Enhancing Resilience in Medical Students with Virtual Metacognitive Training

Iskander, Morkos and Sime, Julie-Ann (2025) Enhancing Resilience in Medical Students with Virtual Metacognitive Training. PhD thesis, Lancaster University.

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Abstract

This thesis explores virtual instruction in meditation and its impact on resilience on medical students in the United Kingdom. It builds on prior research documenting a worldwide rising trend in burnout in doctors and the protective effect of resilience. The topic is viewed through the lens of cognitive load theory, with metacognitive skills acting to prevent overload. This research is situated within the post-positivist paradigm, using mixed methods, conducted in three phases. A total of 112 medical students from four medical schools were recruited and surveyed using the Situated Subjective Resilience Questionnaire for Adults [SSRQA] to establish a baseline. In phase two, 26 students underwent  an asynchronous month-long training program of virtual instruction in meditation via an online platform. All 26 students who took part in the phase two also took part in phase three, repeating the survey post-training to assess for quantitative change, followed by semi-structured interviews assessing perception of virtual instruction, and evaluating resultant behavioural changes. At baseline, resilience was shown to be normally distributed in medical students, with no statistical differences between medical schools or year of study. Students found virtual instruction an acceptable format for meditation training. A statistically significant mean improvement of 4.88 point in resilience scores was seen with training (p<0.001). Improvement was correlated with lower initial score, number of training sessions, lengths of sessions and total time in training. Training resulted in higher levels of self-belief, adaptability, and emotional regulation, but not support seeking behaviours. Participants exhibited evidence of metacognitive development leading to higher resilience levels and increased resilience-related behaviours following instruction.  This thesis provides a proof by demonstration of a novel, effective technique to deliver enhanced resilience in medical students. Targeting metacognitive skill development poses a fresh avenue towards enhancing resilience.