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Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation

Luke Sanders, Georgie Budd, Lebares Carter, Umakant Dave, Andrew Kemp Orcid Logo

BMC Medical Education, Volume: 25, Issue: 1

Swansea University Authors: Luke Sanders, Georgie Budd, Andrew Kemp Orcid Logo

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DOI (Published version): 10.1186/s12909-025-07768-6

Abstract

BackgroundMedical students face demanding academic requirements, fierce competition, self-doubt and financial concerns contributing to high rates of depression, anxiety, stress, sleep problems and burnout, highlighting a need for effective interventions. We explored an intervention called Enhanced S...

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Published in: BMC Medical Education
ISSN: 1472-6920
Published: Springer Science and Business Media LLC 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70255
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We explored an intervention called Enhanced Stress-Resilience Training (ESRT), a modified form of mindfulness training adapted for clinicians, that was applied to medical students for the first time.MethodsGraduate-entry medical students (N&#x2009;=&#x2009;118) were randomised to ESRT or an active control condition as part of a registered trial (ISRCTN16324994). A 3 (Time: pre-, post-, and six-month follow-up) &#xD7; 2 (Group: ESRT, control) mixed design was used to assess changes in psychological flexibility, resilience, and stress reactivity. Due to attrition (T3 n&#x2009;=&#x2009;47), additional sensitivity analyses, including intention-to-treat and subgroup analyses based on baseline resilience, were conducted. Qualitative data from exit evaluations (n&#x2009;=&#x2009;25), interviews (n&#x2009;=&#x2009;12), and focus groups (n&#x2009;=&#x2009;11) underwent reflexive thematic analysis to explore student experience and contextualise quantitative findings.ResultsESRT users demonstrated increased psychological flexibility scores at post-intervention (p&#x2009;=&#x2009;.001, d&#x2009;=&#x2009;0.62) and six-months follow-up (p&#x2009;=&#x2009;&lt;&#x2009;0.001, d&#x2009;=&#x2009;0.96), and these findings were confirmed in intention-to-treat analysis. Exploratory analyses revealed that those with low baseline resilience who underwent ESRT displayed increased resilience (p&#x2009;=&#x2009;&lt;&#x2009;0.001, d&#x2009;=&#x2009;1.86) and decreased stress reactivity (p&#x2009;=&#x2009;&lt;&#x2009;0.001, d&#x2009;=&#x2009;1.58) at the six-month follow-up. Qualitative findings highlighted high acceptability, perceived value, and a strong desire for curricular integration, while also revealing barriers to engagement, particularly time constraints.ConclusionsThis study offers new evidence that ESRT may enhance psychological flexibility and resilience, and decrease stress reactivity, especially among more vulnerable students. 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This article is licensed under a Creative Commons Attribution 4.0 International License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-10-06T15:51:22.4377842 v2 70255 2025-09-02 Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation e16f78b54f72a2abe17a77648b46268d Luke Sanders Luke Sanders true false d78be9da50e81e0ff11e62be78ed0829 Georgie Budd Georgie Budd true false dfd05900f0e2409d3f67dca227c59a93 0000-0003-1146-3791 Andrew Kemp Andrew Kemp true false 2025-09-02 BackgroundMedical students face demanding academic requirements, fierce competition, self-doubt and financial concerns contributing to high rates of depression, anxiety, stress, sleep problems and burnout, highlighting a need for effective interventions. We explored an intervention called Enhanced Stress-Resilience Training (ESRT), a modified form of mindfulness training adapted for clinicians, that was applied to medical students for the first time.MethodsGraduate-entry medical students (N = 118) were randomised to ESRT or an active control condition as part of a registered trial (ISRCTN16324994). A 3 (Time: pre-, post-, and six-month follow-up) × 2 (Group: ESRT, control) mixed design was used to assess changes in psychological flexibility, resilience, and stress reactivity. Due to attrition (T3 n = 47), additional sensitivity analyses, including intention-to-treat and subgroup analyses based on baseline resilience, were conducted. Qualitative data from exit evaluations (n = 25), interviews (n = 12), and focus groups (n = 11) underwent reflexive thematic analysis to explore student experience and contextualise quantitative findings.ResultsESRT users demonstrated increased psychological flexibility scores at post-intervention (p = .001, d = 0.62) and six-months follow-up (p = < 0.001, d = 0.96), and these findings were confirmed in intention-to-treat analysis. Exploratory analyses revealed that those with low baseline resilience who underwent ESRT displayed increased resilience (p = < 0.001, d = 1.86) and decreased stress reactivity (p = < 0.001, d = 1.58) at the six-month follow-up. Qualitative findings highlighted high acceptability, perceived value, and a strong desire for curricular integration, while also revealing barriers to engagement, particularly time constraints.ConclusionsThis study offers new evidence that ESRT may enhance psychological flexibility and resilience, and decrease stress reactivity, especially among more vulnerable students. Sustained effects and positive qualitative feedback suggest that curricular integration could improve feasibility and reach. Journal Article BMC Medical Education 25 1 Springer Science and Business Media LLC 1472-6920 Enhanced Stress-Resilience training; Medical students; Psychological flexibility; Resilience; Stress reactivity 2 9 2025 2025-09-02 10.1186/s12909-025-07768-6 COLLEGE NANME COLLEGE CODE Swansea University Other British Medical Association (⁠JUR1011-100) 2025-10-06T15:51:22.4377842 2025-09-02T10:27:28.7248096 Faculty of Medicine, Health and Life Sciences School of Psychology Luke Sanders 1 Georgie Budd 2 Lebares Carter 3 Umakant Dave 4 Andrew Kemp 0000-0003-1146-3791 5 70255__35266__7389f4440f194e05a0ca1391fa0660a9.pdf 70255.VoR.pdf 2025-10-06T15:46:55.9876432 Output 2046629 application/pdf Version of Record true © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License. true eng http://creativecommons.org/licenses/by/4.0/
title Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation
spellingShingle Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation
Luke Sanders
Georgie Budd
Andrew Kemp
title_short Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation
title_full Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation
title_fullStr Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation
title_full_unstemmed Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation
title_sort Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation
author_id_str_mv e16f78b54f72a2abe17a77648b46268d
d78be9da50e81e0ff11e62be78ed0829
dfd05900f0e2409d3f67dca227c59a93
author_id_fullname_str_mv e16f78b54f72a2abe17a77648b46268d_***_Luke Sanders
d78be9da50e81e0ff11e62be78ed0829_***_Georgie Budd
dfd05900f0e2409d3f67dca227c59a93_***_Andrew Kemp
author Luke Sanders
Georgie Budd
Andrew Kemp
author2 Luke Sanders
Georgie Budd
Lebares Carter
Umakant Dave
Andrew Kemp
format Journal article
container_title BMC Medical Education
container_volume 25
container_issue 1
publishDate 2025
institution Swansea University
issn 1472-6920
doi_str_mv 10.1186/s12909-025-07768-6
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Psychology{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Psychology
document_store_str 1
active_str 0
description BackgroundMedical students face demanding academic requirements, fierce competition, self-doubt and financial concerns contributing to high rates of depression, anxiety, stress, sleep problems and burnout, highlighting a need for effective interventions. We explored an intervention called Enhanced Stress-Resilience Training (ESRT), a modified form of mindfulness training adapted for clinicians, that was applied to medical students for the first time.MethodsGraduate-entry medical students (N = 118) were randomised to ESRT or an active control condition as part of a registered trial (ISRCTN16324994). A 3 (Time: pre-, post-, and six-month follow-up) × 2 (Group: ESRT, control) mixed design was used to assess changes in psychological flexibility, resilience, and stress reactivity. Due to attrition (T3 n = 47), additional sensitivity analyses, including intention-to-treat and subgroup analyses based on baseline resilience, were conducted. Qualitative data from exit evaluations (n = 25), interviews (n = 12), and focus groups (n = 11) underwent reflexive thematic analysis to explore student experience and contextualise quantitative findings.ResultsESRT users demonstrated increased psychological flexibility scores at post-intervention (p = .001, d = 0.62) and six-months follow-up (p = < 0.001, d = 0.96), and these findings were confirmed in intention-to-treat analysis. Exploratory analyses revealed that those with low baseline resilience who underwent ESRT displayed increased resilience (p = < 0.001, d = 1.86) and decreased stress reactivity (p = < 0.001, d = 1.58) at the six-month follow-up. Qualitative findings highlighted high acceptability, perceived value, and a strong desire for curricular integration, while also revealing barriers to engagement, particularly time constraints.ConclusionsThis study offers new evidence that ESRT may enhance psychological flexibility and resilience, and decrease stress reactivity, especially among more vulnerable students. Sustained effects and positive qualitative feedback suggest that curricular integration could improve feasibility and reach.
published_date 2025-09-02T05:30:58Z
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score 11.09611

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