Introduction

Mental health and stress have become increasingly important concerns for veterinarians^1,2,3,4 and, especially so, veterinary students.^5,6,7 A study⁵ in Australia, for example, found that veterinary students self-reported greater levels of personal stress than medical students, junior medical officers, practicing veterinarians, and the general public. Some studies^5,7 have described the transition into the veterinary curriculum (ie, the first and second years) as most stressful, whereas others have described the preclinical and clinical years (ie, the third and fourth years) as most stressful. Proposed reasons for these high levels of stress include the demands of the veterinary curriculum, financial concerns, and limits on access to mental health resources because of time constraints and insufficient availability.⁵ Further, multiple studies^4,5,6,7 have identified higher levels of stress in female veterinarians and veterinary students, compared with male veterinarians and veterinary students. Thus, as the proportions of female veterinarians and female veterinary students increase, the problem is likely to get worse. Female veterinarians are more likely to use negative coping strategies to manage stress, such as rumination and escapism,⁸ and although there is less information on coping strategies used by veterinary students, it appears likely that all veterinary students would benefit greatly from early training in positive coping strategies.

At the University of Minnesota College of Veterinary Medicine (UMN-CVM), students are provided with information and support related to stress management and work-life balance. A social worker is available for 1-on-1 counseling, and group sessions discussing how to process concerns rather than to react to them are available for all students. A 24-hours-off policy for each 2-week clinical rotation has been instituted, and student “houses” have been created to help build camaraderie. In addition, students are regularly surveyed to determine their workload in and out of class and to monitor for mental health concerns.⁹ Still, concerns arise as to how well students are managing the stress of veterinary training.

Resilience plays an important role in stress management and can be broadly defined as the ability to draw on personal and contextual resources to manage stressors, recover from stress, adapt positively to adverse events, maintain stability during stressful times, and function above normal in the face of stress.^10,11 One way to increase resilience is by cultivating mindfulness, defined as real-time awareness and nonjudgmental acceptance of life experiences.^10,12 Mindfulness-based stress reduction involves cultivating practices that increase mindfulness in everyday life, including activities such as meditation and yoga.

As developing professionals, students benefit from modeling of stress management and wellness by faculty and staff. To support this, the UMN-CVM undertook 2 initiatives beginning in 2019 to promote stress management and wellness for all members of the veterinary college community. In mid-March 2020, the University of Minnesota required that all student teaching be done virtually with only select opportunities for hands-on training for clinical-year students. This is a description of those initiatives and their staying power through the imposition of restrictions due to COVID-19.

Yoga

In contrast to exercise in general, which may or may not be associated with decreased stress,⁵ yoga has been demonstrated to relieve stress.^13,14,15,16 Studies^12,17 have demonstrated that participation in yoga courses, even at a beginner level, is associated with an increase in mindfulness, which ostensibly would be associated with a subsequent decrease in stress. Physiologic changes associated with the practice of yoga include decreased waking and evening cortisol concentrations and decreased resting heart rate.¹⁸ A systematic review¹⁹ of the effects of meditation, yoga, and mindfulness in tertiary education students demonstrated a moderate positive effect on stress (ie, decreased stress) and no negative effects for all of these techniques. Health professionals and health professional students in 1 study²⁰ described noon-time yoga offered free of charge as a welcome and relaxing break in the middle of busy days.

Beginning in the fall 2019 semester, yoga was offered by the UMN-CVM free of charge to all students, staff, and faculty. The initiative was begun by a faculty member and was taken over by a student club, Just Breathe, which provides support for student mental health.

The first barrier was finding a consistent site for the yoga class. The venue needed to be large enough to permit an estimated 20 people sufficient space to spread yoga mats and move without hindrance, open enough for the instructor to see all of the students, and, ideally, carpeted. Space was identified in a large, carpeted active-learning classroom.

The second barrier was finding an instructor for the course. A message was sent to all collegiate alumni through Facebook, and a number of local commercial yoga instructors responded. One instructor volunteered to offer in-person instruction for free on Tuesdays during the fall semester, and in spring 2020, a paid instructor was contracted to lead sessions on Tuesdays, with payment supported by a faculty member. Sessions were offered at noon so students would be able to attend. A second class on Fridays at noon was offered that incorporated videos from a yoga instructor recommended by a number of people within the college. However, people did not regularly attend the Friday sessions, presumably because they could watch the videos on their own time and did not see value in doing so with a group.

In fall 2019, attendance at the Tuesday sessions was not rigorously tracked. However, each session had approximately 8 to 10 participants. Participants consisted of students, staff, faculty, and administrators, with the college dean attending the inaugural session. In spring 2020, attendance was tracked and ranged from 3 to 15 participants/session, with a mean of approximately 10 participants/session. Again, participants included administrators, faculty members, graduate students, veterinary students, and staff.

Participants anecdotally reported enjoying the opportunity to participate in yoga over the lunch break and in a location at the school. Some participants preferred yoga exercises that emphasized breathing and stretching without more rigorous work on perfecting poses, whereas others wished for even more attention to the specifics of yoga practice.

