Commentary: An Educational Intervention to Enhance Self-Care Practices Among 1st Year Dental Students: A Mixed-Method Study Design

Fatima Ehsan^*, Munira Abbasi

Riphah International University, Islamabad, Pakistan

---

Abstract

Burnout, stress, and mental health challenges are increasingly common among dental students. Despite their prevalence, structured self-care remains an overlooked element in healthcare education. Research shows that poor self-care among medical professionals contributes to long-term psychological distress and can negatively affect patient care. However, institutional curricula often lack systematic and culturally relevant interventions to address this issue.

There is a growing need to embed proactive self-care education early in professional training. Doing so can promote resilience, emotional well-being, and sustainable career growth. To address this gap, a mixed-method study was conducted at Riphah International University. The study evaluated the impact of a Personal Development Plan (PDP) intervention on first-year dental students.

This commentary critically examines the study’s methodology, highlights its strengths and limitations, and explores its broader implications for medical and dental education. It also outlines future directions for research and policy reform to ensure that self-care becomes an integral part of healthcare training.

---

Introduction

Medical and dental education is recognized worldwide for its rigorous demands, which often lead to elevated levels of stress, anxiety, and burnout among students.¹ Studies from diverse regions report that a substantial proportion of medical and dental students experience moderate to severe psychological distress during their training.^2,3 This psychological burden adversely affects not only academic performance and well-being but may also undermine long-term professional resilience and quality of patient care.

Although awareness of student well-being is increasing, structured interventions promoting self-care remain scarce, particularly in low- and middle-income countries.⁴ Self-care strategies—such as mindfulness, physical activity, and reflective practices—have been shown to reduce stress and enhance coping skills.⁵ However, such practices are infrequently integrated into formal health education curricula, often lacking cultural adaptation. A recent systematic scoping review highlights the urgent need for formal integration of self-care education in medical curricula to enhance student wellbeing.⁶ Notably, dental education, despite facing similar burnout challenges, has received limited attention in this regard.⁷

This study on Personal Development Plan (PDP) intervention at a South Asian undergraduate dental institute was aimed to gain deeper insight into the nature and depth of students’ self-care reflections. This commentary examines the study’s design, outcomes, and relevance for health professions education in diverse and resource-limited settings.

Strengths of the Study

Innovative Curriculum Integration

The study integrated fortnightly self-care sessions into the dental curriculum. This was a novel approach compared to one-time stress management workshops. The ongoing nature of the sessions encouraged long-term behavioral change. Students were able to apply and reinforce self-care habits throughout the academic year. The structured PDP format supported consistent engagement and systematic habit tracking. A somewhat similar innovative approach was used in another study for selfcare of students using a behavior change plan among second year medical students with promising results. However, it comprised of weekly 2hours session for six weeks only.⁸ Recently, a novel smartphone app called WE MD was developed to track and support medical student wellness at Venderbilt School of Medicine. In addition to student’s daily health reports, it also included a resource library and tips on setting SMART goals that would help students in tracking their progress.⁹ This consistent tracking and follow up helps in developing lifelong selfcare awareness/practices especially when employed as part of an institutional educational policy.

Reflective Assessment for Deep Learning

To assess the level of students’ reflections and gain a more objective sense of its quality, a simplified version of scoring-system based on ‘The Reflection Evaluation For Learners’ Enhanced Competencies Tool’ (REFLECT) rubric was used.¹⁰ The reflections were scored in their entirety on a scale from 1-4 and this tool is designed to measure how deeply students engage in reflective writing, to assess their self-awareness and personal growth. Moreover, rubrics clearly communicates to students what is expected at different levels of reflection promoting learner’s accountability. Results showed that over 60% of students reached a high level of reflection, suggesting they meaningfully adopted self-care practices. Through reflective writing, students were able to think critically about their stressors, evaluate their coping strategies, and improve their overall well-being.¹¹ This method supports modern medical education’s focus on self-directed learning and building resilience in students.¹²

