MINDFULNESS IN

MEDICAL EDUCATION

Millaray Sanchez-Campos and Douglas Archibald

Department of Family Medicine 

ADAPTED FOR the Annual DFM RetreatMontebello, QC

September 20, 2014

 

Acknowledgments

Carol Gonsalves MD, FRCP (C), MEdDiana Koszycki PhDHeather MacLean MD, FRCP(C)Veronique Duschesne MD Candidate Class 2016Kay-Anne Haykal MD, CCFP

The following presentation is free from bias and the presenters are not affiliated with any for-profit organizations or parties. The presenters do not have any conflict of interests to disclose and are not affiliated with any commercial entities or organizations that serve to profit from this presentation.

DISCLOSURE

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FACULTY/PRESENTER DISCLOSURE

• Faculty: Dr. Sanchez-Campos and Dr. Archibald

• Relationships with commercial interests: None• Disclosure of Commercial Support: N/A • Mitigating Potential Bias: N/A

WORKSHOP OBJECTIVES

To understand the scientific evidence about the importance of incorporating mindfulness in medical education (undergraduate, graduate and CPD)

For clinical teachers in the DFM to learn about the UGME mindfulness curriculum at the University of Ottawa

To provide an introduction to mindfulness practice and how it can help in building resilience

OUTLINE

Introduction 15 minutes

Practicing Mindfulness15 Minutes

Mindfulness in Medical Education 10 minutesDiscussion

10 minutes

OUR MODERN LIFE

PHYSICIAN HEALTH

BEING IN THE MOMENT...

What is MindfulnessJon Kabat-Zinn

Paying attention on

purpose

In the present moment

Non-judgementally

WHAT IS MINDFULNESS

"The faculty of voluntarily bringing back a wandering attention, over and over again, is

the very root of judgment, character, and will. . . An education which should improve this faculty would be the education par excellence" 

William James, Principles Of Psychology, 1890

SCENARIO “DO-OVER”…MINDFULLY

Medicine: The facts

Physician Distress

• Burnout in 30-60% of specialists and GP

• More prevalent in private practice (55%-67%) than academic faculty (37%-47%)

• Medicine associated with burnout, depression, anxiety, substance abuse, divorce and broken relationships

Shanafelt et al. The Well-Being of Physicians. The American Journal of Medicine. 2003;114:513-519

BURNOUT AND MEDICAL ERRORS

• Of the 7905 American College Surgeons, 700 (8.9%) reported concern they had made a major error in last three months

• Over 70% attributed error to individual factors

Shanafelt et al; Burnout And Medical Errors Among American Surgeons. Ann. Sur 2009

BURNOUT AND SELF-REPORTED CARE

• Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout (Maslach Burnout Inv.)

• Burnout residents were significantly more likely to self report suboptimal patient care at least monthly (53% vs. 21%; P=0.004).

Shanafelt et al. Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program. Ann Inter Med. 2002; 136:358-367

EMPATHY IN MEDICAL SCHOOL

• Medical students from a university-based medical school surveyed yearly from 2007 through 2010, using Jefferson Scale of Physician Empathy-Student Version (JSPE-S)

• Empathy scores of students in pre-clinical years were higher than in clinical years

• Gender was a significant predictor of empathy, women > men

Chen et al. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305-11

MINDFULNESS PRACTICE ON STUDENT STRESS LEVEL

• 66 med. students in their clerkship at University of Tasmania

• Randomized to intervention, 30 min audio CD of guided mindfulness practice and a control group

• Self-report PSS (Perceived Stress Scale) and DASS (Depression, Anxiety and Stress Scale) at baseline and 8 wks.

Warnecke et al. A Randomized controlled trial of the effects of mindfulness practice on medical student stress levels. Medical Education 2011:45:381-388

MBSR AND CHANGES IN GREYMATTER

Memory processEmotion regulation

Self-referential processingPerspective taking

Holzel et al. Mindfulness Practice leads to increases in regional brain grey matter density. Psychiatry Res. 2011 January 30; 191 (1): 36-43

MINDFUL COMMUNICATION IN PCP

• 70 Primary care physicians enrolled in CME in Rochester, NY. 8-wk course, 2.5 hours/wk. , a 7 h retreat, followed by a 2.5 h/mo x 10-month.

