This chapter deals with the concept of mindfulness as a skill required both by teachers and by students. This concept is explored by providing a brief review of why the concept of mindfulness is gaining attention in medicine and higher education. As a mindful practitioner, the author describes examples of how mindful practices in his daily life have opened and enriched his teaching experiences and enhanced student learning. Mindful practice has also enabled the author to take a broader perspective of how medical schools can develop “better” doctors. In engaging with colleagues across the university, the author has applied this perspective to develop a medical humanities course for the undergraduate medical curriculum.
TopWhat Is Mindfulness?
Mindfulness can be defined as the capacity to embrace moment to moment, non judgmental awareness (Kabat-Zinn, 2009). It is based on the eastern tradition of meditative exercises with the purpose of enabling practitioners of mindfulness (those engaging in mindful practice) to acquire insight into the nature of reality by fully paying attention to what is happening in present moment. At the same time, mindfulness requires one to acknowledge, but not be overwhelmed by, whatever feelings, emotions or thoughts arise and to let go of any past beliefs, opinions or commentaries that often prevent one from paying attention. Thus, a mindful practitioner, by seeing things as they really are, and not what they seem, is in a better position to make choices and decisions more clearly whatever the situation.
From its early days as a series of meditative exercises, mindfulness training is now offered to patients by the medical profession as an additional therapeutic tool to help relieve suffering, in particular pain and stress associated with chronic disorders (Ludiwg & Kabat-Zinn, 2008). Through mindfulness training, both mental and physical aspects of suffering can be viewed through a more objective lens. This opens new coping strategies that include the ability to take greater responsibility for one’s choices and the capacity to develop self-compassion. The prototype program applying mindfulness in medicine is the Mindfulness Based Stress Reduction (MBSR) program which was designed by Kabat-Zinn (2009) at University of Massachusetts over 30 years ago.
The efficacy of MBSR has been validated in many clinical studies (reviewed in Baer, 2003; Ludwig & Kabat-Zinn, 2008). These include the relief of chronic pain in a variety of clinical settings, the alleviation of stress and mood symptoms in cancer patients (Speca, Carlson, Goodey, & Angen, 2000) and the prevention of relapses of major depression when supported with mindfulness based cognitive therapy. MBSR programs and those closely linked to MBSR have flourished in many hospitals and health care settings around the world. Mindfulness training has enabled the improvement in well being of individuals with obesity and eating disorders by enabling greater awareness of their dietary habits (Proulx, 2008). Current trials are underway to test whether mindfulness training can help to modify symptoms and clinical progression in medical conditions associated with lifestyle such as diabetes, ischemic heart disease, hypertension, drug abuse and human immunodeficiency virus infection.
The secret of the care of the patient is caring for oneself whilst caring for the patient
– Medicine and the Family: A Feminist Perspective (Candib, 1995).
The rigors and demands of medical training and stress of clinical practice due to long work hours, excessive workload, unrealistic demands from patients, coupled with limited control of the work environment, have led to alarming levels of burnout that affect both medical students and physicians (Shanafelt, Bradley, Wipf, & Back, 2002). Burnout leads to poorer quality of care of the patients including increased medical errors, and a poorer quality of life for the care giver due to higher risk of substance abuse, health problems, family discord and in the extreme, self harm and suicides. Preliminary results in several small and short term studies (Irving, Dobkin, & Park, 2009) show that participation in MBSR programs decreases anxiety and mood symptoms associated with stress and burnout in medical students (Shapiro, Schwartz, & Bonner, 1998), nursing students (Beddoe, 2004), and health care professionals (Shapiro, Astin, Bishop, & Cordova 2005). A recent study compared a large group of primary health care physicians with a control group and results support the impact of mindfulness training to enhance well being; importantly findings also connected mindfulness training with improvement in attitudes towards patient-centred care (Krasner, Epstein, Beckman, Suchman, Chapman, Mooney et al., 2009). The case for cultivating mindfulness in health care professionals is not just compelling, it is established, and opens up the question of not if, but when, medical schools embed this as part of the training of medical students and doctors.