Yoga Improves Resident Physician Psychological Health But Doesn’t Appear to be Feasible and Acceptable.
By John M. de Castro, Ph.D.
“Slammed by long and unpredictable hours, heavy clinical workloads, fatigue and limited professional control, many medical residents experience stress and even burnout. And surveys indicate this burnout can seriously impact physician well-being and patient care outcomes.” – Jennifer Huber
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. 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. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout 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 and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. Yoga is a mind-body practice that includes mindfulness and exercise. Yoga practice has been shown to improve the symptoms of burnout. But it is unclear whether it would be feasible and effective for resident physicians.
In today’s Research News article “Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961714/ ) Loewenthal and colleagues recruited resident physicians and randomly assigned them to a wait-list control condition or to receive 1-hour, once a week for 6-weeks yoga training with daily home practice. They completed a questionnaire regarding the feasibility of the program. They were also measured before and after training and 2-months later for psychological health, including mindfulness, resilience, perceived stress, professional fulfillment, depression, anxiety, sleep disturbance, and resident well-being.
The participants rated the feasibility and acceptability of the program as low and they averaged attending only 1.93 of the 6 sessions with no one completing all 6 sessions. They found that the yoga group had significant increases in mindfulness, resilience, professional fulfillment, and resident well-being and significant decreases in anxiety, perceived stress, and sleep disturbance. While the wait-list group did not.
These efficacy findings are similar to those reported in other studies that yoga training results in increases in mindfulness, resilience, and well-being and significant decreases in anxiety, perceived stress, and sleep disturbance. But the program was very disappointing in feasibility and acceptability. Resident physicians are pressed for time and stressed and may not have the time too attend classes and practice yoga. Other mindfulness programs, particularly those implemented online have been found to be feasible, acceptable, and effective for health care workers. They would appear to be preferable to yoga for resident physicians.
So, yoga improves resident physician psychological health but doesn’t appear to be feasible and acceptable.
“So often we treat others’ bodies and minds, yet often neglect our own. While we encourage our patients to roll out their mats and settle into their asanas, we can remember to do it ourselves. When we treat our stress and anxiety, we will be better able to treat our patients.” – Julia Michie Bruckner,
CMCS – Center for Mindfulness and Contemplative Studies
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Loewenthal, J., Dyer, N. L., Lipsyc-Sharf, M., Borden, S., Mehta, D. H., Dusek, J. A., & Khalsa, S. (2021). Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial. Global advances in health and medicine, 10, 21649561211001038. https://doi.org/10.1177/21649561211001038
Background and Objective
Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers.
We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers. The RISE program consisted of six weekly sessions with suggested home practice. Feasibility was assessed across six domains: demand, implementation, practicality, acceptability, adaptation, and integration. Self-reported measures of psychological health were collected at baseline, post-program, and two-month follow-up.
Among 2,000 residents contacted, 75 were assessed for eligibility and 56 were enrolled. Forty-four participants completed the study and were included in analysis. On average, participants attended two of six sessions. Feasibility of in-person attendance was rated as 28.9 (SD 25.6) on a 100-point visual analogue scale. Participants rated feasibility as 69.2 (SD 26.0) if the program was offered virtually. Those who received RISE reported improvements in mindfulness, stress, burnout, and physician well-being from baseline to post-program, which were sustained at two-month follow-up.
This is the first controlled study of a yoga-based MBI in residents. While the program was not feasible as delivered in this pilot study, initial analyses showed improvement in multiple measures of psychological health. Residents reported that virtual delivery would increase feasibility.