5 Reasons Why Practising Mindfulness Will Make You a Better Doctor

This week we hear from one of our bright new 1st year reps, Amanda.

“Doctors – all health care professionals, really – are exceptionally poor at speaking up about burnout and stress. No one likes to talk about it. And certainly, no one teaches us ways to deal with it.” – John Boockvar, MD, vice-chair of neurosurgery at Lenox Hill Hospital1

If you have seen the Netflix show “Lenox Hill”, then you will know that John Boockvar is a distinguished neurosurgeon in NYC that practises mindfulness before EVERY procedure with his operating team. He says that this mindfulness practice creates a feeling of unity in his team and allows him to tackle any difficult or stressful situation. See this article to read more about his practice.1

Mindfulness is defined as the state of “being in the moment” and not thinking about what has happened in the past or what might happen in the future.2 But surely neurosurgery is a challenging subspecialty that requires mindfulness training more than a typical medical student? Well, I am here to prove that assumption wrong.

Here are 5 key reasons why as a medical student, you should be practising mindfulness:

1. Medical students and doctors in the UK are known to suffer increased rates of anxiety, feelings of pressure, and burnout.

· A 2018 online survey on mental wellbeing from the British Medical Association (BMA) found that medical students and junior doctors reported the highest rate of a formally diagnosed mental health condition in the last 12 months compared to other doctors.3

· Another 2019 online survey from the BMA found that 29% of medical students had a mental health diagnosis and 85% of these students were classified as ‘exhausted’ on the Oldenburg Burnout Scale.4

2. The COVID-19 pandemic has added more pressures to the life of a medical student and has made it more important than ever to implement strategies to improve our mood and wellbeing.

· A recent interim analysis of 2000 participants from 33 UK medical schools found that students and FY1 doctors had a significant decrease in mood during the pandemic compared to before the pandemic.5 The top three reasons for decreased mood were due to social distancing, reports on social media, and self-isolation.

· Realising the impact of the pandemic on our mood is the first step. The next step is to think about ways that we can actively improve our mood and wellbeing!

3. Mindfulness reduces external distractions (i.e., stress) and internal distractions (i.e., mind-wandering), which improves attention to the current task at hand, whether it be working on an assignment or taking a history from a patient.

· Voluntary attentional selection is the process of focusing on a particular goal-directed activity for a certain period of time. Amishi Jha is a neuroscientist that studies the effects of mindfulness training on attention behaviours. In her most cited study, she found that participants that participated in mindfulness training (MT) had improved voluntary attentional selection compared to participants that did not receive MT.6

· Here is a TED talk by Dr Amishi Jha about ‘How to tame your wandering mind’.

4. The positive effects of mindfulness on the brain become stronger the more you practise.

· In this TED talk on ‘The Power of Mindfulness’, Dr Shauna Shapiro uses neuroscience to demonstrate the positive effects of mindfulness on our brain. For example, kind attention is much more effective than shame when thinking about aspects of ourselves that we want to change.

· Cortical thickening is defined as the growth of new neurons or increased connections between neurons in response to repeated practise. Recent studies have shown that meditation increases hippocampal volume and enhances thickness of the prefrontal cortex, which could be the reason for its improvements in wellbeing and attention.7

· A recent structural MRI study on 80 participants found that practising meditation increased grey matter volume in the reward processing centres of the brain that were associated with happiness.8 Years of meditation experience also increased these effects to a greater extent, which suggests that meditation has a greater effect on neural plasticity the longer it has been practised. Meditators also had significantly higher happiness scores compared to non-meditators, which suggests that meditation may contribute to developing positive experiences of reward.

5. Doctors with mindfulness skills are better able to communicate with patients and provide better quality care.

· There is no question that mindfulness (non-judgemental attention to one’s own experience, thoughts and feelings) is associated with improved wellbeing. However, a multi-centre study found that clinicians with higher mindfulness scores were more likely to receive higher ratings from patients on communication and overall satisfaction.9 This suggests that practising mindfulness could make you a better doctor!

· A cross-section study of medical students (N=933) found that those with a greater disposition for mindfulness appeared to be less emotionally distressed in tense interpersonal settings and were better able to take on other people’s perspectives.10 This finding suggests that mindfulness-based training could be important for medical students in becoming better doctors.

How do I practise being in the “present moment” as a medical student?

