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.

Introduction Medical education should portray evidence-based medicine (EBM) and shared decision making (SDM) as central to patient care. However, misconceptions regarding EBM and SDM are common in clinical practice, and these biases might unintentionally be transmitted to medical trainees through a hidden curriculum. The current study explores how assumptions of EBM and SDM can be hidden in formal curriculum material such as PowerPoint slides. Methods We conducted a qualitative content analysis using a purposive sample of 18 PowerPoints on the management of upper respiratory tract infections. We identified concepts pertaining to decision making using theory-driven codes taken from the fields of EBM and SDM. We then re-analyzed the coded text using a constructivist latent thematic approach to develop a rich description of conceptualizations of decision making in relation to EBM and SDM frameworks. Results PowerPoint slides can relay a hidden curriculum, which can normalize: pathophysiological rea-Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40037-020-00578-0) contains supplementary material, which is available to authorized users. E. Braschi ( ) soning, unexplained variations in clinical care, the use of EBM mimics, defensive medicine, an unrealistic portrayal of benefits, and paternalism. Discussion Addressing the hidden curriculum in formal curricular material should be explored as a novel strategy to foster a positive attitude towards EBM and SDM and to improve patient outcomes by encouraging the use of these skills.

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Background Evidence-Based Medicine is built on the premise that clinicians can be more confident when their decisions are grounded in high-quality evidence. Furthermore, evidence from studies involving patient-oriented outcomes is preferred when making decisions about tests or treatments. Ideally, the findings of relevant and valid trials should be stable over time, that is, unlikely to be reversed in subsequent research. Objective To evaluate the stability of evidence from trials relevant to primary healthcare and to identify study characteristics associated with their reversal. Methods We studied synopses of randomized controlled trials (RCTs) published from 2002 to 2005 as “Daily POEMs” (Patient Oriented Evidence that Matters). The initial evidence (E1) from these POEMs (2002–2005) was compared with the updated evidence (E2) on that same topic in a summary resource (DynaMed 2019). Two physician-raters independently categorized each POEM-RCT as (i) reversed when E1 ≠ E2, or as (ii) not reversed, when E1 = E2. For all “Evidence Reversals” (E1 ≠ E2), we assessed the direction of change in the evidence. Results We evaluated 408 POEMs on RCTs. Of those, 35 (9%; 95% confidence interval [6–12]) were identified as reversed, 359 (88%) were identified as not reversed, and 14 (3%) were indeterminate. On average, this represents about 2 evidence reversals per annum for POEMs about RCTs. Conclusions Over 12–17 years, 9% of RCTs summarized as POEMs are reversed. Information alerting services that apply strict criteria for relevance and validity of clinical information are likely to identify RCTs whose findings are stable over time.