Medical Teacher, 43(5), 538-545. https://doi.org/10.1080/0142159x.2021.1874326</bibtext> </blist> <blist> <bibtext> White C. B. (2007). Smoothing out transitions: How pedagogy influences medical students' achievement of self-regulated learning goals. Advances in Health Sciences Education: Theory and Practice, 12(3), 279–297. https://doi.org/10.1007/s10459-006-9000-z</bibtext> </blist> <blist> <bibtext> Wolfe B. D., Kay G. (2011). Perceived impact of an outdoor orientation program for first-year university students. Journal of Experiential Education, 34(1), 19–34. https://doi.org/10.1177%2F105382591103400103</bibtext> </blist> </ref> <ref id="AN0158393537-12"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) received no financial support for the research, authorship and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Jacquelyn B. Kercheval https://orcid.org/0000-0002-4046-098X Alec Bernard https://orcid.org/0000-0003-1494-1322</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> </ref> <aug> <p>By Jacquelyn B. Kercheval; Alec Bernard; Hanna Berlin; Nicole Byl; Boone Marois; Rahul Puttagunta; Elizabeth Holman and Patrick D. Bridge</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib29" firstref="ref5"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref9"></nolink> <nolink nlid="nl3" bibid="bib28" firstref="ref10"></nolink> <nolink nlid="nl4" bibid="bib19" firstref="ref11"></nolink> <nolink nlid="nl5" bibid="bib16" firstref="ref12"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref13"></nolink> <nolink nlid="nl7" bibid="bib12" firstref="ref14"></nolink> <nolink nlid="nl8" bibid="bib13" firstref="ref17"></nolink> <nolink nlid="nl9" bibid="bib26" firstref="ref19"></nolink> <nolink nlid="nl10" bibid="bib24" firstref="ref21"></nolink> <nolink nlid="nl11" bibid="bib17" firstref="ref22"></nolink> <nolink nlid="nl12" bibid="bib15" firstref="ref29"></nolink> <nolink nlid="nl13" bibid="bib14" firstref="ref30"></nolink> <nolink nlid="nl14" bibid="bib27" firstref="ref31"></nolink> <nolink nlid="nl15" bibid="bib20" firstref="ref37"></nolink> <nolink nlid="nl16" bibid="bib25" firstref="ref43"></nolink> <nolink nlid="nl17" bibid="bib10" firstref="ref45"></nolink> <nolink nlid="nl18" bibid="bib21" firstref="ref47"></nolink> <nolink nlid="nl19" bibid="bib22" firstref="ref57"></nolink> <nolink nlid="nl20" bibid="bib23" firstref="ref59"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1347419
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Impact of a Novel Outdoor Orientation Program on Incoming Medical Students
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Kercheval%2C+Jacquelyn+B%2E%22">Kercheval, Jacquelyn B.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4046-098X">0000-0002-4046-098X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Bernard%2C+Alec%22">Bernard, Alec</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1494-1322">0000-0003-1494-1322</externalLink>)<br /><searchLink fieldCode="AR" term="%22Berlin%2C+Hanna%22">Berlin, Hanna</searchLink><br /><searchLink fieldCode="AR" term="%22Byl%2C+Nicole%22">Byl, Nicole</searchLink><br /><searchLink fieldCode="AR" term="%22Marois%2C+Boone%22">Marois, Boone</searchLink><br /><searchLink fieldCode="AR" term="%22Puttagunta%2C+Rahul%22">Puttagunta, Rahul</searchLink><br /><searchLink fieldCode="AR" term="%22Holman%2C+Elizabeth%22">Holman, Elizabeth</searchLink><br /><searchLink fieldCode="AR" term="%22Bridge%2C+Patrick+D%2E%22">Bridge, Patrick D.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Experiential+Education%22"><i>Journal of Experiential Education</i></searchLink>. Sep 2022 45(3):276-294.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 19
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22School+Orientation%22">School Orientation</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Students%22">Medical Students</searchLink><br /><searchLink fieldCode="DE" term="%22Outdoor+Education%22">Outdoor Education</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Adjustment%22">Student Adjustment</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Schools%22">Medical Schools</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Needs%22">Student Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Camps%22">Camps</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Michigan+%28Ann+Arbor%29%22">Michigan (Ann Arbor)</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10538259211048611
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1053-8259<br />2169-009X
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Undergraduate outdoor orientation programs facilitate students' transition into college. Research has yet to be conducted on the few programs at medical schools, which may have unique benefits given the specific challenges of transitioning to medical school and high rates of burnout among medical students. Purpose: This mixed methods study examines the impact of one medical school's outdoor orientation program on its participants. Methodology/Approach: A survey was administered immediately following the 2018 trip (N = 56 responses). Follow-up focus groups were conducted with a sample of the same participants (N = 18) in 2019. Responses were analyzed using descriptive statistics and thematic analysis. Findings/Conclusions: Participants felt that the program helped ease their transition into medical school, establish a support system, and hone personal development and wellness skills. Many of these effects persisted up to one year later. Implications: These findings are of particular interest to the medical and experiential education communities because many outcomes persisted for at least one year after the original trip and aligned with factors believed to protect against medical student burnout. There is opportunity for additional research as well as expansion of similar programs to other medical schools.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1347419
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1347419
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/10538259211048611
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 19
        StartPage: 276
    Subjects:
      – SubjectFull: School Orientation
        Type: general
      – SubjectFull: Medical Students
        Type: general
      – SubjectFull: Outdoor Education
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Student Adjustment
        Type: general
      – SubjectFull: Medical Schools
        Type: general
      – SubjectFull: Student Needs
        Type: general
      – SubjectFull: Camps
        Type: general
      – SubjectFull: Michigan (Ann Arbor)
        Type: general
    Titles:
      – TitleFull: The Impact of a Novel Outdoor Orientation Program on Incoming Medical Students
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Kercheval, Jacquelyn B.
      – PersonEntity:
          Name:
            NameFull: Bernard, Alec
      – PersonEntity:
          Name:
            NameFull: Berlin, Hanna
      – PersonEntity:
          Name:
            NameFull: Byl, Nicole
      – PersonEntity:
          Name:
            NameFull: Marois, Boone
      – PersonEntity:
          Name:
            NameFull: Puttagunta, Rahul
      – PersonEntity:
          Name:
            NameFull: Holman, Elizabeth
      – PersonEntity:
          Name:
            NameFull: Bridge, Patrick D.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 1053-8259
            – Type: issn-electronic
              Value: 2169-009X
          Numbering:
            – Type: volume
              Value: 45
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Journal of Experiential Education
              Type: main
ResultId 1