An educational program in “mindful” communication produced striking improvements in physicians' symptoms of burnout, according to a recent report.
By enhancing physicians' attention to their own feelings and experiences, the 52-hour program not only reduced participants' distress but also increased their empathy for patients and their ability to deliver patient-centered care, which in turn may improve clinical outcomes, Dr. Tait D. Shanafelt said in an accompanying editorial.
“Physicians will face a host of new challenges over the next decade as the nation reforms its health care system,” and the restructuring will likely “increase the already epidemic levels of burnout in physicians and overwhelm those currently near their limits,” he wrote.
In response, some physicians will feel compelled to withdraw from their work. But this study “demonstrates that training physicians in the art of mindful practice has the potential to promote physician health through work,” said Dr. Shanafelt, director of the Program on Physician Well-Being at the Mayo Clinic, Rochester, Minn. (JAMA 2009;302:1338-40).
In the study, Dr. Michael S. Krasner and his associates at the University of Rochester (N.Y.) evaluated a continuing medical education course designed to improve physician well-being. The 1-year program includes an intensive phase with 8 weekly 2.5-hour sessions plus one all-day session toward the end of this phase, followed by a maintenance phase of 10 monthly 2.5-hour sessions.
Each session begins with a brief presentation of that week's theme and may include guided meditation exercises, yoga-type exercises, large-group discussions, writing brief stories about personal experiences in medical practice, discussing challenges in medical practice, and sharing the written stories.
The weekly and monthly topics include self-awareness of thoughts and feelings, examining perceptual biases, dealing with pleasant and unpleasant events, managing conflict, preventing burnout, reflecting on meaningful experiences in practice, setting boundaries, examining attention to patients, exploring self-care, being with suffering, and examining end-of-life care.
Participants are taught mindfulness–“paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” It includes lowering one's reactivity to challenging experiences; noticing and experiencing one's thoughts, feelings, and bodily sensations, even when unpleasant; acting with awareness and attention instead of “on autopilot”; and trying to disregard the labels or judgments applied to experiences in medical practice.
A total of 871 Rochester-area internal medicine, family medicine, and pediatric physicians were invited to partake in the program, and 70 accepted.
These subjects were assessed at five different times before, during, and after the program, using several instruments such as the Maslach Burnout Inventory, the Jefferson Scale of Physician Empathy, the Physician Belief Scale, the Profile of Mood States, and the Big Five Factor Structure personality scale.
Study subjects showed “striking” improvements in self-awareness and well-being, which included decreases in emotional exhaustion, depersonalization, depression, tension, anger, and fatigue, as well as increases in feelings of personal accomplishment, vigor, empathy, and psychosocial beliefs known to correlate with patient-centered behavior, Dr. Krasner and his colleagues said (JAMA 2009;302:1284-93).
The study was funded by the Physicians' Foundation for Health Systems Excellence and sponsored by the New York chapter of the American College of Physicians. Dr. Krasner and Dr. Shanafelt reported no financial conflicts of interest.