Mixed-Methods Approach for Comprehensive Insights

Although reflect rubrics categorize reflections into different levels, it might miss some underlying/unexpected or contextual insights. Combining quantitative reflection scores and qualitative thematic analysis gave a more rich data of student engagement. This enhanced the validity and reliability of the findings. Qualitative data added context to numerical results. It captured in-depth student experiences and challenges. A mixed-method design allowed individual differences in self-care adoption to be acknowledged.¹³

Contextual and Cultural Relevance

The intervention encompassed contextual spiritual practices such as prayer and ethical reflections. Spirituality especially culturally and personally relevant helps students see the daily stressors as part of a larger narrative further supporting physical and mental self-care. Faith and holistic health are often interconnected in South Asian cultures.¹⁴ Including spirituality increased student motivation and behavioral change.¹⁵ The culturally tailored design could inspire similar programs in other regions.

Alignment with Global Trends in Medical Education

The study reflects a shift from reactive mental health support to proactive self-care education. Institutions like the American Medical Association (AMA) now support preventive well-being strategies.¹⁶ The PDP model aligns with international trends that value both physician wellness and clinical excellence.¹⁷

Limitations and Areas for Improvement

Lack of a Control Group

Without a control group, the study cannot prove causality. Comparing students who participated in the PDP with those who did not would improve the evidence. Future studies should use randomized controlled trials to strengthen conclusions.

Potential for Self-Reported Data Bias

Reflections are self-reported and may reflect what students think educators want to hear.¹⁸ This can introduce bias. Objective data like biometric stress indicators (e.g., cortisol levels or heart rate variability) would improve accuracy.¹⁹

Inclusion of only higher-level reflections in qualitative analysis

Although the higher-level reflections represented more than 60% of the total students, excluding level 1 & 2 reflections may lead to selection bias, limiting the diversity and developmental range of students’ reflection capacities. Further, with an inductive qualitative approach omitting certain data may limit the emergence of new themes or instructional/contextual gaps.

Moreover, this study seems an embedded mixed method study design as REFLECT rubric was part of assessment required for built in component of the educational intervention. It was used as a tool for in depth thematic analysis of high-quality reflections which is the main research strategy (quantitative embedded within qualitative). This was not explicitly mentioned in the study which would have further clarified the purpose of the research.

Short-Term Follow-Up

The study spans only one academic year. It does not show if self-care habits last over time. Future longitudinal research could follow students into clinical training and practice to assess lasting effects.²⁰

Limited Generalizability

The study was conducted at a single institution. Its findings may not apply to other schools with different cultural or educational setups. Multi-site studies would help assess broader relevance.²¹

Exclusion of Facilitator Perspectives

The study focused only on student feedback. It did not include views from faculty mentors or facilitators. Their perspectives could help refine the PDP model and inform faculty training programs.²²

Broader Implications for Medical and Dental Education

The study emphasized the need for self-care education in medical and dental programs. Prioritizing well-being can reduce burnout and improve retention. It also prepares students to manage the demands of healthcare work.²³

Recommendations for Future Implementation

• Mandatory Self-Care Curriculum: Institutions should develop formal self-care courses modeled after PDPs to promote long-term habits.
• Mentorship and Peer Support: Structured mentorship and peer support programs can enhance self-care through accountability and guidance.
• Use of Objective Wellness Metrics: Including physiological stress measures can improve how we assess student well-being.⁹
• Application Across Disciplines: The PDP model should be tested in other fields, such as medicine, nursing, and allied health, for broader applicability.²⁴

Integrating Self-Care into Institutional Policy

To support student wellness, institutions should consider:

• Regular faculty development on self-care strategies.
• Peer-led programs to build a culture of support.
• Collaborations with mental health professionals for formal interventions.

Conclusion

Dr. Ehsan et al.’s study contributes meaningfully to the call for well-being education in healthcare training. Despite limitations, the PDP shows promise in helping students adopt effective self-care strategies. Future research should include control groups, long-term tracking, and faculty perspectives.

