Reduce General Practitioner Burnout with On-Line Mindfulness
By John M. de Castro, Ph.D.
“Mindfulness practice — the cultivation of a focused awareness on the present moment — can improve physicians’ performance by not only preventing burnout, but also by helping them better connect with their patients.” – Carolyn Gregoire
“General Practitioners confront stress on a daily basis. Even moderate levels of stress when prolonged, all too frequently results in a professional burnout. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. Healthcare is a high stress occupation. It is estimated that over 45% of healthcare workers experience burnout. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning out has to be a priority.
Mindfulness has been demonstrated to be helpful in coping with stress and in treating and preventing burnout. But, General Practitioners (GPs) are pressed for time and it is difficult for them to commit the time to mindfulness training on a schedule at a therapist’s location. Mindfulness training over the internet is an alternative training for people who find face-to-face training difficult and inconvenient. Online mindfulness training has shown great promise with effectiveness equivalent to face-to-face training.
In today’s Research News article “Impact of a Blended Web-Based Mindfulness Programme for General Practitioners: a Pilot Study.” (See summary below). Montero-Marin and colleagues recruited General Practitioners and provided them with on-line mindfulness training with both audio and video instruction in 45-minute sessions occurring twice a week for 4 weeks. Before and after training the GPs were measured for mindfulness, positive and negative emotions, resilience, and burnout.
They separated the GPs according to their participation rates into completers who completed two or more practices per week and non-completers who completed on average less than one practice per week. They found that the completers in contrast to the non-completers had significant increases in mindfulness and positive emotions. They also found that the amount of practice had a direct effect on positive emotions and also and indirect effect by increasing mindfulness which in turn increases positive emotions.
Hence, on-line mindfulness training appeared to enhance mindfulness and positive feelings in those GPs who completed the provided practices. To some extent the results were disappointing as there were a large proportion of the GPs who did not complete the program’s practice requirements (approximately 80% of those recruited). This could be due to the busy schedules of the GPs or that the program was not sufficiently engaging to motivate participation. In addition, there were no significant effects of the practice on negative emotions, resilience, or burnout. This may be due to the relatively small amount of practice. Perhaps a longer duration program might have more positive effects. Indeed, previous research has shown significant reductions in GP burnout with 8 weeks of in-person mindfulness training. Hence, it is possible that the program in the present study needs to be longer. It is also possible that on-line presentation is not effective for GP burnout.
The program, when completed, did produce greater mindfulness and positive emotions. So, there is reason to believe that it may be effective. This suggests that a modified more engaging and longer program should be developed and tested in a randomized controlled trial as an effective treatment for GPO burnout is sorely needed.
“When I talk or listen to peers and colleagues, I am amazed at how many healthcare professionals are already integrating mindfulness, meditation or relaxation techniques into their lives on a regular basis in order to ground themselves and find headspace and calm.” – Jon Kabat-Zin
CMCS – Center for Mindfulness and Contemplative Studies
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Montero-Marin, J., Gaete, J., Araya, R. et al. Impact of a Blended Web-Based Mindfulness Programme for General Practitioners: a Pilot Study. Mindfulness (2017). doi:10.1007/s12671-017-0752-8
General practitioners (GPs) report high levels of distress. This study examined whether a brief blended web-based mindfulness intervention could be effective at enhancing well-being for GPs and assessed the possible mediating role of awareness. An open uncontrolled trial, with pre-post measurements, was conducted. The programme comprised one face-to-face meeting (4 h) and eight online practice sessions with no support (two weekly sessions over 4 weeks). The primary outcome was positive affect (PANAS-positive). The secondary outcomes were as follows: negative affect (PANAS-negative), awareness (MAAS), resilience (CDRISC), and the burnout subtypes (BCSQ-12). Mixed-effects analysis for repeated measures and mediation analysis by regression models were performed. Two hundred ninety Spanish GPs took part in the study, attending the face-to-face meeting. Nearly one out 10 participants (n = 28) completed ‘one weekly practice’, and 10.4% (n = 30) accomplished ‘two or more weekly practices’. There were benefits for those with ‘two or more weekly practices’ in PANAS-positive (B = 2.97; p = 0.007), and MAAS (B = 4.65; p = 0.023). We found no benefits for those with ‘one weekly practice’ in any of the outcomes. There were mediating effects of MAAS in PANAS-positive (explaining a 60.8% of total effects). A brief blended mindfulness intervention, with minimum face-to-face contact and web-based practice sessions, seems to confer improvements in the well-being of Spanish GPs. The benefits may be mediated by awareness. The implementation of this kind of programme might enhance the well-being among GPs, but there is a need to improve adherence to practice. Further research using randomized controlled designs will be needed to support the evidence found in our study.