Supporting Resilience in Medical School: Breakthroughs and Barriers

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Mindfulness in medical education: Students’ perceptions and four recommendations for implementation of a mindfulness intervention

Background: Faculties of Medicine around the globe have implemented mindfulness-based curricula to deal with medical student’s burnout, anxiety and depression. The purpose of this qualitative study is to assess students’ perception of a mandatory mindfulness intervention and their recommendations for further curricula development and implementation.Methods:  Third-year medical students participated in a mandatory three-hour mindfulness workshop embedded in their family medicine academic week. Eleven students consented to two interviews which explored their perceptions of mindfulness and the workshop in relation to their personal and professional wellbeing as well as their views for the implementation of a longitudinal mindfulness curriculum.Results:  Student and institutional benefits and barriers relating to the curriculum were identified.  Student’s benefits included positive changes in stress, self-awareness and personally   that also translated into self-reported better patient care. Students reported lack of time, forgetting to practice and lack of knowledge about mindfulness as barriers. Institutional pride for their support of student wellness and an overfilled curriculum, were the major institutional benefits and barriers respectively, to the expansion of this curriculum. Among developing an implementing a longitudinal mindfulness curriculum, we found four key features to consider: Firstly to engage the stakeholders; secondly, to incorporate the mindfulness intervention into the curriculum with both a mandatory and elective component; thirdly, to emphasize the clinical implications of the mindfulness intervention and fourthly, to have protected time for wellness interventions.Conclusions: Introducing mindfulness into the undergraduate medical school curriculum through this workshop resulted in perceived personal, institutional and professional benefits. For faculties of medicine that want to implement a mindfulness intervention, we found four key components for implementing a mindfulness intervention in their institutions. Further research is needed to better quantify the benefits and to identify ways to manage barriers at both individual and institutional levels.

Une étude pilote d’un programme cursus longitudinal de méditation pleine conscience durant le doctorat en médecine

Background: To support student well-being, a mindfulness curriculum in undergraduate medical education was launched at our university in 2014. We describe the program and report 3-year results. Methods: Medical students responded to online questionnaires on mindfulness (Freiburg Mindfulness Inventory), empathy (Jefferson Scale of Physician Empathy), resilience (Connor-Davidson Resilience Scale) and perceived stress (Perceived Stress Scale) and were surveyed for demographics, home practice, and subjective experience at curriculum launch and yearly for 3 years. Results: In respondents, high stress (19.2 (SD=6)) and low resilience (71.2 (SD=12.5)) scores were seen throughout training. Scores for mindfulness correlated positively with those for empathy (r=.217 p<0.01) and resilience (r=.539, p<0.01), and negatively with stress scores (r=-.380, p<0.01). While overall scale scores did not statistically change after curriculum implementation, statistically significant increases were seen in mindfulness (12%, p=0.008), empathy (5%, p=0.045), and resilience scores (12%, p=0.002) with a trend toward lower stress scores (8%, p=0.080) in respondents who felt they applied the curriculum principles. Two hours of reported home practice per week was associated with statistically significant changes (14% increased mindfulness scores p<0.001; 6% increased empathy scores p<0.001, 10% increased resilience scores p=0.003; 11% decreased stress scores p= 0.008). Despite positive program evaluations for both mandatory and elective sessions, student attendance at elective sessions was low. Conclusion: A mindfulness curriculum integrated into formal undergraduate medical education is feasible. Benefits may be confined to those students who apply curriculum principles and practice regularly. Further study is needed.Contexte : Pour soutenir le bien-être des étudiants, un cursus de méditation pleine conscience dans le cadre du programme de doctorat en médecine a été lancé à notre université en 2014. Nous décrivons le programme et communiquons les résultats après trois ans. Méthodes :  Des étudiants en médecine ont répondu à des questionnaires en ligne sur la pleine conscience (inventaire de pleine conscience de Freiburg), l’empathie (Échelle de Jefferson sur l’empathie du médecin), la résilience (échelle de résilience de Connor-Davidson) et le stress perçu (échelle du stress perçu) et ont été interrogés pour les caractéristiques démographiques, la pratique de la méditation pleine conscience à domicile et l’expérience subjective au moment du lancement du cursus et, ensuite, annuellement pendant trois ans. Résultats : Chez les répondants, un degré de stress élevé (19,2 (ET = 6)) et une faible résilience (71,2 (ET = 12,5)) ont été observés tout au long de la formation. Il y avait une corrélation positive entre les la pleine conscience et l’empathie (r = 0,17, p < 0,01) et de la résilience (r = 0,539, p < 0,01), et négative avec le stress (r = -0,380, p < 0,01). Alors que les résultats globaux ne changent pas statistiquement après la mise en œuvre du cursus, des augmentations statistiquement significatives ont été observées pour la pleine conscience (12 %, p = 0,008), l’empathie (5 %, p = 0,045) et la résilience (12 %, p = 0,002) avec une tendance vers des résultats inférieurs pour le stress (8 %, p = 0,080) chez les répondants qui estimaient avoir appliqué les principes du programme. On retrouvait des changements significatifs chez les répondants qui rapportaient avoir pratiqué deux heures par semaine à domicile (résultats accrus de 14 % pour la pleine conscience (p < 0,001), de 6 % pour l’empathie (p < 0,001) et de 10 % pour la résilience (p = 0,003), et réduits de 11 % pour le stress (p = 0,008)). Malgré des évaluations de programme positives pour les sessions obligatoires et optionnelles, l’assiduité des étudiants aux sessions optionnelles était faible. Conclusion : Un cursus de méditation pleine conscience intégré dans des études formelles de doctorat en médecine est faisable. Les avantages peuvent être confinés aux étudiants qui appliquent les principes du programme et qui le pratiquent sur une base régulière. D’autres études sont requises

Feasibility and effectiveness of an online mindfulness meditation program for medical students

Background: The need to incorporate tools to promote medical student wellness in medical education is underscored by the concerning rates of psychological distress among them. The objective of this prospective cohort study was to obtain preliminary data on the feasibility and effectiveness of an online mindfulness intervention for medical student wellness.Methods: A convenience sample of 52 medical students consented to participate in this study. Feasibility was assessed by ease of recruitment, number of modules completed, satisfaction with the program, and adherence to a regular meditation practice. Participants completed the Maslach Burnout Inventory, the Jefferson Scale of Empathy-medical student version, the Five Face of Mindfulness Questionnaire-short form, and the Self Compassion Scale-short form pre and post intervention.Results: The convenience sample was recruited within a two-month period. Forty-five participants completed at least one of seven modules. Descriptive statistics (mean±standard deviation) revealed that the mean number of modules completed was 4.85±2.7. Mean satisfaction with the modules was 7.07±1.1 out of 10. Adherence to a regular formal meditation practice was poor; the average amount of formal meditation practice per module was 34.14±27.44 minutes. Self-compassion and the “observe and describe” facets of mindfulness practice significantly statistically increased from baseline, but no such change was observed for levels of burnout and empathy.Conclusion: The present study indicates that an online mindfulness meditation program may be of interest to medical students. The results did not provide any evidence that the program was effective but we believe further research and development is warranted