The study offers a model for integrating well-being into medical and dental education. By teaching students to care for themselves, institutions are ultimately improving the care provided to patients.

Conflict of Interest

None

References

1. Botelho M, Gao X, Bhuyan SY. An analysis of clinical transition stresses experienced by dental students: A qualitative methods approach. European journal of dental education. 2018; 22(3): e564-72.
2. Kurup RG, Kumar J. Comparative analysis of stress levels and quality of life among medical students in Southern Asia and South Caucasus. Int J Community Med Public Health. 2024; 11(5): 1839.
3. Gold JA, Hu X, Huang G, et al. Medical student depression and its correlates across three international medical schools. World J Psychiatry. 2019; 9(4): 65-77.
4. Ellakany P, Folayan MO, El Tantawi M, et al. Associations between depression, fear of COVID-19 infection and students’ self-care measures used during the first wave of the pandemic. BMC Public Health. 2023; 23(1): 1047.
5. Ayala EE, Omorodion AM, Nmecha D, et al. What do medical students do for self-care? A student-centered approach. Teach Learn Med. 2017; 29(3): 237-246.
6. Wan DWJ, Goh LSH, Teo MYK, et al. Enhancing self-care education amongst medical students: a systematic scoping BMC Med Educ. 2024; 24(1): 37.
7. Jiménez-Ortiz JL, Islas-Valle RM, Jiménez-Ortiz JD, et al. Emotional exhaustion, burnout, and perceived stress in dental students. Journal of International Medical Research. 2019; 47(9): 4251-9.
8. Kushner RF, Kessler S, McGaghie WC. Using behavior change plans to improve medical student self-care. Academic Medicine. 2011; 86(7): 901-6.
9. Milne A, Novelli A, Watson C, et al. The potential of real-time behavior and well-being assessments to improve medical student wellness. Academic Medicine. 2023: 10-97.
10. Leijenaar E, Eijkelboom C, Milota M. “An invitation to think differently”: a narrative medicine intervention using books and films to stimulate medical students’ reflection and patient-centeredness. BMC Medical Education. 2023; 23(1): 568.
11. Lutz G, Scheffer C, Edelhaeuser F, et al. A reflective practice intervention for professional development. Patient Educ Couns. 2013; 92(3): 337-45.
12. Thompson G, McBride RB, Hosford CC, et al. Resilience among medical students: coping style and social support. Teach Learn Med. 2016; 28(2): 174-82.
13. Rosenkranz SK, Wang S, Hu W. Motivating medical students to do research. BMC Med Educ. 2015; 15: 95.
14. Chandarana P, Pellizzari JR. Health psychology: South Asian perspectives. In Handbook of cultural health psychology. 2001 (pp. 411-444). Academic Press.
15. Ray C, Wyatt TR. Religion and spirituality as cultural assets in medical students. J Relig Health. 2018; 57: 1062-73.
16. Eranki K. Addressing global healthcare challenges through proactive care. Resilient Health. 2024; 1111-1121.
17. Mendelsohn D. Determinants of physician well-being. Med Educ. 2022; 56(1): 48-55.
18. Mantzoukas S. Bias in reflective research. J Res Nurs. 2005; 10(3): 279-95.
19. James OP, et al. Biosensors and wellness measurement. BMJ Simul Technol Enhanc Learn. 2020; 7(4): 188.
20. Köppe C, Schütz A. Healthy leaders and self-evaluation. Front Psychol. 2019; 10: 998.
21. Jaarsma T, et al. Growing the evidence base for self-care. Int J Nurs Stud. 2020; 105: 103555.
22. Edmonds VS, et al. Wellness curriculum evaluation. Teach Learn Med. 2022; 35(1): 52-64.
23. Sklar DP. Wellness in medical education. Acad Med. 2016; 91(9): 1185-8.
24. Lizarondo L, et al. Allied health in transforming healthcare. Aust Health Rev. 2015; 40(2): 194-204.