Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
Med Educ. 2011 Apr;45(4):381-8. doi: 10.1111/j.1365-2923.2010.03877.x.
This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students.
We carried out a multicentre, single-blinded, randomised controlled trial with intention-to-treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block-randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self-report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow-up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS).
Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age-matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (- 3.44, 95% confidence interval [CI] - 6.20 to - 0.68; p < 0.05) and the anxiety component of the DASS (- 2.82, 95% CI - 4.99 to - 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (- 3.69, 95% CI - 7.38 to 0.01; p = 0.05). Follow-up at 8 weeks post-trial revealed that the effect was maintained.
Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self-administered, evidence-based intervention now exists to manage stress in this at-risk population and should be widely utilised.
本研究旨在确定正念练习是否能降低高年级医学生的压力水平。
我们在塔斯马尼亚大学霍巴特的三所临床学校进行了一项多中心、单盲、随机对照试验，采用意向治疗分析。参与者包括 2009 年最后两年学习的 66 名医学生。参与者按块随机分配到干预组或常规护理对照组。干预组使用为本次试验设计和制作的引导正念练习音频 CD。参与者被建议在试验的 8 周内每天使用干预措施。所有参与者分别在基线和 8 周时完成两份自我报告问卷。干预组还在 16 周时完成一份问卷，以提供随访数据。主要结局测量指标是感知压力量表（PSS）评分随时间的差异。次要结局测量指标是抑郁、焦虑和压力量表（DASS）各分量表评分随时间的差异。
PSS 和 DASS 压力分量表的平均基线得分分别为 15.7（最高得分为 40）和 13.2（最高得分为 42），均高于年龄匹配的正常对照数据。使用多变量分析，干预组参与者的 PSS 评分显著降低（-3.44，95%置信区间[CI] -6.20 至 -0.68；p <0.05）和 DASS 焦虑分量表得分（-2.82，95% CI -4.99 至 -0.64；p <0.05）。DASS 压力分量表也显示出边缘显著的效果（-3.69，95% CI -7.38 至 0.01；p = 0.05）。试验结束后 8 周的随访显示，效果仍然存在。
正念练习降低了高年级医学生的压力和焦虑。压力在医学生中很普遍，会对学生健康和患者产生不利影响。现在有了一种简单、自我管理、基于证据的干预措施，可以在这一高危人群中管理压力，应该广泛应用。
