A. Desai1, E. Guvva1, C. Lebares1 1University Of California – San Francisco,Surgery,San Francisco, CA, USA
Introduction: Burnout in physician trainees is a potent and increasingly prevalent issue which increases the risk of depression, errors and suicidal ideation. To date, interventions have been largely ineffective, which may reflect our incomplete understanding of this complex problem. Institution, systemic and individual factors impact the success of interventions through logistical elements that are poorly understood. Formal mindfulness training (MT) among surgery interns, and other high-performance populations, has been shown to be feasible and acceptable, as well as beneficial for burnout, mental health, executive function and performance. However, dissemination and successful implementation of MT in medical training has been limited. The aim of this study was to explore the logistical and structural factors critical for the successful implementation of MT interventions among physician trainees.
Methods: Using mixed methods, the feasibility and acceptability of MT was explored in three different studies: a longitudinal pilot randomized controlled trial with surgery interns (n=40), a cohort study of mixed level urology residents (n=20), and a registered clinical trial of surgical and non-surgical interns (n=45). Group means were compared for attendance, attrition and daily home practice, with differences evaluated in the context of concepts and themes derived from grounded theory analysis of focus group feedback, field notes, satisfaction surveys and key informant interviews. Logistical and structural factors critical to MT feasibility and acceptability were identified across groups.
Results: Scheduling, protected time and a clear statement of value from leadership were found to be critical structural factors for MT success. Specifically, successful scheduling required dedicated time within the work week, and minimal conflicts with other elements of resident training. Established educational days and natural lulls in the year (i.e. summer or winter holidays) were particularly useful. Protected time was found to be critical not only in terms of being excused to attend class, but also being free from pages. This allowed for consistent attendance and full participation in class without distraction. Attribution of value by leadership (i.e, department chairs and program directors) was found to determine the cultural attitude surrounding MT, both in terms of participant-perceived credibility and the willingness of colleagues to provide service coverage during MT class time, without hostility or retribution.
Conclusion: These results show that scheduling, protected time and attribution of value by leadership are crucial factors for the implementation of MT in a tertiary academic setting. The successful execution of these factors require rigorous planning, communication and flexibility with all program members. These three factors must be tailored in accordance with each program’s unique framework.