Mindfulness in Medicine

Sir William Osler: A forerunner of mindfulness in medical practice

Increasing work hours, patient loads, and regulations have increased burnout among health care professionals, forcing many to neglect their own physical and emotional well-being. In response, several health care organizations are encouraging physicians to adopt mindfulness practices to reduce burnout and difficulties maintaining work-life balance. It is unclear whether mindfulness will improve health outcomes and patient satisfaction or will become another passing trend. With the stakes so high, this discussion should involve the founder of our modern education system, Sir William Osler.

Interest in online interprofessional elective mind-body skills (MBS) training

INTRODUCTION

There is growing interest in mind-body skills (MBS) education and online interprofessional elective MBS training for health professionals. We conducted this study to understand a) the demand among different health professionals for an online MBS course; b) engagement with different MBS topics; and c) planned behavior changes.

METHODS

We examined registrations from May 1 through August 31, 2014 for a new online MBS elective, analyzing the percentage of registrants who engaged with one or more of 12 modules by September 30, 2014. We also reviewed written comments about planned behavior change.

RESULTS

The 693 registrants included physicians, nurses, social workers, dietitians, psychologists, and others. The two most popular topics were "Introduction: to Stress, Resilience, and Relaxation Response" and "Autogenic Training". Half of registrants (57%) engaged with at least one module and 9% completed all 12 modules within the study period. Nearly all (90%) of those who completed evaluations planned to use the technique they learned for themselves, introduce it to patients, or both.

DISCUSSION

Online elective MBS training attracts diverse health professionals and leads to plans for personal and professional behavior change. Additional research is necessary to understand the impact of different amounts and kinds of MBS training on professionals' resilience, burnout, and quality of care.

What Is the Impact of Online Training in Mind–Body Skills?

Background.

Mind–body skills (MBS) training is popular, but in-person training can be inconvenient and costly. We assessed the impact of online MBS training on clinicians’ and trainees’ stress, mindfulness, and confidence in providing calm, compassionate care.

Methods.

This was a prospective cohort trial. Trainees entering medical school; graduate programs in nursing, social work, and dietetics; and residencies in family medicine and pediatrics at a large Midwestern academic health center were invited to complete online surveys before and 12 weeks after enrolling in online elective integrative health courses on MBS training or not. The elective offered no course credit and had no mandated deadlines for completion.

Results.

At baseline, the 60 who engaged in MBS training were similar to the 43 who did not in terms of profession, gender, perceived stress levels, mindfulness, resilience, and compassion. MBS participants engaged in a median of 3 of 12 available modules with a bimodal distribution peaking at 1 to 2 and 12 modules. Twelve weeks later, those who participated in MBS showed significantly greater improvements in measures of stress, mindfulness, and confidence in providing calm, compassionate care than those who did not.

Conclusions.

Online elective training offers a feasible strategy to improve mindfulness, stress, and confidence in providing calm, compassionate care. Additional studies are needed to determine the impact of required versus elective courses, the optimal dosage and content of training, and the costs and benefits of online versus in-person training.

Applying Mindful Evidence-Based Practice at the Bedside Using Catheter-Associated Urinary Tract Infection as a Model

We introduce a mindful evidence-based practice model to operationalize mindfulness to improve bedside infection prevention practices. Using catheter-associated urinary tract infection prevention as an example, we illustrate how clinicians can be more mindful about appropriate catheter indications and timely catheter removal.

Physician health and wellness

Physician health and wellness is a critical issue gaining national attention because of the high prevalence of physician burnout. Pediatricians and pediatric trainees experience burnout at levels equivalent to other medical specialties, highlighting a need for more effective efforts to promote health and well-being in the pediatric community. This report will provide an overview of physician burnout, an update on work in the field of preventive physician health and wellness, and a discussion of emerging initiatives that have potential to promote health at all levels of pediatric training. Pediatricians are uniquely positioned to lead this movement nationally, in part because of the emphasis placed on wellness in the Pediatric Milestone Project, a joint collaboration between the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Updated core competencies calling for a balanced approach to health, including focus on nutrition, exercise, mindfulness, and effective stress management, signal a paradigm shift and send the message that it is time for pediatricians to cultivate a culture of wellness better aligned with their responsibilities as role models and congruent with advances in pediatric training. Rather than reviewing programs in place to address substance abuse and other serious conditions in distressed physicians, this article focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Examples of positive progress and several programs designed to promote physician health and wellness are reviewed. Areas where more research is needed are highlighted.