Burnout and overwhelming stress are growing issues in medicine and are associated with mental illness, performance deficits and diminished patient care. Among surgical trainees, high dispositional mindfulness decreases these risks by 75% or more, and formal mindfulness training has been shown feasible and acceptable. In other high-stress populations formal mindfulness training has improved well-being, stress, cognition and performance, yet the ability of such training to mitigate stress and burnout across medical specialties, or to affect improvements in the cognition and performance of physicians, remains unknown. To address these gaps and thereby promote the wider adoption of contemplative practices within medical training, investigators have developed Enhanced Stress Resilience Training, a modified form of MBSR - streamlined, tailored and contextualized for physicians and trainees. Investigators propose to test Enhanced Stress Resilience Training (ESRT), versus active control and residency-as-usual, in mixed-specialty interns (from Emergency Medicine, Internal Medicine, Pediatrics, Family Practice, OBGYN and Surgery Departments) evaluated for well-being, cognition and performance changes at baseline, post-intervention and three or six-month follow-up.
Enhanced Resilience Training to Improve Mental Health, Stress and Performance in Resident Physicians
Experiencing joy in the practice of medicine is by no means guaranteed. For many physicians, the unique bond with patients, the deep satisfaction of saving a life, and a profound sense of calling make the sacrifice and heartache worthwhile. In contrast, the growing prevalence of burnout and mental distress in physicians is being linked to diminished performance, patient outcomes, and hospital economics. This has broad ramifications, including threatening the physician-patient bond and the societal pillar this represents.
Overwhelming stress without adequate coping skills has been posited to promote burnout and distress, and may promote performance deficits (from surgical errors to poor professionalism) by impairing cognition and self-regulation. In other high-stress/high-performance groups formal mindfulness training has been shown to enhance stress resilience, well-being and performance. Nevertheless, quality research exploring the effects of mindfulness training on chronic stress and performance in physicians remains scarce, contributing to the slow adoption of mindfulness training into medical practice and residency.
To date, investigators have conducted a national survey which showed that the presence of high dispositional mindfulness in surgery residents reduced the risk of burnout and distress by 75% or more. Investigators have conducted a Randomized Clinical Trial of Mindfulness-Based Stress Reduction (MBSR) in surgery interns, demonstrating feasibility and acceptability of formal mindfulness training as well as promising positive effects in well-being, cognition and performance. Finally, investigators developed an MBSR-based, streamlined curriculum tailored for physicians called Enhanced Stress Resilience Training (ESRT). ESRT has been beta-tested in surgery and anesthesia faculty and mixed-level residents allowing refinement in terms of logistics, dose and delivery. Investigators have disseminated promising results, thereby generating access to a larger study population for the proposed Randomized Clinical Trial in mixed-specialty interns, studying ESRT as a means to improve well-being, cognition and performance.
As such, the investigators aim to:
Aim 1. Assess the feasibility of ESRT for multi-specialty interns. Aim 2. Optimize and Manualize ESRT. Aim 3. Identify outcome measures that are feasible and reflect relevant intervention targets for physicians' well-being, cognition and performance.
While this study will likely not reach statistical power, it will absolutely allow for broader vetting of the curriculum, testing of scaled-up data acquisition and management methods, and the appropriateness of the outcome measures in a mixed-specialty population, paving the way for a high-quality, fully-powered multi-center trial in the near future.
The significance of studying mindfulness mental training in medical and surgical trainees is two-fold.
One, as a process-centered skill with demonstrated effects on psychological well-being, perceived stress, cognitive performance and physiologic health, mindfulness represents a potential gateway mechanism for providing individuals with a 'universal tool' to address challenges across all stages of medical training and practice. This includes burnout and errors, both looming issues that have been largely immutable for the last decade.
Two, if feasibility and efficacy among medical and surgical trainees can be shown, the social clout of impacting such a high stress and high performance field is uniquely powerful and could further the dissemination of evidence-based mindfulness interventions to a remarkable degree. Finally, the enhanced self-awareness and equipoise frequently resulting from mindfulness training has been contagious in other settings, and could hold great promise for a culture change in medicine that benefits patients and providers, alike.
The innovation of this work is in bringing a mind-body intervention to bear not only on well-being but also on the fundamental cognitive processes believed to sub-serve performance, such as the impact of attention and working memory capacity on medical decision-making, and the impact of emotional regulation and self-awareness on professionalism and team work. The potential to improve both the operative and clinical environments as well as medical errors is unprecedented. Finally, a vetted, manualized curriculum specifically crafted for physicians could accelerate dissemination nationally.
Stress Mindfulness Cognitive Change Residents Well-being Enhanced Stress Resilience Training (ESRT) Active Control Mental Training for Residents
You can join if…
Open to people ages 18-64
- Any consented medical intern from Emergency Medecine, Internal Medicine, Pediatrics,Family Practice, OBGYN and Surgery Depratments in-coming to University of California San Francisco in the study year.
You CAN'T join if...
- Current personal mindfulness practice;
- Use of medications with Central Nervous System effects;
- Lifetime history of an organic mental illness;
- Acute or chronic immune or inflammatory disorders;
- Implanted MRI-incompatible metal.
- University of California San Francisco accepting new patients
San Francisco California 94143 United States
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