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Feasibility of Formal Mindfulness-Based Stress-Resilience Training Among Surgery InternsA Randomized Clinical Trial

Educational Objective To identify to what extent formal mindfulness-based stress-resilience training is feasible for interns at a tertiary academic center.
1 Credit CME
Key Points

Question  Is formal mindfulness-based, stress-resilience training feasible for surgical interns at a tertiary academic center?

Findings  In this pilot randomized clinical trial of 21 surgical interns, an 8-week formal stress-resilience training course was found to be in demand and was practical, acceptable, and adaptable to this unique environment. The training was fully implemented and readily integrated into work and personal life by participants.

Meaning  Formal mindfulness-based stress-resilience training is feasible among academic surgery interns who find it to be acceptable and meaningful to their training experience.


Importance  Among surgical trainees, burnout and distress are prevalent, but mindfulness has been shown to decrease the risk of depression, suicidal ideation, burnout, and overwhelming stress. In other high-stress populations, formal mindfulness training has been shown to improve mental health, yet this approach has not been tried in surgery.

Objective  To test the feasibility and acceptability of modified Mindfulness-Based Stress Reduction (MBSR) training during surgical residency.

Design, Setting, and Participants  A pilot randomized clinical trial of modified MBSR vs an active control was conducted with 21 surgical interns in a residency training program at a tertiary academic medical center, from April 30, 2016, to December 2017.

Interventions  Weekly 2-hour, modified MBSR classes and 20 minutes of suggested daily home practice over an 8-week period.

Main Outcomes and Measures  Feasibility was assessed along 6 domains (demand, implementation, practicality, acceptability, adaptation, and integration), using focus groups, interviews, surveys, attendance, daily practice time, and subjective self-report of experience.

Results  Of the 21 residents included in the analysis, 13 were men (62%). Mean (SD [range]) age of the intervention group was 29.0 (2.4 [24-31]) years, and the mean (SD [range]) age of the control group was 27.4 (2.1 [27-33]) years. Formal stress-resilience training was feasible through cultivation of stakeholder support. Modified MBSR was acceptable as evidenced by no attrition; high attendance (12 of 96 absences [13%] in the intervention group and 11 of 72 absences [15%] in the control group); no significant difference in days per week practiced between groups; similar mean (SD) daily practice time between groups with significant differences only in week 1 (control, 28.15 [12.55] minutes; intervention, 15.47 [4.06] minutes; P = .02), week 2 (control, 23.89 [12.93] minutes; intervention, 12.61 [6.06] minutes; P = .03), and week 4 (control, 26.26 [13.12] minutes; intervention, 15.36 [6.13] minutes; P = .04); course satisfaction (based on interviews and focus group feedback); and posttraining-perceived credibility (control, 18.00 [4.24]; intervention, 20.00 [6.55]; P = .03). Mindfulness skills were integrated into personal and professional settings and the independent practice of mindfulness skills continued over 12 months of follow-up (mean days [SD] per week formal practice, 3 [1.0]).

Conclusions and Relevance  Formal MBSR training is feasible and acceptable to surgical interns at a tertiary academic center. Interns found the concepts and skills useful both personally and professionally and participation had no detrimental effect on their surgical training or patient care.

Trial Registration  ClinicalTrials.gov identifier: NCT03141190

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Article Information

Accepted for Publication: May 13, 2017.

Corresponding Author: Carter C. Lebares, MD, Department of Surgery, University of California, San Francisco, 513 Parnassus Ave, HSW 1601, San Francisco, CA 94143 (carter.lebares@ucsf.edu).

Published Online: August 29, 2018. doi:10.1001/jamasurg.2018.2734

Author Contributions: Dr Lebares had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Lebares, Mitchell, Reilly, O'Sullivan, Ascher, Harris.

Acquisition, analysis, or interpretation of data: Lebares, Hershberger, Guvva, Desai, Shen, Delucchi.

Drafting of the manuscript: Lebares, Hershberger, Guvva, Desai.

Critical revision of the manuscript for important intellectual content: Lebares, Mitchell, Shen, Reilly, Delucchi, O'Sullivan, Ascher, Harris.

Statistical analysis: Hershberger, Guvva, Desai, Delucchi.

Obtained funding: Lebares, Harris.

Administrative, technical, or material support: Lebares, Desai, Mitchell, Reilly, Harris.

Supervision: Lebares, Mitchell, Shen, Reilly, O'Sullivan, Ascher.

Conflict of Interest Disclosures: No disclosures were reported.

Funding/Support: Ms Desai was supported by National Institutes of Health grant R25#125451-03 Short Term Research Education Program to Increase Diversity in Health-Related Research.

Role of the Funder/Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We acknowledge the interns who participated in this study, in particular those randomized to the control group. In addition, we thank all the surgery leadership, staff, and residents who made intern participation possible. Finally, Pamela Derish, MA (Department of Surgery, University of California, San Francisco), helped to edit this manuscript; there was no financial compensation.

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