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    Bringing the Lessons of Mindfulness to Medical School


    As soft music played in the background, 200 academic medicine faculty closed their eyes and took deep breaths, in through the nose and out through the mouth. In a soothing voice, their guide encouraged them to be present, immersing themselves in the moment and the movement of their breath.

    This wasn’t a retreat in a new age spa. The relaxation technique was part of a session on “Optimizing the Learning Environment: Faculty and Resident Resilience,” held during a recent meeting of the AAMC’s Council of Faculty and Academic Societies (CFAS) in San Diego.

    “I found it remarkably calming,” said Mona Abaza, MD, MS, residency program director in the Department of Otolaryngology at the University of Colorado School of Medicine. “Everyone seemed open-minded about trying it, and I do think it opened a lot of people’s minds. It was a powerful first-person experience for a lot of academic faculty in a setting where this isn’t normally done.”

    The experience may have been new to many faculty members in the room, but the purpose—to promote resiliency and encourage healthy techniques for managing work-related stress—is part of a growing conversation across academic medicine. Abaza, who chairs the CFAS Faculty Resilience Task Force, noted that as physicians experience high rates of job burnout, divorce, and even suicide, addressing stress must shift from an individual problem to an institution-wide priority. “The backbone of academic medicine is the faculty—we’re the workforce,” she said.

    Emotional exhaustion, burnout, and job dissatisfaction are not uncommon in the halls of teaching hospitals and schools of medicine. A 2012 survey published in Academic Medicine found that among thousands of full-time medical school faculty, 21 percent had considered leaving academic medicine altogether because of dissatisfaction. That study concluded that the “central and concerning finding is that faculty dissatisfaction was saliently associated with faculty members’ negative perceptions and distress about the nonrelational and ethical culture of the workplace.”

    Larry Bergstrom, MD, assistant professor of medicine at the Mayo Clinic and an integrative medicine practitioner at the Mayo Clinic in Scottsdale, Ariz., likens the physical manifestation of living with chronic stress to “sitting in the jungle and listening for a saber tooth tiger all day long. It’s exhausting.” Bergstrom has conducted workshops on resiliency for faculty at schools of medicine nationwide. Physicians and faculty members often have three traits in common that contribute to burnout and stress, he said. The culprits: perfectionism, people-pleasing, and being hyper-responsible.

    “I do see things getting worse,” said Ron Epstein, MD, a professor in the Departments of Family Medicine, Psychiatry, Oncology, and Nursing at the University of Rochester Medical Center, who offers another perspective. “Doctors have always worked hard, so it’s not about the sheer quantity of hours—it’s how your time is actually spent. We’re spending less and less time with patients and more time in front of computers, which erodes [our] sense of meaning, [our] sense of purpose.”

    “There’s a stigma around asking for help,” Abaza added. “If we do nothing (about the problem), the ability of academic faculty to sustain themselves is fundamentally at risk.”

    Minding your stress

    Years ago, as Epstein was designing educational assessments for medical students, he realized that what makes a great doctor is more than just knowledge. A capacity for self-awareness, emotional regulation, and mindfulness in daily life and work also is critical. He began to see parallels between his meditation practice—an activity he first began at age 17—and his experience on the job. Eventually, those parallels led him, along with colleague Michael Krasner, MD, to develop a series of “Mindful Practice” curricula that have since reached thousands of physicians, students, and residents. In studying the curriculum’s effects on participating practitioners, Epstein and his colleagues found reduced burnout, decreased negative moods, and improved resilience.

    Mindfulness is defined in the curriculum as “an open, receptive, and non-judgmental orientation to one’s present moment-to-moment experience.” It’s about awareness, Epstein emphasized, not about relaxing, although that might be a positive benefit. In becoming mindful through meditative practices and reflection techniques, people can more readily recognize stressors and regulate thoughts and feelings before those stressors take a toll, he explained.

    “Having a greater ability to recognize what’s going on inside allows you to set aside distractions and really attend to the moment,” Epstein said. “Paradoxically, what you learn in meditation is that turning toward the distress and becoming curious about it rather than being swept away by it is a way to detoxify it. The more we try to escape the stress, the worse it becomes.”

    “Having a greater ability to recognize what’s going on inside allows you to set aside distractions and really attend to the moment.”

    Ron Epstein, MD

    Aviad Haramati, PhD, a professor of physiology in the Departments of Biochemistry, Molecular, and Cellular Biology and Medicine at Georgetown University School of Medicine, has taken his message of mindfulness and resiliency to more than 70 medical schools around the world. As co-leader of Georgetown’s Mind-Body Medicine Program, Haramati has helped train nearly 100 faculty members, who then bring a variety of techniques, from meditation to journal writing, to their medical students.

    Haramati, who guided the faculty members through the breathing exercise at the CFAS meeting, admitted that meditation and mindfulness have a reputation for being on the fringe. The first time he led medical students through a meditative experience, “I was very uncomfortable—it felt contrived.” But knowing that such exercises can be a “transformative experience,” he pointedly wraps his message in a context that physicians can relate to: the science and physiology of stress reduction.

    “I think we’ve turned a corner because the awareness of resiliency is so great that we’re already beginning to address it,” Haramati said. Presently, the CFAS Faculty Resilience Task Force is gathering information on stress-related tools and resources to create a reference hub for academic medicine faculty and institutions.

    In the long run, stress reduction techniques and the self-awareness that can follow will manifest in better patient care, Haramati believes. “The status quo is definitely unacceptable,” he said. Just as flight attendants instruct passengers to put on their own oxygen masks before helping others, physicians also must prioritize their own self-care to optimize their ability to help their patients, Haramati said.

    This article originally appeared in print in the May 2015 issue of the AAMC Reporter.