MINDFULNESS
IN
MEDICAL EDUCATION
Millaray Sanchez-Campos and Douglas
Archibald
Department of Family Medicine
ADAPTED FOR the Annual DFM Retreat
Montebello, QC
September 20, 2014
Acknowledgments
Carol Gonsalves MD, FRCP (C), MEd
Diana Koszycki PhD
Heather MacLean MD, FRCP(C)
Veronique Duschesne MD Candidate Class 2016
Kay-Anne Haykal MD, CCFP
DISCLOSURE
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.
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
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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
Practicing Mindfulness
Mindfulness in Medical Education
Discussion
15 minutes
15 Minutes
10 minutes
10 minutes
OUR MODERN LIFE
PHYSICIAN HEALTH
BEING IN THE MOMENT...
What is Mindfulness
Jon Kabat-Zinn
Paying
attention on
purpose
In the present
Nonmoment
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 “DOOVER”…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 SELFREPORTED 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 GREY
MATTER
Memory process
Emotion regulation
Self-referential processing
Perspective 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 uOTTAWA
FACULTY 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 uOTTAWA
FACULTY OF MEDICINE
•
•
•
•
•
•
•
definite eye opener
truly enjoyed
excellent
Interesting
insightful,
relaxing,
important to teach in the curriculum
MINDFULNESS AT uOTTAWA
FACULTY 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 uOTTAWA
FACULTY 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 uOTTAWA
FACULTY OF MEDICINE
 Importance of incorporating a “Mindful
Practice “ curriculum in medical schools
 Sep 2014 will commence a 2-yearMindfulness 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
RESOURCES
Guided meditation:
www.mindfulselfcompassion.org
Mindfulness meditation as a tool for
compassion fatigue:
https://compassionfatigue.ca
RESOURCES
Modern Meditation Mindfulness Resources
http://www.modernmeditation.ca/mindfulnessresources/
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!