Plans to expand the yoga initiative included identifying additional grant funding or partnering with yoga training programs to provide in-person instruction without cost to the college and identifying a space with movable tables to permit the instructor to more readily see and direct participants. However, because of restrictions imposed as a result of the COVID-19 pandemic, the college was unable to continue providing in-person yoga sessions. The instructor with whom we had worked in spring 2020 provided ready access to online yoga training. Many students reported at the end of the spring 2020 semester that they felt they had had more time for self-care, including exercise, after the switch to virtual training because they had more flexible schedules and more autonomy in how they spent their time. However, it was not known whether this included yoga. Thus, the goal of having yoga available to manage stress may or may not have been maintained through the pandemic, and the community aspect of yoga practice definitely was lost.

Leisure Reading

Leisure reading is reported by students in health profession programs to increase empathy and understanding of groups outside their personal experience and to decrease stress.^21,22 Barriers to leisure reading by health profession students include lack of time, fatigue, the expense of purchasing materials for leisure reading, and poor access to leisure reading materials at their institution.^21,22 Among students who read for leisure, hard copy books are preferred to e-books.²¹ Preferred genres are fiction (romantic fiction, science fiction, and crime and mystery) and biography.^23,24 One review²⁵ of 7 academic health science and science libraries identified leisure reading collections in those libraries varying in size from 186 to 9,700 books. Librarians generally felt these collections were well used.

In August 2019, the UMN-CVM began soliciting donations for a lending library for leisure reading. Books were solicited from students, staff, faculty, and administrators. Books of all genres were accepted with the stipulation that only leisure reading materials would be accepted; textbooks and proceedings were not accepted.

The first consideration was identifying a site for this leisure reading collection. The UMN-CVM library is not in a central location, minimizing the likelihood that students, staff, and faculty would peruse the collection on impulse if it were housed in the library. Initially, therefore, a bookshelf provided by the college was placed in a vending area in the building where first- and second-year students spent much of their time and that contained staff and faculty offices. A second bookshelf was added about 12 months after the collection was instituted.

Students, staff, and faculty were regularly reminded to use and donate to the free lending library, and alumni were solicited for donations. From August 2019 through February 2020, the number of books donated to the library increased from 18 to 616. Books from many genres were contributed, with books classified as fiction, mystery, nonfiction, and science fiction and fantasy; books about personal growth; and books about animals most commonly donated. Jigsaw puzzles and DVDs also were donated. The percentage of books circulating averaged 50% initially and increased over time.

Students, staff, and faculty were surveyed to determine who was using the library. Books were donated or borrowed by veterinary students in all 4 years of the curriculum; graduate students; hospital, teaching, and research staff; faculty from all 3 departments; and college administrators.

Plans for expanding the leisure reading collection included creating a second location within the UMN-CVM and seeking grant funding and other means for purchasing books with no cost to the college. Because of restrictions around on-campus work due to the COVID-19 pandemic, the library was unattended from mid-March through August. At the end of August, the library clearly was actively being used, with 74 new books on the shelf (85% fiction and 7% nonfiction books, including several books about racial justice) and circulation of 60% for books, 63% for DVDs, and 100% for jigsaw puzzles. These findings indicated that reminders sent over the previous year and the size of the collection were sufficient to make the library self-sustaining. Following guidelines of the American Libraries Association and the CDC, signs were put up asking people not to handle the books unnecessarily and providing a box into which returning and new books could be placed for at least a day before the covers were disinfected and the books placed on the shelves. The library clearly has met the college's desire for a way to provide support for work-life balance for members of the college community.

Conclusion

Much attention is being paid to the mental health and general wellness of veterinarians, veterinary support staff, and veterinary students. Defining the negative aspects of the veterinary profession that drive mental health concerns is valuable. However, there also is great benefit in better defining what makes veterinary work meaningful and focusing on well-being.²⁶

Students offered opportunities to learn about and practice resilience have been demonstrated to have greater awareness that can support greater resilience in their personal and professional lives.²⁷ Students in a previous study²⁷ who received resilience training also appreciated this evidence of support for their personal growth from their institution. Longstanding changes in health behaviors require changes in the physical and social environment that promote and support those changes for individuals.²⁸ Creation of easily accessed yoga sessions and opportunities for leisure reading met the goals of diminishing physical barriers to these opportunities and increasing the social bond of performing these behaviors over time. A study²⁹ of self-reported very happy people suggests that exposure to others in social situations is a valuable component of that happiness. In 1 study,³⁰ medical students cited lack of company as a barrier to their continuing yoga. This highlights the value of finding a suitable space and an in-person instructor to promote group yoga sessions. A goal of the UMN-CVM is to reestablish in-person yoga sessions when permitted to do so.

The leisure reading library has definitely been a positive addition to the UMN-CVM. The library has been used by a wide cross section of people who live and work in the veterinary college community. Students report visiting the library and taking time to read over breaks during the day. Users value this library because it promotes reading the kinds of books they may not have access to through other campus libraries. New books donated to the library over the summer of 2020 reflected community concerns and gave the members of the college community access to materials to educate themselves about these issues. Staff who work second (afternoon and evening) and third (evening and night) shifts have found the library to be a resource that links them with the much larger group of colleagues on campus during the first (day) shift.

Costs for these initiatives have been minimal and have mostly involved the time for someone to ensure the initiatives move forward. The 2019 Veterinary Wellbeing Summit, hosted by the AVMA, Association of American Veterinary Medical Colleges, and industry partners suggested that workplaces can play a substantial role in promoting health and well-being by reducing barriers to emotional and physical health. Provision of things as simple as free yoga classes weekly and a readily accessible library for leisure reading are examples of how veterinary colleges can meet this challenge.