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Letters to the Editor

Acknowledging a Holistic Framework for Learner Wellness: The Human Capabilities Approach

Kassam, Aliya PhD; Ellaway, Rachel PhD

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doi: 10.1097/ACM.0000000000003026
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To the Editor:

We commend Gengoux and Roberts’ recent Invited Commentary1 for raising important issues about student mental health and wellness. Wellness programs clearly need to be evidence- based and tailored to meet individual learner needs and circumstances. They also need to be respectful of issues arising from intersections of—among other facets of identity—race, culture, socioeconomic status, and gender in the context of medical education training. We also agree that this is not just a matter of respecting identities and legitimate differences in the human condition, it is about actively challenging social stigma and the tendency to reduce others to a single negatively framed characteristic that condemns them to a socially excluded and pilloried class.

In response to the “epidemic of burnout”2 in medicine, wellness initiatives at our institution, the Cumming School of Medicine, are increasingly focusing on early prevention and intervention through engagement, advocacy, and scholarship. Wellness depends, we believe, on a core principle of embracing individual differences and vulnerability. If we recognize that everyone has abilities and disabilities, everyone is unique, there is no superordinate class or characteristic, and anyone can struggle with issues arising from their circumstances, then we can begin to address wellness at a more fundamental systems level.

To that end, we draw on Nussbaum’s human capabilities approach,3 which is based on the principle that

the freedom to achieve well-being is of primary moral importance, and . . . that freedom to achieve well-being is to be understood in terms of people’s capabilities, that is, their real opportunities to do and be what they have reason to value.3

By attending to opportunity as well as competence, we aim to orient and integrate wellness initiatives and programing and the scholarship we build around them.

This approach is central to the Wellness Innovation Scholarship for Health Professions Education and Health Sciences (WISHES) laboratory at our institution. WISHES is taking a holistic approach that focuses on areas of wellness, such as mental, physical, occupational, social, and intellectual domains for individual learners and teachers; health professions education/training programs; and the intersection of the higher education system and the health care system.4 By using a human capabilities approach, we consider the interplay between competence and opportunity when addressing issues associated with wellness, and by doing so, we are seeking to have a positive impact not just on the individuals that make up our community but on the systems that influence wellness for all.

Aliya Kassam, PhD
Assistant professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;
Rachel Ellaway, PhD
Professor, Department of Community Health Sciences, and director, Office of Health and Medical Education Scholarship (OHMES), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.


1. Gengoux GW, Roberts LW. Ethical use of student profiles to predict and prevent development of depression symptoms during medical school. Acad Med. 2019;94:162–165.
2. Vogel L. Physician health charter calls on health systems, organizations to share responsibility for burnout. CMAJ. 2018;190:E812–E813.
3. Nussbaum MC. Women and Human Development: The Capabilities Approach. 2001.Cambridge, UK: Cambridge University Press.
4. Kassam A, Cowan M, Topps M. Lessons learned to aid in developing fatigue risk management plans for resident physicians. Teach Learn Med. 2019;31:136–145.
Copyright © 2019 by the Association of American Medical Colleges