Center for Mindfulness in Surgery Announces New Funding and Plans for Faculty Study in Fall
The UCSF Center for Mindfulness in Surgery was recently awarded grants by the Physicians Foundation and UCSF Medical Center "Excellence Fund" to support a study of mindfulness training of faculty in the Departments of Surgery and Anesthesia. The program, led by Carter Lebares, M.D., Principal Investigator on the study, is also funded by the Department of Surgery, which has supported a similar study by Dr. Lebares in surgical interns.
Physician burnout, which comprises emotional exhaustion, depersonalization and diminished satisfaction with one’s work, has been documented in medical students, trainees and every medical specialty examined, and has been growing across specialties. Burnout, diminished performance and the development of mental and physical illness are related. Among physicians, performance deficits from surgical errors to poor professionalism have been shown to result, at least in part, from the effects of stress on cognition.
Mindfulness-based interventions have shown exceptional promise in improving burnout and distress symptoms, protecting cognition, and enhancing meaningfulness and satisfaction in work among physicians and other high-stress/high-performance groups. Dr. Lebares, working with collaborators in psychiatry, neuropsychiatry, neuroradiology, integrated medicine at UCSF as well as the laboratory of Elizabeth H. Blackburn, a Nobel laureate for her work in telomeres, has developed a streamlined, mindfulness-based intervention for physicians based on the model pioneered by Jon Kabat-Zinn, Ph.D at the University of Massachusetts School of Medicine, Mindfulness-Based Stress Reduction, or simply MBSR.
Dr. Lebares tested her hypothesis that mindfulness training would reduce burnout and enhance stress resilience in surgeons in by enrolling surgical interns in a randomized clinical trial (RCT) beginning in June 2016. The "Mindful Surgeon" study, Mindful Mental Training for Surgeons to Enhance Resilience and Performance Under Stress, just enrolled a 2nd cohort of surgical interns for the current (2017-18) academic year.
A cross-sectional national survey of general surgery residents, undertaken by the UCSF Center for Mindfulness in Surgery in the fall of 2016, found that high dispositional mindfulness reduces the risk of emotional exhaustion, depersonalization, alcohol misuse and abuse, moderate to severe depression and suicidal ideation, by 75% or more. This suggests that while mindfulness may seem out of place among surgeons and the operating room culture, it is in fact already in use in this setting. Promising preliminary data from the first wave of training in surgical interns of the Mindful Surgeon RCT, suggests that mindfulness training could be a powerful component of stress resilience training among surgeons and anesthesiologists.
The upcoming faculty study will look at the feasibility and acceptability of tailored mindfulness training adapted to the culture of the OR for surgeons and anesthesiologists. The study is designed to test outcomes of well-being, cognition and performance at multiple hospital sites in the UCSF School of Medicine community.
Hobart W. Harris, M.D., M.P.H., Professor and Chief of the Division of General Surgery, was enthusiastic about the concept of using mindfulness training to promote stress resilience in surgeons:
The dynamic interplay between stress, performance and health (both physical and mental) is a fascinating area of research, one with extraordinary practical relevance to the training and management of surgeons. Dr. Lebares’ research represents an exciting and comprehensive investigation into how mindfulness training may not only mitigate the potentially harmful physical and psychological effects of stress on surgeons, but also enhance performance. I am certain that her research will change the way we train and work as surgeons in the not too distant future.
Comments from residents enrolled in the RCT provided powerful anecdotal support for the training's benefit:
“I’m on Neurosurg at the General. I find I’m more purposeful and present with the pts’ and families. I wrote the orders to withdraw care on a 32 yo today and I’m just feeling it. I’m in it, and it’s ok."
“I thought I’d be learning a relaxation technique, but this is work. I didn’t believe in it at first, I thought it was sort of ridiculous, but it has changed me. Practicing is work, but it feels like a gift…it’s changed how I think, how I see things, how things affect me. Before I go in the OR to update the chief - especially if I have something that will upset him - I do the breathing, I focus, and I am clearer, explain better, am not nervous.”