Presented By: Stephanie Neary, Yale University; Medical University of South Carolina
Co-Authors: Benjamin Doolittle, Yale University
Martina Mueller, Medical University of South Carolina
Michelle Nichols, Medical University of South Carolina

Purpose 
The social determinants of health (SDOH) overlap with the domains of the Secure Flourish Index (SFI). The purpose of this study was to determine if demographic, intrapersonal, social, or economic factors are associated with perceptions of flourishing among medical (MD), physician assistant (PA), and nurse practitioner (NP) students. 

Methods 
This study consisted of a single survey using a cross-sectional design. Current MD, PA, and NP students from two academic medical centers were recruited to complete an online survey between August 6 and October 9, 2023. Survey questions included demographics and the following validated instruments: SFI, WellRx, 2 Question Maslach Burnout Inventory, Brief COPE Inventory, the Short Grit Scale, and Duke University Religion Index. Descriptive statistics, t-tests, ANOVA, correlation, and regression analyses were performed with an alpha of 0.05. 

Results 
A total of 280 out of ~1820 (15.4%) eligible students participated in this study. Flourishing scores were significantly higher with higher grit (r=.368, p<.001), intrinsic spirituality (r=.186, p=.003), or organized religious participation (r=.153, p=.013). Similarly, flourishing scores were significantly higher for married (M=86.7, SD=15.8) versus not married students (M=82.6, SD=14.6; p=.036) or those with more legal dependents (r=.135, p=.027). However, flourishing scores were lower with higher social needs (WellRx; r= -.336, p<.001), burnout (r= -.466, p<.001), or avoidant (r= -.453, p<.001) or emotional (r= -.126, p=.043) coping styles. Flourishing scores were also lower for students who had considered leaving training in the past 6 months (M=75.3, SD=16.2) than those who had not (M=85.6, SD=14.4; p<.001). Regression revealed that burnout accounts for 23.4% of variability observed in flourishing scores, followed by avoidant coping style (13.7%) and social needs (4.7%).

Conclusion 
Student flourishing is highly correlated with intrinsic factors including avoidant coping style, grit, and burnout. The correlation between social needs and flourishing highlights the importance of expanded support for students that is informed by the social determinants of health.