Editorial: Why mindfulness matters in medical education

Mindfulness can be described as a generic life-skill that has an endless number of applications. It is both a form of meditation and a way of living. It involves the training of present-moment attention and also the attitude with which we pay attention – one of curiosity, acceptance, openness and compassion. Historically, the ‘soft’ subject of mindfulness or meditation was marginalised as just a ‘relaxation exercise’ and would not have been seen as an integral part of medical education with its strong emphasis on learning the ‘hard’ biomedical sciences and producing ‘battle-hardened’ future medical practitioners. But for good reason that perception is changing. This article will briefly outline why mindfulness is now increasingly seen as a necessary and integral part of training the modern medical practitioner

The freedom vs. health paradox

We all want to be free but freedom is both an outer and an inner state. For example, we want to be free of the suffering brought about by external factors such as oppression, bullying, injustice, discrimination, deprivation and illness. We also want to be free inwardly in the sense of being free of the suffering brought on by internal factors such as worry, anxiety, fear, depression, obsession, compulsion, addiction and attachment. There may however be a paradox in our pursuit of freedom in that we tend to pursue the former without paying much attention to the latter. As a result we may find the opposite of what we seek – freedom, health, happiness – because outer freedom is actually dependent upon inner freedom.In this article we will explore how unfettered freedom is central to the causation of poor mental and physical health whereas, paradoxically, freedom, health and happiness are brought about by discipline, reason, restraint and setting limits

The Rural Clinical School of Western Australia Mindfulness Project

Background: Medical students experience high levels of stress during their training. Literature suggests that mindfulness can reduce stress and increase self-compassion levels in medical students. Most mindfulness training programs are delivered face-to-face and require significant time commitments, which can be difficult to achieve for rurally-based students with heavy academic workloads.Aim: We sought to determine the feasibility and effectiveness of a mindfulness training program delivered online to medical students at a Rural Clinical School.Methods: An 8-week online training program was delivered to third year medical students at the Rural Clinical School of Western Australia in 2016.Using quantitative-qualitative mixed-methods approach, we measured the frequency and duration of the participants’ mindfulness meditation practice, and assessed changes in their perceived stress, self-compassion and compassion levels, as well as personal and professional attitudes and behaviours.Results: 47 students were recruited to the study. 50% of participants were practising at least weekly by the end of the 8-week program, and 32% of responding students reported practising at least weekly 6 months following the intervention. There was a statistically significant reduction in participants’ perceived stress levels and a significant increase in self-compassion at 6 month follow up. Participants reported qualitative insights about the personal and professional impact of mindfulness meditation training as well as barriers to practice

Brief online mindfulness training for medical students: a randomized control study

BACKGROUNDMedical students experience high levels of stress during their training. Literature suggests that mindfulness can reduce stress and increase self-compassion levels in medical students. However, most mindfulness training programs are delivered face-to-face and require significant time commitments, which can be challenging for rurally-based students with heavy academic workloads and limited support networks. PURPOSETo evaluate the feasibility and efficacy of a brief online Mindfulness training program for medical students based in rural areas, with regards to reducing stress, increasing self-compassion, mindfulness and study engagement. METHODSThis is a non-registered randomised control trial. Participants included both urban and rural medical students from UWA, University of Notre Dame and the RCSWA from 2018-2020. Participants were randomised to the intervention group, an 8-week online mindfulness training program, or the control group. Using quantitative-qualitative mixed-methods approach, we measured the frequency, duration and quality of the participants mindfulness meditation practice, and assessed changes in their perceived stress, self-compassion, mindfulness and study engagement levels. Further, the intervention group recorded a weekly reflective journal documenting their experience of the program. RESULTS114 participants were recruited to the study. 61 were randomised to the intervention, and 53 to the control. Quantitative analysis of the frequency, duration and quality of mindfulness meditation practice and changes in stress, self-compassion, mindfulness and study engagement is currently being conducted. Preliminary qualitative results reveal that participants experienced increased self-awareness, more mindfulness of their day-to-day activities, improved emotional regulation and increased productivity, while also facing difficulties with making time for their mindfulness practice. CONCLUSIONWe anticipate that this study will demonstrate that an online mindfulness training program tailored to reach rurally located medical students is feasible and effective in modifying their stress levels and psychological wellbeing.

