Mindfulness training for medical students in their clinical clerkships: two cross-sectional studies exploring interest and participation

BMC Medical Education

Anne EM Speckens¹  Peter LBJ Lucassen²  Inge van Dijk² 

[1]Department of Psychiatry, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands

[2]Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands

关键词: Online survey;    Mindfulness skills;    Psychological distress;    Participation;    Interest;    Mindfulness-based stress reduction;    Clinical clerkships;    Medical students;   

Others  :  1138512
DOI  :  10.1186/s12909-015-0302-9

 received in 2014-06-19, accepted in 2015-02-04,  发布年份 2015

【 摘 要 】

Background

So far, studies investigating Mindfulness Based Stress Reduction (MBSR) training in medical students are conducted in self-selected, pre-clinical samples, with modest response rates without collecting data on non-participants. This study first examines interest and participation rates of students starting their clinical clerkships. Second, it compares students interested in a mindfulness training with non-interested students and students participating in a trial on the effect of MBSR with non-participating students on levels of psychological distress, personality traits, cognitive styles and mindfulness skills.

Methods

We examined two student samples from the Radboud University Medical Center, Nijmegen:

Study 1 From March to December 2010 we performed a cross-sectional pilot-study among 4th year medical students starting their clinical clerkships, assessing interest in a MBSR training. We compared scores on the Brief Symptom Inventory, the Neo Five Factor Inventory and the Five Facet Mindfulness Questionnaire of interested students with those of non-interested students using t-tests with Bonferroni correction.

Study 2 From February 2011 to August 2012 we invited 4th year medical students starting their clinical clerkships to participate in a randomized controlled trial (RCT) on the effectiveness of MBSR. We compared scores on the Brief Symptom Inventory, the Irrational Beliefs Inventory and the Five Facet Mindfulness Questionnaire of participating students with those of non-participants using t-tests with Bonferroni correction.

Results

Study 1: Ninety-five out of 179 participating students (53%) were interested in a MBSR training. Interested students scored significantly higher on psychological distress (p = .004) and neuroticism (p < .001), than 84 non-interested students.

Study 2: Of 232 eligible students, 167 (72%) participated in our RCT. Participants scored significantly higher on psychological distress (p = .001), worrying (p = .002), problem avoidance (p = .005) and lower on mindfulness skills (p = .002) than 41 non-participants.

Conclusions

Interest in mindfulness training and response rates in a RCT on the effectiveness of MBSR among clinical clerkship students are equal to (study 1) or higher (study 2) than in studies on pre-clinical students. Interested students and participants in a RCT reported more psychological distress and psychopathology related character traits. Participants scored lower on mindfulness skills.

