It is no secret that surgeons often work in high-stakes environments and they are under a constant pressure to perform. Although there has been a lot of work to show that mindfulness can positively influence the patient-physician encounter, how does it impact surgical skills? Stress is also a known modulator of performance so whether a mindfulness based stress reduction program can be a means of adaptive coping amongst surgical trainees remains to be seen. Researchers at the University of California are attempting to answer these questions using a mindfulness based stress reduction course for surgical residents.
Twenty-one first year surgical residents were randomized to an 8-week mindfulness intervention versus an active control (a course with the same structure but different content). The mindfulness based stress reduction program consisted of two hour classes once per week and 20 minutes of daily home practice. This small pilot study explored preliminary efficacy on perceived stress and executive function and secondarily looked at burnout, depression, motor skill performance and emotional regulation amongst the residents in both groups. Executive function assessed six cognitive domains including working memory, inhibition, planning and more and motor function was determined on the basis of two surgical tasks that were scored for time and accuracy. These outcomes were assessed at baseline before the start of the residency year and after the course was delivered three and a half months later. The residents were then assessed again 12 months later at the end of their first year of residency.
Lebares et al found that perceived levels of stress were twice as high in the control arm at 3.5 months versus the group that received the mindfulness based intervention but this difference was not sustained at 12 months. Working memory and executive function increased more in trainees receiving the mindfulness based intervention but the difference between groups was not significant. Cognitive control was also shown to be lower amongst the control group at the end of the 12 month study. However, burnout scores were not different between the two groups which could suggest that mindfulness based interventions are not effective in reducing burnout amongst surgical trainees or could reflect the low sample size in the study.
So, this preliminary evidence suggests that there could be some benefits to mindfulness based interventions for surgical trainees. However, it is difficult to tease all of these outcomes apart – for example, it is possible that decreased perceived stress lead to increased working memory and executive function amongst those participating in the mindfulness program. That said, finding ways that can effectively address perceived stress amongst surgical trainees is likely to have many downstream benefits that couldn’t be fully captured by this very small pilot study. While this study was ultimately underpowered and it is hard to draw any serious conclusions about the efficacy of this intervention, there is some suggestion that mindfulness could be useful in trainees and this deserves more attention moving forward.
This article was written by Zoe O’Neill, a first year medical student at McGill University and a member of the McGill Med Mindfulness team.