Enhanced Stress Resilience Training for Faculty
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 64 |
| Updated: | 1/11/2019 |
| Start Date: | July 9, 2018 |
| End Date: | December 2020 |
| Contact: | Carter K Lebares, MD |
| Email: | carter.lebares@ucsf.edu |
| Phone: | (415) 502-5588 |
Enhanced Stress Resilience Training for Faculty Physicians
Mounting evidence shows that burnout, a critical metric for dissatisfaction and distress, is
a growing problem within medicine. Burnout is a syndrome associated with worse physician
performance, patient outcomes, and hospital economics. Furthermore, investigators are coming
to understand that burnout, diminished performance and the development of mental and physical
illness are related. It has been proposed that chronic and overwhelming stress, in the
absence of adequate coping skills, promotes performance deficits from surgical errors to poor
professionalism due to the effects of stress on cognition.
Notably, in small studies of physicians and other high-stress/high-performance groups
mindfulness-based interventions have shown exceptional promise in improving burnout and
distress symptoms, protecting cognition, and enhancing meaningfulness and satisfaction in
work. Nevertheless, in spite of promising results in various populations the translation of
mindfulness-based interventions to real-world settings has been slow.
There is a paucity of quality research examining individually-based interventions, formal
mindfulness training in physicians, or either of these things in the high stakes world of
surgeons and anesthesiologists. To address these gaps, investigators have developed Enhanced
Stress-Resilience Training (ESRT) based on Mindfulness-Based Stress Reduction (MBSR), but
streamlined and tailored for surgeons and anesthesiologists. Investigators have administered
a needs assessment and found almost 100 faculty interested in such training, and concluded
beta-testing of the curriculum which allowed for further refinement of logistics, dose and
delivery. Finally, to establish a baseline in both departments, investigators administered a
comprehensive well-being survey which captures multiple facets of psychosocial well-being and
will be used along with executive function testing and measures of performance to evaluate
the efficacy of out training in a stepped-wedge trial of faculty surgeons and
anesthesiologists at multiple UCSF hospital sites.
a growing problem within medicine. Burnout is a syndrome associated with worse physician
performance, patient outcomes, and hospital economics. Furthermore, investigators are coming
to understand that burnout, diminished performance and the development of mental and physical
illness are related. It has been proposed that chronic and overwhelming stress, in the
absence of adequate coping skills, promotes performance deficits from surgical errors to poor
professionalism due to the effects of stress on cognition.
Notably, in small studies of physicians and other high-stress/high-performance groups
mindfulness-based interventions have shown exceptional promise in improving burnout and
distress symptoms, protecting cognition, and enhancing meaningfulness and satisfaction in
work. Nevertheless, in spite of promising results in various populations the translation of
mindfulness-based interventions to real-world settings has been slow.
There is a paucity of quality research examining individually-based interventions, formal
mindfulness training in physicians, or either of these things in the high stakes world of
surgeons and anesthesiologists. To address these gaps, investigators have developed Enhanced
Stress-Resilience Training (ESRT) based on Mindfulness-Based Stress Reduction (MBSR), but
streamlined and tailored for surgeons and anesthesiologists. Investigators have administered
a needs assessment and found almost 100 faculty interested in such training, and concluded
beta-testing of the curriculum which allowed for further refinement of logistics, dose and
delivery. Finally, to establish a baseline in both departments, investigators administered a
comprehensive well-being survey which captures multiple facets of psychosocial well-being and
will be used along with executive function testing and measures of performance to evaluate
the efficacy of out training in a stepped-wedge trial of faculty surgeons and
anesthesiologists at multiple UCSF hospital sites.
Investigators believe the myriad positive effects of Mindfulness training are due to the very
central mechanistic effect of mindfulness training on the brain. This is a critical facet of
mindfulness mental training in particular because it is the centrality of the training effect
that allows it to be meaningful through stages of practice, changing career trajectories and
variable stressors which will inevitably occur over the course of a physician's career.
It is currently held that mindfulness mental training acts to reduce stress by changing
relationship to stressors. thereby affecting the perception of daily experience. Put a
different way, the transformative ability of mindfulness doesn't come from changing the
content of thoughts, or eradicating negative emotions. It comes from changing how humans
relate to thoughts and emotions. It is not changing how humans intellectualize or understand
circumstances, it is changing how they experience them. Learning mindfulness is in some
regards like push-ups for the brain, that result in the ability to non-judgmentally
experience life on life's terms (whether it be emotional, stressful or thought-provoking)
which can result in any one of the myriad facets of well-being described in this proposal.