Chronic condition self-management support: proposed competencies for medical students

Author version made available in accordance with the publisher's policy.Objective Governments and the medical profession are concerned that there continues to be less than optimal health outcomes despite escalating expenditure on health services from the effect of the ageing population with chronic illnesses. In this context, doctors will need to have knowledge and skills in effective Chronic Condition Management (CCM) and Chronic Condition Self-Management (CCSM). Method A national workshop of representatives of eight medical schools from the CCSM Special Interest Group (SIG) of the Australian and New Zealand Association on Medical Education (ANZAME) met in September 2004, to consider curriculum content in CCM and CCSM. Results The workshop recommended that the Committee of Deans of Australian Medical Schools (CDAMS) and the Commonwealth Department of Health and Ageing (DoHA) consider the identification and possible development of a specific curriculum for CCM and CCSM within the curricula of Australian Medical Schools. Discussion Consideration needs to be given to the changing nature of medical practice and that as part of this; doctors of the future will need skills in team participation, continuity of care, self-management support and patient-centered collaborative care planning. Doctors will also need skills to assist patients to better adhere to medical management, lifestyle behaviour change and risk factor reduction, if optimal health outcomes are to be achieved and costs are to be contained

RBPJ Mutations Identified in Two Families Affected by Adams-Oliver Syndrome

Through exome resequencing, we identified two unique mutations in recombination signal binding protein for immunoglobulin kappa J (RBPJ) in two independent families affected by Adams-Oliver syndrome (AOS), a rare multiple-malformation disorder consisting primarily of aplasia cutis congenita of the vertex scalp and transverse terminal limb defects. These identified mutations link RBPJ, the primary transcriptional regulator for the Notch pathway, with AOS, a human genetic disorder. Functional assays confirmed impaired DNA binding of mutated RBPJ, placing it among other notch-pathway proteins altered in human genetic syndromes

Research enrichment: evaluation of structured research in the curriculum for dental medicine students as part of the vertical and horizontal integration of biomedical training and discovery

<p>Abstract</p> <p>Background</p> <p>Research programs within medical and dental schools are important vehicles for biomedical and clinical discovery, serving as effective teaching and learning tools by providing situations in which predoctoral students develop problem-solving and critical-thinking skills. Although research programs at many medical and dental schools are well-established, they may not be well integrated into the predoctoral curriculum to effectively support the learning objectives for their students.</p> <p>Methods</p> <p>A series of structured seminars, incorporating faculty research, was designed for first-year dental students at the University of Nevada, Las Vegas, School of Dental Medicine to reinforce and support the concepts and skills taught in concurrent courses. A structured research enrichment period was also created to facilitate student engagement in active research using faculty and student curricular release time. Course evaluations and surveys were administered to gauge student perceptions of the curricular integration of research, the impact of these seminars on recruitment to the research program, and overall levels of student satisfaction with research enrichment.</p> <p>Results</p> <p>The analysis of course surveys revealed that students perceived the research-containing seminars effectively illustrated concepts, were logically sequenced, and were well-integrated into their curriculum. In addition, analysis of surveys revealed that the Integration Seminar courses motivated students to engage in research enrichment. Finally, this analysis provided evidence that students were very satisfied with their overall learning experience during research enrichment.</p> <p>Conclusion</p> <p>Curricular integration is one method of improving the teaching and learning of complicated and inter-related concepts, providing an opportunity to incorporate research training and objectives into traditionally separate didactic courses. Despite the benefits of curricular integration, finding the most appropriate points of integration, obtaining release time for curricular development and for research engagement, and funding predoctoral student research remain issues to be addressed in ways that reflect the character of the faculty and the goals of each institution.</p

Mindfulness meditators show altered distributions of early and late neural activity markers of attention in a response inhibition task

Attention is vital for optimal behavioural performance in every-day life. Mindfulness meditation has been shown to enhance attention. However, the components of attention altered by meditation and the related neural activities are underexplored. In particular, the contributions of inhibitory processes and sustained attention are not well understood. To address these points, 34 meditators were compared to 28 age and gender matched controls during electroencephalography (EEG) recordings of neural activity during a Go/Nogo response inhibition task. This task generates a P3 event related potential, which is related to response inhibition processes in Nogo trials, and attention processes across both trial types. Compared with controls, meditators were more accurate at responding to Go and Nogo trials. Meditators showed a more frontally distributed P3 to both Go and Nogo trials, suggesting more frontal involvement in sustained attention rather than activity specific to response inhibition. Unexpectedly, meditators also showed increased positivity over the right parietal cortex prior to visual information reaching the occipital cortex (during the pre-C1 window). Both results were positively related to increased accuracy across both groups. The results suggest that meditators show altered engagement of neural regions related to attention, including both higher order processes generated by frontal regions, and sensory anticipation processes generated by poster regions. This activity may reflect an increased capacity to modulate a range of neural processes in order to meet task requirements. This increased capacity may underlie the improved attentional function observed in mindfulness meditators.Neil W. Bailey, Gabrielle Freedman, Kavya Raj, Caley M. Sullivan, Nigel C. Rogasch, Sung W. Chung, Kate E. Hoy, Richard Chambers, Craig Hassed, Nicholas T. Van Dam, Thomas Koenig, Paul B. Fitzgeral