Implementation of clerkship-specific spaces for debriefing at Vanderbilt University School of Medicine

Difficult experiences like challenging clinical situations, patient death, and navigation of team dynamics during clerkships can lead to distress for medical students during the transition to the clinical learning environment. Evidence suggests that debriefing and reflecting on distressing experiences benefit medical students; however, barriers to doing so persist. A needs assessment at Vanderbilt University School of Medicine (VUSM) demonstrated that additional opportunities for real-time, clerkship-specific debriefing were desired by second-year clerkship medical students. The CIRCLE (Cultivating Increased Resilience in the Clinical Learning Environment) Lunch & Debrief initiative was created to address this need. CIRCLE sessions were conducted once per 8-week clerkship block for two cohorts of VUSM second-year clerkship students. Students were optionally surveyed before and after sessions from December 2022 through May 2024. Student resilience was assessed using the Connor Davidson Resilience Scale© (CD-RISC 10). The proportion of students reporting distress stemming from health care team interactions and patient death demonstrated significant increases from blocks 1-3 to blocks 4-5. More students reported participation in debriefing following a distressing experience with peers than with faculty across all pre-session surveys (78% vs 37%; p = 1.6e-10). Reported comfort with asking to debrief with peers increased from 80% to 94% before and after sessions (p = 0.006) and with faculty from 52% to 73% (p = 0.004.) Of post-session survey respondents (n = 71), 96% indicated they would attend a similar session in the future. Perceived support by the medical school curriculum to navigate emotional distress as a clerkship student increased from 69% to 90% when comparing pre- and post-session survey responses, respectively (p = 0.003). Overall, reception of the CIRCLE Lunch & Debrief initiative by students was positive and was associated with increased perceived institutional support and student comfort with asking to debrief with both faculty and peers.