managing stress
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Managing Stress & Burnout: An AUA Student Initiative

Over the past few years, the medical community has grown concerned about high rates of depression and suicide among students, residents, and physicians. Efforts are underway to address some of the systemic issues that make medical residents three times as likely to be depressed when compared to others their age. However, as these issues are being explored, each individual also needs to develop specific strategies for managing his or her own stress and mental health.

AUA alumnus Dr. Chase Parsons, who is completing a transitional year at The University of Tennessee Health Science Center developed a mindfulness program and research project that began on October 16th. The study seeks to determine what impact mindfulness training may have on students’ academic success. Researchers will find out what the median Clinical Core Subject Shelf Exam scores have been overall for clinical students who tested at different levels of performance for the USMLE Step 1. Third and Fourth-Year AUA students take these Clinical Core Subject Shelf Exams at the end of each of the six clinical core rotations.  hey will then look at whether those participating in the mindfulness program out-performed the prediction for students at that level, after the students take their Clinical Core Subject Shelf Exams. If students with Step 1 scores below 205 normally earn a median score of 62 on Clinical Core Subject Shelf exams for example, the researchers will determine whether participants in the mindfulness program who also scored below a 205, score below, above, or show no variation from a score of 62 on the clinical Shelf exams.

In consultation with Dr. Chase, current AUA student Nathan Moriarty has recently taken over leadership of the program. In the meantime, Dr. Chase and Nathan have identified the following areas where mindfulness may benefit students:

1.  Stress Management
A 2014 systematic review and meta-analysis of 47 trials with 3,515 participants found that mindfulness meditation programs had moderate evidence of reducing anxiety. It recommended further study because “despite the limitations of the literature, the evidence suggests that mindfulness meditation programs could help reduce anxiety, depression, and pain in some clinical populations,” (JAMA Intern Med 2014; 174:357).

2.    Focus and Cognition
The benefits of Mindfulness meditation practices (MMPs), including Mindfulness-Based Stress Reduction (MBSR) are well documented. After performing a review of the literature, I came across a systemic review of 23 controlled or case-controlled studies that found that mindfulness meditation may enhance attention, memory, and some executive functions (Clin Psychol Rev 2011; 31:449).

Three years ago, I began using the same mindfulness program that we introduced to clinical students. I had struggled with test anxiety for a long time and mindfulness training helped my own academic performance tremendously. I was especially happy to see my Clinical Knowledge score improve by a large margin over my Step 1 score.

3.   Development of Specific Skills Physicians May Teach Patients (this is especially important in primary care).
Mindfulness meditation is a mind-body integrative medicine technique gaining popularity across North American healthcare settings to help overcome the challenges posed by stressors, symptoms, and illnesses that they encounter (Black 2014; Buchholz 2015; Gilbert and Waltz 2010; Ludwig and Kabat-Zinn 2008).

A recent New York Times editorial mentioned that “when doctors develop skills to manage their own wellbeing, it makes it easier for them to teach these skills to patients.”  This is important, as research has shown benefits to patients in their ability to manage pain and chronic illness.

4.   Development of Skills of Interest to Residency Programs
Dr. Chase reported that during his many residency interviews, most programs asked him about his mindfulness training and seemed genuinely interested in the related skills he would be able to bring to their program. This isn’t surprising. As mentioned earlier, the mental health of medical students, residents, and physicians is a hot topic within the profession, so being able to bring specific skills to address it would naturally be of interest to program administrators.

Nathan reported that during his past few electives, programs expressed great interest in his mindfulness training and skills. They have also been impressed with AUA for engaging in this mindfulness initiative and research.

5.   Résumé Enhancement Students who complete this program will receive a University of Massachusetts Palouse Mindfulness certificate of completion for eight weeks of training. This is the program we are using for this initiative. It consists of a combination of readings and videos, coupled with an experiential component involving daily practice of various techniques.

Explore the AUA Mindfulness Facebook Page
Nathan has developed a Facebook page for AUA students. I encourage you to “Like” and explore this page. Each week, Dr. Chase will be adding additional resources and materials to it: facebook.com/AUAMindfulness

From Skeptic to Proponent Dr. Chase understands that AUA students may not warm to the idea of practicing mindfulness meditation right away but encourages them to try it nonetheless. “Like most medical students, I was wary of the purported benefits of mindfulness at first, and even after performing a thorough literature review. However, I have personally completed the online training course the new program is based around and can confidently say the benefits are real and obtainable. After a few short weeks, I noticed significant benefits including enhanced focus and reduced stress,” he says.