【 授权许可】

   
2015 van Dijk et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al.: Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 2008, 149:334-41.
• [2]Dyrbye LN, Thomas MR, Power DV, Durning S, Moutier C, Massie FS Jr, et al.: Burnout and serious thoughts of dropping out of medical school: a multi-institutional study. Acad Med J Assoc Am Med Coll 2010, 85:94-102.
• [3]Boudreau D, Santen SA, Hemphill RR, Dobson J: Burnout in medical students: examining the prevalence and predisposing factors during the four years of medical school. Ann Emerg Med 2004, 44(4, Supplement):S75-6.
• [4]Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F: Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med 1998, 91:237.
• [5]Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al.: Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med 2011, 86:996-1009.
• [6]Pedersen R: Empathy development in medical education – a critical review. Med Teach 2010, 32:593-600.
• [7]Kjeldstadli K, Tyssen R, Finset A, Hem E, Gude T, Gronvold NT, et al.: Life satisfaction and resilience in medical school – a six-year longitudinal, nationwide and comparative study. BMC Med Educ 2006, 6:48. BioMed Central Full Text
• [8]Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH, Tomenson B: Embarking upon a medical career: psychological morbidity in first year medical students. Med Educ 1995, 29:337-41.
• [9]Finset KB, Gude T, Hem E, Tyssen R, Ekeberg O, Vaglum P: Which young physicians are satisfied with their work? A prospective nationwide study in Norway. BMC Med Educ 2005, 5:19. BioMed Central Full Text
• [10]Prins JT, van der Heijden FMMA, Hoekstra-Weebers JEHM, Bakker AB, van de Wiel HBM, Jacobs B, et al.: Burnout, engagement and resident physicians’ self-reported errors. Psychol Health Med 2009, 14:654-66.
• [11]Shanafelt TD, Bradley KA, Wipf JE, Back AL: Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002, 136:358.
• [12]West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD: Association of resident fatigue and distress with perceived medical errors. JAMA 2009, 302:1294.
• [13]Anagnostopoulos F, Liolios E, Persefonis G, Slater J, Kafetsios K, Niakas D: Physician burnout and patient satisfaction with consultation in primary health care settings: evidence of relationships from a one-with-many design. J Clin Psychol Med Settings 2012, 19:401-10.
• [14]Argentero P, Dell’Olivo B, Ferretti MS: Staff burnout and patient satisfaction with the quality of dialysis care. Am J Kidney Dis Off J Natl Kidney Found 2008, 51:80-92.
• [15]Halbesleben JRB, Rathert C: Linking physician burnout and patient outcomes. Health Care Manage Rev 2008, 33:29-39.
• [16]Zwack J, Schweitzer J: If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med J Assoc Am Med Coll 2013, 88:382-9.
• [17]Kabat-Zinn J: An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry 1982, 4:33-47.
• [18]Keng S-L, Smoski MJ, Robins CJ: Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev 2011, 31:1041-56.
• [19]Grossman P, Niemann L, Schmidt S, Walach H: Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res 2004, 57:35-43.
• [20]Fjorback LO, Arendt M, Ørnbøl E, Fink P, Walach H: Mindfulness-based stress reduction and mindfulness-based cognitive therapy – a systematic review of randomized controlled trials. Acta Psychiatr Scand 2011, 124:102-19.
• [21]Epstein RM: Mindful practice. JAMA 1999, 282:833.
• [22]Ludwig DS, Kabat-Zinn J: Mindfulness in medicine. JAMA 2008, 300:1350-2.
• [23]Irving JA, Dobkin PL, Park J: Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR). Complement Ther Clin Pract 2009, 15:61-6.
• [24]Irving JA, Park-Saltzman J, Fitzpatrick M, Dobkin PL, Chen A, Hutchinson T: Experiences of health care professionals enrolled in mindfulness-based medical practice: a grounded theory model. Mindfulness 2014, 5:60-71.
• [25]Beckman HB, Wendland M, Mooney C, Krasner MS, Quill TE, Suchman AL, et al.: The impact of a program in mindful communication on primary care physicians. Acad Med 2012, 87:815-9.
• [26]Shapiro SL, Schwartz GE, Bonner G: Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med 1998, 21:581-99.
• [27]Rosenzweig S, Reibel D, Greeson J, Brainard G, Hojat M: Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med 2003, 15:88-92.
• [28]Jain S, Shapiro SL, Swanick S, Roesch SC, Mills PJ, Bell I, et al.: A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Ann Behav Med 2007, 33:11-21.
• [29]Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR: A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med Educ 2011, 45:381-8.
• [30]de Vibe M, Solhaug I, Tyssen R, Friborg O, Rosenvinge JH, Sørlie T, et al.: Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Med Educ 2013, 13:107. BioMed Central Full Text
• [31]Erogul M, Singer G, McIntyre T, Stefanov DG: Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med 2014, 26:350-6.
• [32]Dobkin PL, Hutchinson TA: Teaching mindfulness in medical school: where are we now and where are we going? Med Educ 2013, 47:768-79.
• [33]Derogatis LR, Melisaratos N: The brief symptom inventory: an introductory report. Psychol Med 1983, 13:595-605.
• [34]de Beurs E: Brief symptom inventory handleiding herziene editie 2011. Pits publishers, Leiden; 2011.
• [35]de Beurs E, Zitman F: De Brief Symptom Inventory (BSI). De betrouwbaarheid en validiteit van een handzaam alternatief voor de SCL-90. Leids universitair medisch centrum, Leiden; 2005.
• [36]Hoekstra HA, Ormel J, de Fruyt F: NEO-PI-R/NEO-FFI Big Five Persoonlijkheidsvragenlijst Handleiding. Hogrefe, Amsterdam; 2003.
• [37]Baer RA, Walsh E, Lykins EL: Assessment of mindfulness. In Clinical handbook of mindfulness. Edited by Didonna F. Springer, New York; 2009:153-68.
• [38]De Bruin EI, Topper M, Muskens JGAM, Bogels SM, Kamphuis JH: Psychometric properties of the five facets mindfulness questionnaire (FFMQ) in a meditating and a Non-meditating sample. Assessment 2012, 19:187-97.
• [39]Ellis A: Reason and emotion in psychotherapy. Rev sub edition. Citadel, Secaucus, NJ; 1994.
• [40]Jones RG: A factored measure of Ellis’ irrational belief system with personality and maladjustment correlates. 1968.
• [41]Shorkey CT, Whiteman VL: Development of the rational behavior inventory: initial validity and reliability. Educ Psychol Meas 1977, 37:527-34.
• [42]Timmerman I, Sanderman R, Koopmans P, Emmelkamp P: Het meten van irrationele cognities met de Irrational Beliefs Inventory (IBI-50), een handleiding. Noordelijk Centrum voor Gezondheidsvraagstukken, Groningen; 1993.
• [43]Ellis PD: The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. 1st edition. Cambridge University Press, Cambridge ; New York; 2010.
• [44]Langelaan S, Bakker AB, van Doornen LJP, Schaufeli WB: Burnout and work engagement: do individual differences make a difference? Personal Individ Differ 2006, 40:521-32.