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Mindfulness Education in Medical School
Transcript of Mindfulness Education in Medical School
Brown University Alpert Medical School Existing Approaches MBSR Offered as an elective at UMass Medical School
Once weekly sessions for 8 weeks, meditation 'homework'
Combines sitting meditation, mindful movement, and reflection Excellent introduction to meditation and mindfulness
Up to 60 hours of mindfulness exercises
Not specifically geared for medical students
Unlikely that med students will do meditation homework What and where? Pros and Cons: Restorative Medicine Mandatory course at Johns Hopkins School of Medicine
Two cores: Food as Medicine and a Restorative Practice
QiGong, yoga, mindfulness meditation, reflective writing, life drawing and improvisational acting The entire student body is involved
The student's chosen practice is reinforced throughout the year
Meditation is only included in one of six tracts What and where? Pros and Cons: Healer's Art Created by Dr. Rachel Remen, and is currently offered at 60+ med schools in the US to first or second year students
Five 3-hour sessions comprised of didactics, discussion, reflection exercises, and meditation practices Equates a career in medicine to a 'life of service'
Specifically geared for medical students and very well received
Does not establish an ongoing meditation practice What and where? Pros and Cons: The BIG Picture Why mindfulness in medical school? Burnout: emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment or effectiveness
Affects up to 40% of medical students and physicians
Contributes to depression, suicidal ideation, unprofessional behavior, and increasing physician attrition rates
Prevents and treats burnout
Increases physician empathy, improves health outcomes, and might even reduce medical errors Mindful Communication Created by Drs. Mick Krasner and Ron Epstein at the University of Rochester School of Medicine and Dentistry
12 modules interspersed throughout 3rd year clerkships comprised of didactic, reflection and communication exercises, meditation and mindfulness practices Specifically addresses clinical applications of mindfulness practice
Includes little in-class meditation, relies on meditation homework What and where? Pros and Cons: Challenges: 1. Medical school curriculum is packed - very hard to find time for meditation as a class or individually
2. Conceptually, burnout and compassionate care may seem like distant concerns to a medical student Solutions: 1. Hold few, 8-hour weekend workshops to accrue adequate experience with meditation practices
2. Make meditation relevant: it improves your ability to study effeciently! Three Pillars of Contemplative Scholarship Trust Study Practice this stuff really works Buddhist philosophy pointedly states that doubt in the practice impedes progress along the path
Luckily, evidence-based-medicine is considered very trustworthy
Reviewing pertinent mindfulness and meditation research can help expound doubt in the practice Learning to meditate is like learning to ride a bike: it takes some time to find balance and get rid of the training wheels
The meditation 'loading dose' provides familiarity with the practice so it can be done independently
'Maintenance doses' are offered weekly at lunch-time, and an at-home practice is encouraged it's like pharmacology Traditionally, practice and trust are mutually supported by study of Buddhist texts and Sutras, but this is an unrealistic expectation of medical students
Can the essence of Buddhist philosophy can be boiled down and presented in a clear and concise manner?
I've found graphics and visual aids very helpful to convey the more nuanced aspects of Buddhism Buddhist Philosophy 101 WHO: Guide to Good Prescribing, 1994 MacLean et. al. 'Intensive Meditation Training Improves Perceptual Discrimination and Sustained Attention.' 2010 Psychological Science 21(6) 829–839 Jha et. al. 'Examining the Protective Effects of Mindfulness Training on Working Memory Capacity and Affective Experience.' 2010 American Psychological Association,10 (1) 54–64 1528-3542 Improved sustained attention Improved working memory Beginning to Meditate We begin with simple breath-awareness meditaton - shamatha practices
'Training wheels' are described and practiced, noting that the intention is to eventually drop these aids
In time, aversion to the practice naturally arises - this is an excellent opportunity to invite students to begin surface level insight practice Imagine you are sitting in a chair in an otherwise empty room...what would prevent you from being at peace? The Essence of Mindfulness "Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally." - Jon Kabat-Zinn Paying attention to what exactly? What changes in the mind to bring about that particular way of paying attention? Sensations Perception Attention Consciousness Action You are here Visualizing the mind Earth Sensations Perception Attention Consciousness Action Earth 'Autopilot' Focused Awareness of Sound Open Monitoring What about that particular way of paying attention? Orientation x3 Person how does your perception of self relate to those around you? "Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care."
— Core Competency expected by most medical residency programs in the US "The fact is, selflessness is the soul of teamwork...it's the unselfish players—players who are more interested in reading what's happening and keeping the flow going on the floor—who are the most valuable players that you have."
— Interview with Phil Jackson in EnlightenNext Magazine, 2004 “If we think only of ourselves, forget about other people, then our minds occupy very small area. Inside that small area, even a tiny problem appears very big. But the moment you develop a sense of concern for others, you realize that, just like ourselves, they also want happiness; they also want satisfaction. When you have this sense of concern, your mind automatically widens. At this point, your own problems, even big problems, will not be so significant. The result? Big increase in peace of mind. So, if you think only of yourself, only your own happiness, the result is actually less happiness. You get more anxiety, more fear.”
— Dalai Lama XIV, The Wisdom of Forgiveness “Every single being, even those who are hostile to us, is just as afraid of suffering as we are, and seeks happiness in the same way we do. Every person has the same right as we do to be happy and not to suffer. So let's take care of others wholeheartedly, of both our friends and our enemies. This is the basis for true compassion.”
― Dalai Lama XIV Place within what kind of space do you perceive yourself? and how much do you actually know about it? One morning, Osler was discovered by a colleague, “struggling in the effort to pass a stomach tube upon himself, resulting in the ordinary gagging and retching which such a procedure produces in one unaccustomed to it.” When asked what he was doing, he replied: “Well, we often pass these on people, and I thought we ought to find out what it feels like ourselves.” Wisdom led Osler to appreciate those things that characterize human vulnerability and patienthood; humility helped him understand that there are aspects of human suffering that are not easily penetrable. “This grace of humility,” Osler wrote, “is a precious gift.”
― Harvey Max Chochinov, MD PhD. Humility and the practice of medicine: tasting humble pie. CMAJ • AUGUST 10, 2010 • 182(11) Time what is the significance of passing time? "When I am sitting with a dying person, I sometimes hear the following words inside me: “Whatever suffering this person is experiencing, it will change.” Maybe for better, maybe for worse. Change is inevitable—that’s impermanence. And at the same time, it is necessary to be fully there for the often overwhelming and raw truth of moment-to-moment suffering."
— Roshi Joan Halifax in Being With Dying: Cultivating Compassion and Fearlessness in the Presence of Death "Coming to terms with the truth of impermanence is one of the most important ways for us to transform our relationship to dying and death."
— Roshi Joan Halifax in Being With Dying: Cultivating Compassion and Fearlessness in the Presence of Death "If we are able to realize that we aren’t separate from others, that we have no inherent identity, and that nothing is fixed in time and space, our suffering diminishes or even ceases."
— Roshi Joan Halifax I have no financial relationships to disclose "Fullness of knowledge always means some understanding of the depths of our ignorance; and that is always conducive to humility and reverence."
― Robert Millikan, Nobel Laureate in physics Thank you! Why am I here?
The state of mindfulness in med school
What we're trying to do at Brown
My attempt to communicate mindfulness philosophy The Agenda