Go to your nearest Barnes & Nobles and the first thing you’ll see past the Tom Clancy thriller novels and the Harry Potter “Build-Your-Own-Wand-Kit” is a table full of books dedicated to “Mindfulness”, “Universal Consciousness”, “Finding True Inner Peace” or any combination of the above! Yes, in recent years the Western vocabulary has expanded to make room for a growing interest in Eastern philosophy. Popular authors like Jon Kabat-Zinn, Deepak Chopra, and more have found international recognition breaking down the art of meditation and making it accessible to the wide public.
But what is mindfulness? And why talk about it here, in a medical student blog?
Mindfulness is a state of active, open attention on the present. When you’re mindful, you observe your thoughts and feelings from a distance, without judging them good or bad. Instead of letting your life pass you by, mindfulness means living in the moment and awakening to experience[1. http://www.psychologytoday.com/basics/mindfulness].
Just last month the Harvard Gazette had an article which discussed recent research led by Harvard-affiliated researchers at Massachusetts General Hospital reporting incredible results in which they became the first to document meditation-produced changes over time in the brain’s gray matter. Wow!
“Although the practice of meditation is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that meditation also provides cognitive and psychological benefits that persist throughout the day,” says study senior author Sara Lazar of the MGH Psychiatric Neuroimaging Research Program and a Harvard Medical School instructor in psychology. “This study demonstrates that changes in brain structure may underlie some of these reported improvements and that people are not just feeling better because they are spending time and relaxing[2. http://news.harvard.edu/gazette/story/2011/01/eight-weeks-to-a-better-brain/]”.
Among the structures of the brain that underwent noticeable changes were increases in the hippocampus (responsible for learning, self-awareness, introspection, and memory) and decreases in the amygdala known to play an important role in stress.
Which brings us full circle here; medical students (and later medical professionals) are some of the most stressed out people in the world! There have been tons of studies trying to better understand the effects of the medical school environment on the poor, unsuspecting first semester [and the equally albeit slightly less so second semester]. Researchers have cited multiple factors responsible for the high anxiety levels reported:
Workload and feeling overwhelmed by amount of information to be mastered are major sources of stress. Fears of failing or falling behind are particular preoccupations. Other signicant academic sources of stress include disillusionment with medicine and the realities of medical school, perception of `hurdle jumping’, relationships with teachers, and dealing with death and suffering. Social issues which can cause stress include the effects of being a medical student on personal life, in particular managing leisure activities and social relationships[3. Medical Education, July, 2001. 10.1046/j.1365-2923.2001.00996. More on medical student stress. J Morrison, K Moffat].
Ah, memories of being a pre-clinical student..I’d rather be anywhere else! What’s important here though, is wondering if there is any role for MSBR (Mindfulness Based Stress Reduction) in medical school and if it could actually help.
A study in 2009 showed exactly that in which 140 second year students elected to participate in a 10 week MSBR seminar. Their moods were assessed pre and post intervention and compared against a control of 160 students who only participated in a didactic on complementary medicine. At the end of the 2 1/2 months the same questionnaire was administered asking students to rate their moods via several criteria. The results were significant for showing a drop in “Total Mood Disturbance” in the MSBR cohort specifically in Tension-Anxiety, Confusion-Bewilderment, Fatigue-Inertia, and Vigor-Activity subscales[4. http://www.tandfonline.com/doi/citedby/10.1207/S15328015TLM1502_03#tabModule].
With such promising research coming out in favor of meditation’s beneficial effects I can see no reason why more medical school’s aren’t offering these services to their students. As of 2013 only 14 schools in the U.S have been offering mindfulness to their students/residents[5. http://www.ncbi.nlm.nih.gov/pubmed/23837423]. Sure there are questions that remain to be answered; when is the best time to introduce training? What formats work best? And for whom?
But for me the question of whether or not services like these belong in school has already been answered. I remember the first very stressful semesters of medical school and trying to find some way to cope with the jarring transitions. Sports, working out, friends, going out on the town all helped me get through test after test. It wasn’t until I stumbled upon Jon Kabat-Zinn’s classic book, Wherever You Go, There You Are that I tried giving meditation a try. Timidly at first for ten minutes at a time I sheepishly would sit around waiting for something extraordinary to happen. After a couple of attempts though I realized that the beauty of it all was that you were doing just that, sitting around, a moment to be yourself and forget about the millions of things you had to do. I kept at it and although I’m not levitating over rocks or walking over water (I wish) I can safely say that it’s now a helpful tool that I have whenever I need to moment to reset.
What are some of the methods you use to cope with stress? Do you think that medical schools should incorporate these classes into their curriculum? Is mindfulness meditation a pseudoscience? Would you practice it if given the opportunity? Post below!