OA05.03. Impact of a mind-body medicine skills course on medical students’ perceived stress, mindfulness and elements of emotional intelligence

Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review

INTRODUCTION

Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue.

METHODS

PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article.

RESULTS

Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed.

CONCLUSIONS

Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms' effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.

Promoting Resilience in Medicine: The Effects of a Mind-Body Medicine Elective to Improve Medical Student Well-being

Background

Poor mental health is common among medical students. In response, some medical schools have implemented wellness interventions. The University of Florida College of Medicine recently introduced a mind–body medicine elective, Promoting Resilience in Medicine (PRIMe), based on the Georgetown University School of Medicine course. PRIMe teaches meditation techniques including mindfulness, biofeedback, art, and journaling in a faculty-facilitated small group setting.

Methods

First- and second-year medical students (N = 24) who participated in the 11-week elective (3 cohorts over 2 years) completed anonymous surveys regarding their experiences. Measures included the Freiberg Mindfulness Inventory (FMI), Perceived Stress Scale-10 item (PSS-10), and a series of multiple-choice and free-response questions developed for this study. The study was approved by the University of Florida Institutional Review Board.

Results

Among students with available pre- and posttest scores, the average PSS-10 score at pretest was 14.4 (SD = 6.17, range = 3–26) and at posttest was 14.2 (SD = 4.17, range = 8–22), suggesting no change in perceived stress. However, average scores on the FMI improved from 34.4 (SD = 6.10, range = 24–47) at pretest to 41.8 (SD = 4.81, range = 33–49) at posttest. The overwhelming majority of participants (95.8%) described the course as “definitely” worth it. The greatest improvements were noted in mindfulness, relationships with peers, and having a safe place in medical school to receive support. Learning mindfulness/meditation skills and increasing social support were noted as the primary factors impacting student well-being.

Conclusion

A mind–body medicine elective course may be a practical method to improve medical student well-being and improve ability to care for patients. Future studies should include follow-up testing to determine if benefits are sustained over time. In addition, more work is needed to understand the cost–benefit of providing instruction in mind–body medicine techniques to all medical students.

Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed-methods study

BACKGROUND

Primary care physicians are subjected to a high workload, which can lead to stress and a high incidence of burnout. A mindfulness training course was developed and implemented for primary care physicians to better cope with stress and improve job functioning.

AIM

To gain insight into the effects of the mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians.

DESIGN & SETTING

A pragmatic mixed-methods pre-post design in which physicians received 8 weeks of mindfulness training.

METHOD

Participants completed validated questionnaires on perceived stress (Perceived Stress Scale [PSS]), self-compassion (Self-Compassion Scale [SCS]), and self-reflection (Groningen Reflection Ability Scale [GRAS]) before the training, directly after, and 6 months later. Semi-structured interviews were conducted with six participants after the training and a content analysis was performed to gain in depth understanding of experiences.

RESULTS

A total of 54 physicians participated in the study. PSS was reduced (mean difference [MD] -4.5, P<0.001), SCS improved (MD = 0.5, P<0.001), and GRAS improved (MD = 3.3, P<0.001), directly after the 8-week training compared with before training. Six months later, PSS was still reduced (MD = -2.9, P = 0.025) and SCS improved (MD = 0.7, P<0.001). GRAS did not remain significant (MD = 2.5, P = 0.120). Qualitative analysis revealed four themes: being more aware of their own feelings and thoughts; being better able to accept situations; experiencing more peacefulness; and having more openness to the self and others.

CONCLUSION

Mindfulness training might be an effective approach for improving stress resilience, self-compassion, and self-reflection in primary care physicians.

Long-term follow-up of mind-body medicine practices among medical school graduates

INTRODUCTION

We sought to determine the long-term use of mind-body medicine (MBM) skills after graduation from medical school.

METHODS

An online survey was sent to Georgetown University School of Medicine (GUSOM) graduates who completed at least one semester of a MBM skills training course. Using a quantitative-qualitative mixed-methods approach, we assessed the personal and professional practices of graduates, and identified factors that may influence practice/training after graduation.

RESULTS

Current personal practices were positively related to the level of the course completed and amount of home practice during medical school (N = 112). Over half the sample indicated they currently practice MBM and refer patients to MBM. Moreover, physician specialty and awareness of home institution MBM training was associated with MBM patient training and referral. Participants reported a dearth of MBM training at their home institutions, and provided qualitative insights about the personal and professional impact of MBM training as well as barriers to continued MBM practice.

CONCLUSIONS

The results provide preliminary evidence that MBM training during medical school may be related over time to physician trainee self-care and patient care. Rigorous tests of these relationships should be conducted in future work.

Long-term benefits by a mind-body medicine skills course on perceived stress and empathy among medical and nursing students

BACKGROUND

A significant number of medical students suffer from burnout symptoms and reduced empathy. This controlled, quasi-experimental study aimed to investigate whether a mind-body medicine (MBM) skills course could reduce perceived stress and increase empathy and self-reflection in medical and nursing students.

METHODS

The MBM course (consisting of experiential sessions of mind-body techniques and group reflections) was piloted among Dutch medical students and Swedish nursing students. Main outcome variables were perceived stress (PSS), empathy (IRI subscales perspective taking, fantasy, empathic concern, and personal distress), and self-reflection (GRAS). Participating and control students completed questionnaires at baseline, post-intervention, at 6 and 12 months follow-up.

RESULTS

Seventy-four medical and 47 nursing students participated in the course. Participating medical students showed significantly increased empathic concern [1.42 (95% CI 0.05, 2.78), p = 0.042], increased fantasy [3.24 (95% CI 1.58, 4.90), p < 0.001], and decreased personal distress [-1.73 (95% CI -3.04, -0.35), p = 0.010] compared to controls until 12 months follow-up. Participating nursing students showed significantly decreased levels of perceived stress [-5.09 (95% CI -8.37, -1.82), p = 0.002] and decreased personal distress [-5.01 (95% CI -6.97, -3.06), p < 0.001] compared to controls until 12 months follow-up.

CONCLUSIONS

This study demonstrated long-term beneficial effects of the MBM course on perceived stress and empathy in medical and nursing students.

The effect of Mind Body Medicine course on medical student empathy: a pilot study

INTRODUCTION

Empathy among medical practitioners has been shown to affect patient care and outcomes. Factors such as stress and depression are known to have a negative impact on medical student empathy. Approaches such as mindfulness, meditation, and other mind-body techniques can enhance empathy and reverse burnout symptoms. In the present study, we evaluated impact of Mind Body Medicine (MBM) course on perceived stress and empathy on first-year medical students.

METHODS

Thirteen first-year medical students in total self-selected into MBM (experimental) and seven non-MBM (control) groups completed a prospective, pre- and post-test analysis, using the Jefferson Scale of Physician Empathy - Students (JSPE-S), Perceived Stress Scale (PSS), and Personal Health Questionnaire (PHQ) to evaluate empathy, stress, and depression, respectively.

RESULTS

Our results showed an increase in stress, as well as a decrease in empathy, in both MBM and non-MBM groups throughout the course of the study.

CONCLUSION

Our study demonstrated that the inverse relationship increased stress and decreased empathy among first-year medical students and participation in the MBM course did not attenuate the changes. However, a statistically significant rise in the depression score in the non-MBM group was not observed in the MBM group.