Fostering a Health-Promoting Learning Environment in Medical Education: Adapting the Okanagan Charter for Administrators and Medical Educators

Abstract

Medical students enter medical school with similar or even better well-being than their age-matched peers in other educational programs, but there is predictable erosion of their well-being following matriculation. Interventions to counter this erosion predominantly focus on the individual level; however, significant systemic issues persist that thwart meaningful change. Effectively reforming the learning environment and more broadly targeting problematic aspects of the culture of medical education are essential steps to advance efforts to improve medical learner well-being. Although a healthy environment may allow learners to be well in the educational setting, a health-promoting learning environment strives to promote and embed well-being across all aspects of the learner’s experience. Health-promoting learning environments operate by infusing health principles into all aspects of operations, practices, mandates, and businesses. The Okanagan Charter is a widely adopted international framework with principles for best practices of adoption. This charter has the recent endorsement of the Association of Faculties of Medicine of Canada, representing all faculties of medicine in Canada, and serves as a framework for reassessing work on well-being in medical education. In response to this endorsement, the authors have adapted the 5 strategies from the charter for pragmatic integration into the medical education environment and added a sixth strategy: (1) embed health in all policies; (2) develop sustainable, supportive spaces; (3) create thriving medical communities and culture; (4) encourage, support, and sustain meaningful personal development; (5) review, develop, and strengthen faculty-level health services; and (6) collaborate and invest in continuous improvement and evaluation. For each of these 6 strategic directions, actionable steps for implementation in academic medicine are provided to create sustainable and meaningful change.