E. V. Guvva1, A. Desai1, C. Lebares1 1University Of California – San Francisco,Surgery,San Francisco, CA, USA
Introduction: Burnout and distress are high stakes issues in medicine, affecting patient care, satisfaction, and physician well-being. Surgical trainees appear to be particularly high risk, as evidenced by alarming rates of burnout, depression and suicidal ideation. Few successful interventions exist for this complex problem, which has been framed as involving institutional, systemic and individual components. In regard to the latter, Mindfulness-Based Interventions (MBIs) have been shown to be highly feasible and acceptable as well as subjectively and objectively beneficial in surgical trainees. However, focused modification of MBIs could optimize them for dissemination across medical specialties. We explored cultural factors critical for successful implementation of MBIs among surgical and non-surgical trainees at our institution, identifying those factors universally important across groups versus those that were specialty- or training level- specific.
Methods: Using mixed methods, we conducted three different studies at a tertiary academic center: a longitudinal pilot RCT with surgery interns (n=40), a cohort study of mixed level urology residents (n=20), and a registered clinical trial of interns from surgical and non-surgical specialties (n=45). Qualitative data from field observations, focus groups and key interviews were analyzed using grounded theory. Common concepts of perceived need, acceptability, and barriers to participation were identified and coded in an iterative fashion with consensus reached on major themes.
Results: Three influential factors emerged regarding successful implementation of MBIs across groups: motivation, relevance, and cultural norms. Framing MBI training as a discipline for the development of a discrete skill set was universally motivating, and contextualization of skills within familiar professional and personal situations conferred relevance. For example, using defined breathing techniques to transition from work to home or between patients; heightening focus in a code or in the operating room; or using objective self-awareness to observe thoughts when spiraling into self-doubt or when struggling with a new procedure. Cultural norms, while universally influential, showed the greatest variation across specialties and training levels. For instance, surgical specialties were the least willing to discuss personal struggles and feelings, which necessitated activities that approached these subjects in an oblique fashion. Interns, regardless of specialty, were found to be more receptive to the idea of MBIs conferring a professional skill set, whereas senior trainees required objective evidence of MBI effectiveness in other fields.
Conclusion: Wider dissemination of MBIs within medicine may require involving both a cultural insider and a flexible MBI instructor for each new setting. The former, to provide nuanced understanding for optimized motivation, relevance and acceptability, and the latter to adapt the MBI accordingly.