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MINDFULNESS IN MEDICAL EDUCATION Millaray Sanchez-Campos and Douglas Archibald

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 P h D Heather MacLean MD, FRCP(C)

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MINDFULNESS IN MEDICAL EDUCATION Millaray Sanchez-Campos and Douglas Archibald

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  1. 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

  2. Acknowledgments Carol GonsalvesMD, FRCP (C), MEd Diana Koszycki PhD Heather MacLean MD, FRCP(C) Veronique Duschesne MD Candidate Class 2016 Kay-Anne Haykal MD, CCFP

  3. 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.

  4. 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 Click View then Header and Footer to change this text

  5. WORKSHOP OBJECTIVES

  6. OUTLINE • Introduction 15 minutes • Practicing Mindfulness 15 Minutes • Mindfulness in Medical Education 10 minutes • Discussion 10 minutes

  7. OUR MODERN LIFE

  8. PHYSICIAN HEALTH

  9. BEING IN THE MOMENT...

  10. 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

  11. SCENARIO “DO-OVER”…MINDFULLY

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. MBSR AND CHANGES IN GREYMATTER 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

  18. 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

  19. 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. FamSyst Health 2003:21:11-17

  20. MINDFULNESS CURRICULUM

  21. MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE • 2012: A-pilot project of « Mindful Practice in Clinical Practice » wasadded as a teaching innovation to the 3rd year rotation in FamilyMedicine. • PIME grantawarded to studythisteaching innovation. Researchis in progress. • 2013-2014 class evaluations are very positive:

  22. MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE • definiteeyeopener • trulyenjoyed • excellent • Interesting • insightful, • relaxing, • important to teach in the curriculum

  23. MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE • willtry to make sure I use it in the future • itprompted me to bepresent in myeveryday life, will use in the future to relieve stress • willdefinitelytry to implementsome of the mindfulness technique in mywork and daily routine • now I try to bemindfulbeforedoingthings

  24. MINDFULNESS AT uOTTAWAFACULTY OF MEDICINE The session waswellrun and wellled. This beingsaid, itwas time wasted. A mindfulness workshop is a greatthing to offer to medicalstudentsoutside of academic time. As a mandatory portion of ouracademicteaching, itisnothing short of a farce. Instead of choosingfrom a myriad of useful topics to teachfromany area rangingfromclinicalmedicine to pharmacology, I spentmyacademicmorningeating a raisin and contemplatingits texture. This is nonsense. In my opinion, this time shouldbespent on topics thatwillenrichourknowledge and performance as physicians

  25. 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

  26. 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

  27. 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

  28. 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

  29. RESOURCES Guided meditation: www.mindfulselfcompassion.org Mindfulness meditation as a tool for compassion fatigue:  https://compassionfatigue.ca

  30. RESOURCES Modern Meditation Mindfulness Resources http://www.modernmeditation.ca/mindfulness-resources/

  31. 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, ThichNhat. You Are Here. Boston: Shambhala Publications, 2001.

  32. THANK YOU! Questions? Contact: Millaray Sanchez msanchez@uottawa .ca

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