PURPOSE Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes. METHOD This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation. RESULTS We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students' wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students' trust underpins the whole activity system. CONCLUSIONS Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.

中文翻译：

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打开全校学生福祉计划的黑匣子：以活动理论为基础的批判性叙述审查。

目的 医学院有责任支持学生的福祉，但关于如何将这一使命转化为实践的指导很少。学校通常注重实施和报告个人层面的干预措施，这些干预措施通常只解决福祉的一个方面。相反，对于解决多个福祉维度的全校范围内的学生福祉整体方法的关注较少。因此，本次审查旨在提高我们对如何在此类全校福利计划中调解支持的理解。方法 这一批判性叙述回顾分两个阶段进行。首先，作者使用系统搜索策略和趋势清单来指导我们的数据提取过程，在几个关键数据库中搜索了截至 2021 年 5 月 25 日发表的论文。后来我们扩大了搜索范围，纳入了从原始日期到 2023 年 5 月 20 日发表的文献。其次，使用活动理论作为理论镜头来帮助解释，对所识别的文章进行了批判性分析。结果 我们发现全校范围内的福利计划强调社交联系和建立社区意识。导师在支持学生福祉的活动中发挥着关键作用。我们制定了活动系统组件来描述这个导师角色的复杂性。这一分析表明：系统中的紧张和矛盾可能会带来变革的机会；上下文对于影响系统组件如何交互的重要性；学生的信任是整个活动体系的基础。结论 我们的审查揭示了全校整体福利计划的黑匣子。我们发现导师在福利系统中发挥着关键作用，但保密性是一种反复出现的紧张局势，可能会危及福利系统。现在是更详细地研究这些系统的时候了，在寻找共同线索的同时拥抱和探索上下文的作用。