• Improvement in burnout, empathy, mindfulness, total mood disturbance and personality.

• Improvements in mindfulness were correlated with improvements in all other measures.

Krasner, M, Epstein, R et al. Association of an Educational Program in Mindful Communication with Burnout, Empathy, and Attitudes among Primary Care Physicians. JAMA, 2009; 302(12):1284-1293

SELF-MONITORING IN CLINICAL PRACTICE

• Self-monitoring as an important component of the professional competence of physicians

• It allows early recognition of cognitive biases

• Avoidance of technical errors

• Awareness of emotional reactions

• Facilitates self-correction

• Development of therapeutic relationships

Epstein R. Mindful Practice in Action (II): Cultivating Habits of Mind. Fam Syst Health 2003:21:11-17

MINDFULNESS CURRICULUM

MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE

• 2012: A-pilot project of « Mindful Practice in Clinical Practice » was added as a teaching innovation to the 3rd year rotation in Family Medicine.

• PIME grant awarded to study this teaching innovation. Research is in progress.

• 2013-2014 class evaluations are very positive:

MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE

• definite eye opener• truly enjoyed• excellent• Interesting• insightful, • relaxing, • important to teach in the curriculum

MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE

• will try to make sure I use it in the future• it prompted me to be present in my

everyday life, will use in the future to relieve stress

• will definitely try to implement some of the mindfulness technique in my work and daily routine

• now I try to be mindful before doing things

MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE

The session was well run and well led. This being said, it was time wasted. A mindfulness workshop is a great thing to offer to medical students outside of academic time. As a mandatory portion of our academic teaching, it is nothing short of a farce.

Instead of choosing from a myriad of useful topics to teach from any area ranging from clinical medicine to pharmacology, I spent my academic morning eating a raisin and contemplating its texture.

This is nonsense. In my opinion, this time should be spent on topics that will enrich our knowledge and performance as physicians

MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE

Importance of incorporating a “Mindful Practice “ curriculum in medical schools

Sep 2014 will commence a 2-year-Mindfulness Curriculum for pre-clerkship at uOttawa

To be linked with workshop in mindfulness given in 3rd year FM rotation with anticipated similar workshops in postgraduate programs in the future

Possibility to be linked with an online-MBSR program

OTHER FACULTIES OF MEDICINE

Canadian: McGill University, Montreal: Mindful Medical Practice (Drs. T. Hutchinson, Dobkin): Students; University of Toronto: Students/Residents; University of Alberta, Edmonton - Residents

Monash University (Australia):Health Enhancement Program (Dr. C. Hassed)

University of Rochester (NY): Mindfulness Curriculum for Clerkship (Drs. Krasner, Epstein)

University of Massachusetts (MA): The Contemplative Mind In Medicine (Drs. Santorelli and Kabat-Zinn)

Other electives throughout US, UK, Germany

STARTING A MINDFULNESS PRACTICE

• Stop-breath and be: Take few moments during the day to take 3-5 breaths, before starting a new activity and/or seeing a new patient

• 2-5 minutes of sitting meditation in am-hs

• Stop and breath at red/yellow lights

• Practice walking meditation

• Practice mindful listening

STARTING A MINDFULNESS PRACTICE

• Practice mindful eating/drinking for few minutes

• Use background noise to stop and take three breaths

• Breathe 3-5 times before getting up and at bedtime

• Being mindful when working out

• Bringing mindfulness to everyday activities

Guided meditation:www.mindfulselfcompassion.org

Mindfulness meditation as a tool for compassion fatigue: https://compassionfatigue.ca

RESOURCES

RESOURCES

Modern Meditation Mindfulness Resourceshttp://www.modernmeditation.ca/mindfulness-resources/

RESOURCES

• Kabat-Zinn, Jon. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 1994.

• Kabat-Zinn, Jon. Full Catastrophe Living.• Bantam Dell. New York. 1991.

• Tolle, Eckhart. The Power of Now. Novato, CA: New World Library, 1999.

• Hanh, Thich Nhat. You Are Here. Boston: Shambhala Publications, 2001.

THANK YOU!

Questions?

Contact: Millaray Sanchez

msanchez@uottawa .ca