Presence, Resilience, and Compassion Training in Clinical Education (PRACTICE): A Follow-Up Evaluation of a Resident-Focused Wellness Program

Abstract

Background Graduate medical education is demanding, and many residents eventually experience a reduced sense of well-being. Interventions are in development, but knowledge gaps remain in terms of time commitment and efficacy. Objective To evaluate a mindfulness-based wellness program for residents—PRACTICE (Presence, Resilience, and Compassion Training in Clinical Education). Methods PRACTICE was delivered virtually by the first author in the winter and spring of 2020-2021. The intervention totaled 7 hours delivered over 16 weeks. An intervention group of 43 residents (19 primary care and 24 surgical) participated in PRACTICE. Program directors electively enrolled their programs, and PRACTICE was integrated into residents' regular educational curriculum. The intervention group was compared to a non-intervention group of 147 residents whose programs did not participate. Repeated measure analyses were conducted before and after the intervention using the Professional Fulfillment Index (PFI) and Patient Health Questionnaire (PHQ)-4. The PFI measured professional fulfillment, work exhaustion, interpersonal disengagement, and burnout; the PHQ-4 measured depression and anxiety symptoms. A mixed model was used to compare scores between the intervention and non-intervention groups. Results Evaluation data were available from 31 of 43 (72%) residents in the intervention group, and from 101 of 147 (69%) residents in the non-intervention group. Significant and sustained improvements were demonstrated in professional fulfillment, work exhaustion, interpersonal disengagement, and anxiety in the intervention group versus the non-intervention group. Conclusions Participation in PRACTICE resulted in improvements in measures of resident well-being that were sustained over the 16-week duration of the program.

The Impact of Resilience Interventions on University Students’ Mental Health and Well-Being: A Systematic Review

“…A range of measures was used for each of these constructs, summarised in Table 2. The most common measures of depression were the Beck depression inventory [93] (BDI) [50,70,74,76], the patient health questionnaire [94] (PHQ)-4 or -9 [48,55,68,86,88], and the depression anxiety stress scales [95] (DASS) [51,52,57,[59][60][61]84,91]. The most common measures for anxiety were the generalised anxiety disorder assessment [96] (GAD-7) [48,62,63], state-trait anxiety inventory [97] (STAI) [50,76,89,90], and DASS [52,57,[59][60][61]84].…”

“…Eight studies implemented a non-randomised controlled trial (NRCT) study design [53,58,62,77,79,80,82,87]. Seventeen studies employed a pre-post without control group study design [48,50,51,59,60,[64][65][66][68][69][70]83,84,86,88,89,91], and twenty-two studies adopted a randomised controlled trial (RCT) study design [45][46][47]49,52,[54][55][56][57]61,63,67,[71][72][73][74][75][76]78,81,85,90].…”

“…Most of the studies recruited undergraduate students (n = 38) [45][46][47][49][50][51][53][54][55][56][57]59,[61][62][63][64][65][66][67][68][69]71,72,[74][75][76][77][78][79][80][81][82]84,85,87,88,90,91]. Only four studies recruited graduate students [48,58,69,83] and a subset did not specify, but all those not specifying focused on medical students [60,70,73,86,89]; as such, the level may not have been reported as medical degrees can include a typical undergraduate degree within the higher medical degree. Apart from medical students, some studies recruited specific disciplines, with the most common being psychology (n = 3) …”

“…For skills-based interventions, nine used face-to-face delivery [45,50,63,[74][75][76]78,80,82] and five used online delivery [51,52,59,66,68]. For mindfulness interventions, ten used face-to-face delivery [47,53,60,67,69,71,77,81,87,89] and eight used online delivery [49,[55][56][57]72,86,88,90]. Within the psychoeducation interventions, around half were delivered using face-to-face sessions (n = 5) [48,64,70,79,85] with the same number using online delivery [46,54,62,84,91].…”

“…Twenty-nine studies were rated 'fair' [45,[47][48][49][52][53][54][55][61][62][63][67][68][69][70][71][72][73][74][75][77][78][79]81,83,85,88,89,91]. The remaining fourteen studies were rated 'poor' [50,52,56,[58][59][60][64][65][66]80,82,84,86,87].…”