Improve Mental Health in Medical Residents with Mindfulness
By John M. de Castro, Ph.D.
“increasing physician resilience, or the ability to “bounce back” from experiences such as burnout, has been shown to have a significant positive impact on patient care and physician wellbeing. . . benefits include improved quality of care, reduced errors and minimized attrition . . . mindfulness-influenced wellness programs for residents can improve self-compassion, empathy, burnout and stress reactions. Mindfulness meditation introduces a way of cultivating awareness of one’s relationship with the present moment. With practice, it may lead to healthier ways of working with stressful life experiences, including those inherent to residency training.” – Vincent Minichiello
Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. Currently, over a third of healthcare workers report that they are looking for a new job. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses.
Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout, so it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. It would be best to provide techniques to combat burnout early in a medical career. Medical residency is an extremely stressful period and many express burnout symptoms. This would seem to be an ideal time to intervene.
In today’s Research News article “Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880763/ ), Verweij and colleagues examined the ability of a Mindfulness-Based Stress Reduction (MBSR) program to treat the symptoms of burnout in medical residents. They recruited medical residents and randomly assigned them to either receive an 8-week, once a week, 2,5 hour session of Mindfulness-Based Stress Reduction (MBSR) or be assigned to a wait-list control condition. MBSR consists of a combination of meditation, yoga, and body scan practice in combination with discussion and home practice. The residents were measured before the program and 3 weeks later for emotional exhaustion, worry, home-work interference, mindfulness, self-compassion, positive mental health, physician empathy, and medical errors.
They found that in comparison to baseline and to the wait-list control condition, the residents who received MBSR training had significantly higher mindfulness, self-compassion, personal accomplishment, and perspective taking empathy, and significantly lower worry. These outcomes were all of moderate effect sizes. There were no significant effects on the primary measure of burnout, emotional exhaustion. But, the residents who had the highest levels of emotional exhaustion did show a significant improvements in emotional exhaustion after treatment.
These results suggest that Mindfulness-Based Stress Reduction (MBSR) maybe an effective treatment to improve the mental health of medical residents and perhaps reduce the tendency toward burnout. It should be noted, however, that medical residents are very restricted for time and MBSR training requires a considerable investment of time both in the training sessions and in home practice, making participation difficult. Future research should include an active control condition such as aerobic exercise to help control for potential sources of confounding and bias.
So, improve mental health in medical residents with mindfulness.
“I experienced burnout as a resident, and meditation was a key aspect to my recovery. My mother advised me to meditate, and afterwards, I felt like my brain had been rebooted.” – Louise Wen
CMCS – Center for Mindfulness and Contemplative Studies
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Verweij, H., van Ravesteijn, H., van Hooff, M. L. M., Lagro-Janssen, A. L. M., & Speckens, A. E. M. (2018). Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial. Journal of General Internal Medicine, 33(4), 429–436. http://doi.org/10.1007/s11606-017-4249-x
Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents.
To determine the effectiveness of MBSR in reducing burnout in residents.
A randomized controlled trial comparing MBSR with a waitlist control group.
Residents from all medical, surgical and primary care disciplines were eligible to participate. Participants were self-referred.
The MBSR consisted of eight weekly 2.5-h sessions and one 6-h silent day.
The primary outcome was the emotional exhaustion subscale of the Dutch version of the Maslach Burnout Inventory–Human Service Survey. Secondary outcomes included the depersonalization and reduced personal accomplishment subscales of burnout, worry, work–home interference, mindfulness skills, self-compassion, positive mental health, empathy and medical errors. Assessment took place at baseline and post-intervention approximately 3 months later.
Of the 148 residents participating, 138 (93%) completed the post-intervention assessment. No significant difference in emotional exhaustion was found between the two groups. However, the MBSR group reported significantly greater improvements than the control group in personal accomplishment (p = 0.028, d = 0.24), worry (p = 0.036, d = 0.23), mindfulness skills (p = 0.010, d = 0.33), self-compassion (p = 0.010, d = 0.35) and perspective-taking (empathy) (p = 0.025, d = 0.33). No effects were found for the other measures. Exploratory moderation analysis showed that the intervention outcome was moderated by baseline severity of emotional exhaustion; those with greater emotional exhaustion did seem to benefit.
The results of our primary outcome analysis did not support the effectiveness of MBSR for reducing emotional exhaustion in residents. However, residents with high baseline levels of emotional exhaustion did appear to benefit from MBSR. Furthermore, they demonstrated modest improvements in personal accomplishment, worry, mindfulness skills, self-compassion and perspective-taking. More research is needed to confirm these results.