Investigators have already shown that such an intervention, when supported institutionally,
is feasible and acceptable to surgical trainees - a significant litmus test. Moreover, the
preliminary data from that work suggests that mindfulness training is effective in increasing
mindfulness, improving psychological well-being, protecting or enhancing executive function,
improving motor skills and changing the brain in ways that reflect new cognitive habits as
compared to controls. Finally, the faculty have demonstrated a need and are receptive to this
intervention. They have beta-tested the current curriculum, helping us to further refine the
content, delivery and logistics, such that investigators feel confident that ESR training in
surgery and anesthesia faculty will prove feasible as well as efficacious in improving
well-being, work satisfaction and distress in this population.
To test this, investigators have developed a streamlined form of mindfulness training based
on the proven efficacy of Mindfulness-Based Stress Reduction, but modularized for more
widespread use and, for this project, tailored to surgeons and anesthesiologists. Training
involves 1.5 hour classes, once per week for 6 weeks; a 2-3 hour retreat and suggested daily
home practice of 20 minutes. Investigators have designed a pragmatic, longitudinal
stepped-wedge trial involving up to four of University of California, San Francisco (UCSF)
hospital campuses, expected to recruit more than 100 faculty. Investigators have already been
granted seed money by the UCSF Medical Center for teachers, facilities and supplies; a grant
from The Physicians Foundation, and spent 18 months building myriad relationships to support,
facilitate and populate this project. Investigators will collect pre-, post- and 6- month
follow-up data on wellbeing, physiologic stress, cognitive function and performance.
Additionally, investigators will rigorously assess and monitor feasibility.
Investigator's goal is to establish a culturally-adaptable, pragmatic intervention that
promotes personal resilience as one necessary component of restoring the joy to the practice
of medicine - even when it's hard.
central mechanistic effect of mindfulness training on the brain. This is a critical facet of
mindfulness mental training in particular because it is the centrality of the training effect
that allows it to be meaningful through stages of practice, changing career trajectories and
variable stressors which will inevitably occur over the course of a physician's career.
It is currently held that mindfulness mental training acts to reduce stress by changing
relationship to stressors. thereby affecting the perception of daily experience. Put a
different way, the transformative ability of mindfulness doesn't come from changing the
content of thoughts, or eradicating negative emotions. It comes from changing how humans
relate to thoughts and emotions. It is not changing how humans intellectualize or understand
circumstances, it is changing how they experience them. Learning mindfulness is in some
regards like push-ups for the brain, that result in the ability to non-judgmentally
experience life on life's terms (whether it be emotional, stressful or thought-provoking)
which can result in any one of the myriad facets of well-being described in this proposal.
Investigators have already shown that such an intervention, when supported institutionally,
is feasible and acceptable to surgical trainees - a significant litmus test. Moreover, the
preliminary data from that work suggests that mindfulness training is effective in increasing
mindfulness, improving psychological well-being, protecting or enhancing executive function,
improving motor skills and changing the brain in ways that reflect new cognitive habits as
compared to controls. Finally, the faculty have demonstrated a need and are receptive to this
intervention. They have beta-tested the current curriculum, helping us to further refine the
content, delivery and logistics, such that investigators feel confident that ESR training in
surgery and anesthesia faculty will prove feasible as well as efficacious in improving
well-being, work satisfaction and distress in this population.
To test this, investigators have developed a streamlined form of mindfulness training based
on the proven efficacy of Mindfulness-Based Stress Reduction, but modularized for more
widespread use and, for this project, tailored to surgeons and anesthesiologists. Training
involves 1.5 hour classes, once per week for 6 weeks; a 2-3 hour retreat and suggested daily
home practice of 20 minutes. Investigators have designed a pragmatic, longitudinal
stepped-wedge trial involving up to four of University of California, San Francisco (UCSF)
hospital campuses, expected to recruit more than 100 faculty. Investigators have already been
granted seed money by the UCSF Medical Center for teachers, facilities and supplies; a grant
from The Physicians Foundation, and spent 18 months building myriad relationships to support,
facilitate and populate this project. Investigators will collect pre-, post- and 6- month
follow-up data on wellbeing, physiologic stress, cognitive function and performance.
Additionally, investigators will rigorously assess and monitor feasibility.
Investigator's goal is to establish a culturally-adaptable, pragmatic intervention that
promotes personal resilience as one necessary component of restoring the joy to the practice
of medicine - even when it's hard.
Exclusion Criteria:
- Lifetime history of an organic mental illness.
Inclusion Criteria:
- Any consented surgery or anesthesia faculty who does not meet exclusion criteria.
We found this trial at
1
site
San Francisco, California 94143
Principal Investigator: Carter Lebares, MD
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