Abstract
BACKGROUND: Medical students are known to have high rates of stress, burnout, anxiety, depression, and suicidality. Resilience training has been shown to be beneficial for stress among medical students. This systematic review and meta-analysis evaluated the literature on resilience interventions in medical students and assessed the impact of those interventions on both stress and resilience outcomes. METHODS: A comprehensive search was completed including multiple databases, bibliographic, and hand-searching. Twenty-one studies were included, 15 with resilience outcomes, nine with stress outcomes, and three with both. The standardized mean difference effect sizes were calculated using a random-effects model. RESULTS: Resilience interventions had a small-to-moderate effect on resilience (d = 0.39, k = 17, n = 15, 95% PI [-0.10 - 0.87], p < 0.001), and a moderate effect on stress (d = 0.53, k = 10, n = 9, 95% PI [-0.96 - 2.02], p = 0.01). Sub-group analyses found that clinical students displayed higher resilience than preclinical students post-intervention. Significant heterogeneity was present in both models. Funnel plots, Egger's regression intercept, and Duval & Tweedie's trim and fill tests revealed at least mild publication bias. Risk of bias in the primary studies was high. CONCLUSIONS: This meta-analysis suggests that resilience interventions are moderately effective at reducing stress and mildly effective at increasing resilience among medical students. Resilience intervention may have more of an impact on stress than resilience, and clinical students may benefit more with regards to resilience, but not stress. Further research would be beneficial to examine specific factors that influence resilience most. TRIAL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024501653.