Enhanced Stress Resilience Training for Residents

Experiencing joy in the practice of medicine is by no means guaranteed. For many physicians,
the unique bond with patients, the deep satisfaction of saving a life, and a profound sense
of calling make the sacrifice and heartache worthwhile. In contrast, the growing prevalence
of burnout and mental distress in physicians is being linked to diminished performance,
patient outcomes, and hospital economics.

Overwhelming stress without adequate coping skills has been posited to promote burnout and
distress, and may promote performance deficits (from surgical errors to poor professionalism)
by impairing cognition and self-regulation. In other high-stress/high-performance groups
formal mindfulness training has been shown to enhance stress resilience, well-being and
performance. Nevertheless, quality research exploring the effects of mindfulness training on
chronic stress and performance in physicians remains scarce, contributing to the slow
adoption of mindfulness training into medical practice and resident training.

To date, investigators have conducted a national survey which showed that the presence of
high dispositional mindfulness in surgery residents reduced the risk of burnout and distress
by 75% or more. Investigators have conducted a pilot randomized controlled trial of
Mindfulness-Based Stress Reduction (MBSR) in surgery interns, demonstrating feasibility and
acceptability of formal mindfulness training as well as promising preliminary effects in
well-being, cognition and performance. Finally, investigators developed an MBSR-based,
streamlined curriculum tailored for physicians called Enhanced Stress Resilience Training
(ESRT). ESRT has been beta-tested in surgery and anesthesia faculty and mixed-level residents
allowing refinement in terms of logistics, dose and delivery. Investigators have disseminated
promising results, thereby generating access to a larger study population for the proposed
pilot feasibility and potential efficacy trial in mixed-specialty interns, studying ESRT as a
means to improve well-being, cognition and performance.

As such, the investigators aim to:

Aim 1. Assess the feasibility of ESRT for multi-specialty interns. Aim 2. Optimize and
Manualize ESRT based on Aim 1 findings Aim 3. Identify outcome measures that are feasible and
sensitive to relevant outcomes for physician trainees.

While this study will likely not reach statistical power, it will absolutely allow for
broader vetting of the curriculum, testing of scaled-up data acquisition and management
methods, and the appropriateness of the outcome measures in a mixed-specialty population,
paving the way for a high-quality, fully-powered multi-center trial in the near future.

The significance of studying mindfulness mental training in medical and surgical trainees is
two-fold.

One, as a process-centered skill with demonstrated effects on psychological well-being,
perceived stress, cognitive performance and physiologic health, mindfulness represents a
potential gateway mechanism for providing individuals with a 'universal tool' to address
challenges across all stages of medical training and practice. This includes burnout,
professionalism and errors, all looming issues that have proved difficult to address.

Two, if feasibility and efficacy among physician trainees can be shown, the social capital
from impacting such a high stress and high performance field is uniquely powerful and could
further the dissemination of evidence-based mindfulness interventions to a remarkable degree.

Finally, the enhanced self-awareness and equipoise frequently resulting from mindfulness
training has been contagious in other settings, and could hold great promise for a culture
change in medicine that benefits patients and providers, alike.

The innovation of this work is in bringing a mind-body intervention to bear not only on
well-being but also on the fundamental cognitive processes believed to sub-serve performance,
such as the impact of attention and working memory capacity on medical decision-making, and
the impact of emotional regulation and self-awareness on professionalism and team work. The
potential to improve both the operative and clinical environments as well as medical errors
is unprecedented.

Finally, a vetted, manualized curriculum specifically crafted for physicians could accelerate
dissemination nationally.

Inclusion Criteria:

- Any consented medical intern from Emergency Medecine, Internal Medicine, Pediatrics,
Family Practice, OBGYN and Surgery Depratments in-coming to University of California
San Francisco in the study year.

Exclusion Criteria:

- Current personal mindfulness practice, once a week or more frequent;

- Use of medications with Central Nervous System effects;

- Lifetime history of an organic mental illness;

- Acute or chronic immune or inflammatory disorders;

- Pregnancy;