Resident Physician Perspectives on Mindfulness Education in Residency: A Multispecialty Qualitative Assessment of Clinical Care Impact.

Background: Mindfulness training positively influences residents personally and professionally. Routine integration into residency may be impacted by limited understanding of the ways in which mindfulness training enhances clinical care. Objective: We explored residents' direct experience and personal application of mindfulness in their clinical work following 10 hours of mindfulness training. Methods: Mindfulness training sessions were facilitated between 2017 and 2019 for 5 groups of residents: pediatrics, ophthalmology, postgraduate year (PGY)-1 anesthesiology, and 2 different years of PGY-1 family medicine residents. Training was integrated into resident protected didactic time and attendance was expected, although not mandated, with the exception of pediatrics, in which the department mandated the training. Qualitative evaluation was conducted using a voluntary, semi-structured, de-identified phone interview within 2 months post-training. Reviewers independently coded the transcripts and then dialogued to reach consensus around emergent themes. Results: Thirty-six of 72 residents (50%) who participated in the training completed interviews. Themes were similar across specialties. All residents acknowledged the potential usefulness of mindfulness training during residency. Six residents (17%) reported they had not applied the mindfulness training to their daily work by the end of the course. There were 4 emergent themes related to clinical application of mindfulness training: integrating brief moments of mindfulness practice, self-awareness, relational presence with patients, and maintaining perspective during clinical encounters and residency training as a whole. Conclusions: After completing a 10-hour mindfulness training program, residents reported enhanced perspective-taking and relationship-building with themselves and their patients in clinical settings across medical and procedural specialties.

Developing a Mindfulness Skills-Based Training Program for Resident Physicians.

BACKGROUND AND OBJECTIVES: Resident physicians experience a high level of stress. Mindfulness meditation has been shown to offer medical students and physicians a healthier way to relate to daily stressors. We developed and pilot tested a mindfulness training program and assessed its impact on resident physician burnout and resilience. METHODS: The residency program offered 17 family medicine residents a 10-hour mindfulness training over the course of 2 months in 2016. Residents were encouraged, but not mandated, to attend. Experienced Mindfulness-Based Stress Reduction teachers and a family physician/integrative health fellow cotaught the program. A research team qualitatively assessed deidentified, postintervention resident interviews. Residents completed four quantitative questionnaires preintervention, immediately postintervention, and 3 months postintervention. A t score was calculated to assess for statistical significance. RESULTS: Three residents (18%) attended all five training sessions, seven residents (41%) completed at least four sessions, and 16 residents (94%) completed either one or two sessions. Eight residents completed the postintervention interview. Twelve, nine and 14 residents completed the four questionnaires at the three time points, respectively. Qualitative results identified multiple personal/professional benefits of participating in mindfulness training, and we found a statistically significant decrease in perceived stress and increase in mindful awareness from pre- to postintervention (P<.05). CONCLUSIONS: A resident physician mindfulness training program can be reasonably integrated into the residency schedule as part of the wellness curriculum required by the Accreditation Council for Graduate Medical Education. Preliminary results show potential for personal growth and positive changes in patient relationships.

Tai Chi Improves Sleep Quality in Healthy Adults and Patients with Chronic Conditions: A Systematic Review and Meta-analysis.

BACKGROUND: Physical activity and exercise appear to improve sleep quality. However, the quantitative effects of Tai Chi on sleep quality in the adult population have rarely been examined. We conducted a systematic review and meta-analysis evaluating the effects of Tai Chi on sleep quality in healthy adults and disease populations. METHODS: Medline, Cochrane Central databases, and review of references were searched through July 31, 2013. English-language studies of all designs evaluating Tai Chi's effect on sleep outcomes in adults were examined. Data were extracted and verified by 2 reviewers. Extracted information included study setting and design, population characteristics, type and duration of interventions, outcomes, risk of bias and main results. Random effect models meta-analysis was used to assess the magnitude of treatment effect when at least 3 trials reported on the same sleep outcomes. RESULTS: Eleven studies (9 randomized and 2 non-randomized trials) totaling 994 subjects published between 2004 and 2012 were identified. All studies except one reported Pittsburg Sleep Quality Index. Nine randomized trials reported that 1.5 to 3 hour each week for a duration of 6 to 24 weeks of Tai Chi significantly improved sleep quality (Effect Size, 0.89; 95% confidence interval [CI], 0.28 to 1.50), in community-dwelling healthy participants and in patients with chronic conditions. Improvement in health outcomes including physical performance, pain reduction, and psychological well-being occurred in the Tai Chi group compared with various controls. LIMITATIONS: Studies were heterogeneous and some trials were lacking in methodological rigor. CONCLUSIONS: Tai Chi significantly improved sleep quality in both healthy adults and patients with chronic health conditions, which suggests that Tai Chi may be considered as an alternative behavioral therapy in the treatment of insomnia. High-quality, well-controlled randomized trials are needed to better inform clinical decisions.