Resident & Student Health

Mindfulness helps surgical residents cut stress, perform better

Research exploring the effects of mindfulness training suggests it produces broad and significant improvements in attributes applicable to patient care and physician well-being.

First-year surgical residents were provided two hours of experiential mindfulness-based stress reduction training weekly for eight weeks, with 20 minutes of daily home practice encouraged. In this pilot randomized control trial, researchers found “higher mindfulness, lower stress, better executive function scores, faster motor skills, and unique activation of neural substrates associated with executive control and self-awareness during an emotional regulation task compared with control participants.”

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The results were reported in “Efficacy of Mindfulness-Based Cognitive Training in Surgery,” published in JAMA Network Open. The effect size of specific improvements ranged from medium to large.

“Working memory appears to be more greatly enhanced in those who participated in the intervention. And then, equally as compelling, is that cognitive control appears to be protected, whereas it deteriorates in the control arm,” said study lead author and surgeon Carter C. Lebares, MD, of the University of California, San Francisco (UCSF).

Those executive-function domains have special meaning for medicine.

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“We know that executive function is the actual machinery of a working brain which it recruits to do every part of the higher order thinking, acting and decision-making that a physician or a surgeon relies upon,” she said.

The study was a small-scale pilot—21 UCSF residents, including the control arm. Data from a larger number of later research subjects is being analyzed. The researchers have their sights set on a multicenter trial, which will provide the statistical power to confirm findings.

Expanded research will carry on the study’s use of brain imaging. “While other mindfulness-based intervention studies have looked at brain scans, it’s only a very small handful that have looked at brain scans in addition to all of the other domains that we evaluated,” said Dr. Lebares.

“Mindfulness” made meaningful

Mindfulness is often described as living or being in the moment, but Dr. Lebares defines it in terms related to medicine. The mindfulness training provided was experiential—not didactic—and included meditation and breathing exercises to train specific cognitive skills. According to Dr. Lebares, they are:

  • Interoception—moment-to-moment awareness of thoughts, emotions and sensations.
  • Emotional regulation—development of nonreactivity in response to stimuli.
  • Metacognition—conscious awareness of one’s cognitive control processes.

Explaining mindfulness that way to a medical audience provides relevance that the overarching term does not. “People in medicine, particularly in surgery, have a hard time connecting with the term ‘mindfulness,’” she said.

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Protect doctors by protecting time

Physicians protecting and strengthening themselves may be the focus of mindfulness training, but Dr. Lebares cautioned that the stressors in health care are systemic and promoting individual-based interventions “should not be equated with saying that this problem is our fault.”

If research makes a compelling case for mindfulness training, it will be up to institutions to provide and support it. A crucial support in the surgical resident research—and required for any institution seeking to partner in further study—is protected time for participants, said Dr. Lebares.

“When their time is really protected, and they're allowed to turn off their pagers and not face retribution when they exit the classroom and go back on service, then pretty uniformly they get a tremendous amount out of it,” she said. “But when their time is not protected, we get diminishing returns.”