1. There are several techniques to enable us to appreciate the present moment, such as focusing attention on breathing, sounds and body sensations.

· Mindfulness breathing is something that you can practise at home for a few minutes each day. Here are 9 different apps to practise mindfulness breathing: https://www.thegoodtrade.com/features/best-meditation-apps

· Here is a useful article by Dr Amishi Jha on how to practise mindfulness breathing. She says that the key is to focus, sustain attention, notice mind-wandering, and re-direct attention. Practising this ‘mindfulness push-up’ will improve your attention span over time, just as you would improve a skill for any fitness activity over time!

2. Yoga is another potential avenue to practise mindfulness, and it also has an added physical and psychological benefit.

· Mindfulness is something that can be obtained through yoga practise. Yoga and mindfulness are intertwined because you cannot practise yoga effectively without being mindful of your thoughts and feelings in the present moment.

· Yoga-based physical activity has been shown to decrease perceived stress levels and state anxiety levels (psychological and physiological reactions related to adverse situations in the moment) in young adults.11

“Dwelling on past failures, or thinking about all the responsibility we’re given, feeling we have little control over certain situations… these are all daily challenges to mindfulness…The only thing we have with us all the time is our breath.” – John Boockvar, MD1

Thank you for reading and I hope you all have a relaxing and enjoyable holiday! xx

References:

1. Lenox Hill Hospital. Reducing stress before neurosurgery. [Internet]. 2018 Aug [cited 2020 Dec 09]. Available from: https://lenoxhill.northwell.edu/news/reducing-stress-before-neurosurgery

2. Greater Good Magazine. What is mindfulness? University of California, Berkley [Internet]. [cited 2020 Dec 09]. Available from: https://greatergood.berkeley.edu/topic/mindfulness/definition#what-is-mindfulness

3. Bhugra D, Sauerteig S, Bland D, Lloyd-Kendall A, Wijesuriya J, Singh G et al. A descriptive study of mental health and wellbeing of doctors and medical students in the UK. Int Rev Psychiatry [Internet]. 2019 Nov [cited 2020 Dec 09];31:563-68. DOI: 10.1080/09540261.2019.1648621

4. Farrell SM, Kadhum M, Lewis T, Singh G, Penzenstadler L, Molodynski A. Wellbeing and burnout amongst medical students in England. Int Rev Psychiatry [Internet]. 2019 Nov [cited 2020 Dec 09];31:579-83. DOI: 10.1080/09540261.2019.1675960

5. Bandyopadhyay S, Georgiou I, Baykeens B, Gillespie CS, Crespo M, Bashir MT et al. Medical students’ mood adversely affected by COVID-19 pandemic: an interim analysis from the SPICE-19 prospective cohort study of 2075 medical students and interim foundation doctors. Research square [Internet]. 2020 Jul [cited 2020 Dec 09]. DOI: 10.21203/rs.3.rs-40503/v1

6. Jha AP, Krompinger J, Baime MJ. Mindfulness training modifies subsystems of attention. Cog Affect Behav Neurosci [Internet]. 2007 Jun [cited 2020 Dec 09];7:109-19.

7. Shen H, Chem M, Cui D. Biological mechanism study of meditation and its application in mental disorders. Gen Psychiatry [Internet]. 2020 Jun [cited 2020 Dec 09];33:e100214.

8. Ramesh Babu MG, Kadavigere R, Koteshwara P, Sathian B, Rai KS. Rajyoga meditation induces grey matter volume changes in regions that process reward and happiness. Nature Scientific Reports [Internet]. 2020 Sep [cited 2020 Dec 09];10:16177.

9. Beach MC, Roter D, Korthuis PT, Epstein RM, Sharp V, Ratanawongsa N et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med [Internet]. 2013 Sep [cited 2020 Dec 09];11(5):421-8.

10. Ardenghi S, Rampoldi G, Pepe A, Bani M, Salvarani V, Strepparava MG. Teaching and Learning in Medicine [Internet]. 2020 Sep [cited 2020 Dec 09]; DOI: 10.1080/10401334.2020.1813582

11. Yuce GE, Muz G. Effect of yoga-based physical activity on perceived stress, anxiety, and quality of life in young adults. Psychiatric Care [Internet]. 2020 Feb [cited 2020 Dec 09];56:697-704.