Presence, resilience, and compassion training in clinical education (PRACTICE): Evaluation of a mindfulness-based intervention for residents

Abstract

Background Residents’ well-being tends to decline in the course of training, yet research on preventive and restorative interventions for residents is limited. Mindfulness-based interventions have been successfully employed to support well-being in practicing physicians, but their impacts on residents are not well established. Objective This paper describes the structure, content, and evaluation of a pilot mindfulness-based intervention program designated PRACTICE (presence, resilience and compassion training in clinical education) that was designed specifically to support resident well-being. Methods A combined sample of 14 postgraduate year one residents from two residency training programs participated in a four-session (8 h) mindfulness-based intervention in the Fall/Winter of 2018. Participants were surveyed before, after, and at 3 months postintervention, on measures of wellness (Professional Fulfillment Index) and mental health (Patient Health Questionnaire-4), along with measures of program engagement. Results Participants demonstrated a significant reduction in burnout at the conclusion of the program. Depression and anxiety screening scores also trended toward improvement. However, participants were not able to sustain these gains. Three months after the conclusion of the program wellness measures had returned to preintervention levels. Conclusions The results of this study support the use of mindfulness-based interventions in resident wellness programs. The lack of an enduring effect indicates the need for a maintenance phase intervention.

Mindfulness-Based Approaches for Managing Stress, Anxiety and Depression for Health Students in Tertiary Education: a Scoping Review

“…Based on the nature of the course, 15 students could register to attend, and those expressing an interest were placed on a reserve list Shearer et al ( 2016 ) 74 undergraduate students recruited from psychology courses at the University of Pennsylvania who consented to participate in the study in exchange for extra credit in a psychology course Song and Lindquist ( 2015 ) Flyers with inclusion criteria posted on website and community board in nursing school for 480 eligible undergrad nursing students were offered, 50 respondents for participation, 44 participated Spadaro and Hunker ( 2016 ) Invitation to participate sent via institutional email to all undergrad and graduate students in nursing study programs by program coordinator. Interested students replied by email Szuster et al ( 2020 ) The program was integrated into the regular didactic curriculum for postgraduate first year non-surgical training programs van Dijk et al ( 2017 ) Of 232 eligible students, 167 students (72%) participated. Informed the students about the trial during classroom teaching in the fifth month of their clerkships.…”

“…Significantly greater increase in mindfulness Spadaro and Hunker ( 2016 ) Single cohort, before/after trial Online and online discussion forum Adapted MBSR 1 × week for 8 weeks Duration not specified Depression, anxiety, stress, cognition Significant reduction in stress. Decreasing trend for anxiety Szuster et al ( 2020 ) Single cohort, before/after trial Face-to-face and self-guided Adapted MBSR Every 2 weeks over 8 weeks (4 sessions) 2 h per session Depression, anxiety, professional satisfaction and course engagement Significant reduction in burnout. Depression and anxiety screening scores trended towards improvement.…”

Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review

“…Of the 24 studies included in this review, 8 produced significant positive results pertaining to burnout reduction using the MBI and 3 produced significant results using other burnout measurement scales. Nine studies occurred solely within residents' protected education time, 13,16,18,[20][21][22][23][24][25] one had training elements occur both inside and outside of protected time, 17 and one occurred completely outside of residents' protected time. 19 It is possible that incorporating training programs within residents' protected time, such as part of academic half-day lectures or scheduled wellness days, could effectively reduce burnout.…”

“…Of the 11 studies that produced significant results related to burnout, 5 used the Maslach Burnout Inventory (MBI), [16][17][18][19][20] 2 used the abbreviated MBI, 13,21 1 used the MBI General Survey, 22 2 used the Copenhagen Burnout Inventory (CBI), 23,24 and 1 used the Professional Fulfillment Index (PFI). 25 The abbreviated MBI adds job satisfaction as a measure of burnout, and the MBI General Survey measures emotional exhaustion on a 5-point scale which is shortened to ''exhaustion'' as well as cynicism and professional efficacy. The CBI examines personal, work-related, and client-related burnout, while the PFI examines work exhaustion and interpersonal disengagement.…”

“…Of the 15 single group (pre/post) trials, 7 reported significant results from the instituted program. 13,16,17,[21][22][23]25 Five of these studies utilized the MBI, 13,16,17,21,22 one used the CBI, 23 and one used the PFI. 25 Six single group studies produced decreased burnout while one produced a significant increase in burnout.…”