Stanford University School of Medicine, Stanford, CA, USA.
Acad Psychiatry. 2017 Oct;41(5):646-650. doi: 10.1007/s40596-017-0768-3. Epub 2017 Aug 9.
Stress and burnout are increasingly recognized as urgent issues among resident physicians, especially given the concerning implications of burnout on physician well-being and patient care outcomes.
The authors assessed how a mindfulness and meditation practice among residents, supported via a self-guided, smartphone-based mindfulness app, affects wellness as measured by prevalidated surveys.
Residents in the departments of general surgery, anesthesia, and obstetrics and gynecology were recruited for participation in this survey-based, four-week, single-arm study. All participants used the app (Headspace) on a self-guided basis, and took surveys at enrollment, at 2 weeks, and at 4 weeks. The Positive and Negative Affect Schedule (PANAS) assessed mood, and the Freiburg Mindfulness Inventory (FMI) measured mindfulness.
Forty-three residents enrolled in this study from April 2015 to August 2016; 30 residents (90% female) completed two or more surveys, and so were included for further analysis. In a comparison of baseline scores to week four scores, there was a significant increase in FMI at week four (36.88 ± 7.00; Cohen's d = 0.77, p = 0.005), a trend toward increase in the positive affect score (PAS) (31.73 ± 6.07; Cohen's d = 0.38, p = 0.08), and no change in negative affect score (NAS) (21.62 ± 7.85; Cohen's d = -0.15, p = NS). In mixed-effect multivariate modeling, both the PAS and the FMI scores showed significant positive change with increasing use of the smartphone app (PAS, 0.31 (95% CI 0.03-0.57); FMI, 0.38 (95% CI 0.11-0.66)), while the NAS did not show significant change.
Study limitations include self-guided app usage, a homogenous study subject population, insufficient study subjects to perform stratified analysis of the impact of specialty on the findings, lack of control group, and possible influence from the Hawthorne effect. This study suggests the feasibility and efficacy of a short mindfulness intervention delivered by a smartphone app to improve mindfulness and associated resident physician wellness parameters.
压力和倦怠感在住院医师中日益受到关注，尤其是倦怠感对医生健康和患者护理结果的影响令人担忧。
本研究评估了住院医师通过自我指导的智能手机应用正念冥想练习对健康的影响，该应用使用了预先验证的调查进行测量。
普通外科、麻醉科和妇产科的住院医师参与了这项基于调查的、为期四周的单臂研究。所有参与者都在自我指导的基础上使用该应用程序（Headspace），并在入组时、第 2 周和第 4 周进行调查。正性和负性情绪量表（PANAS）评估情绪，弗赖堡正念量表（FMI）测量正念。
2015 年 4 月至 2016 年 8 月，43 名住院医师参加了这项研究；30 名住院医师（90%为女性）完成了两项或更多调查，因此被纳入进一步分析。与基线评分相比，第 4 周时 FMI 显著升高（36.88±7.00；Cohen's d=0.77，p=0.005），积极情绪评分（PAS）呈上升趋势（31.73±6.07；Cohen's d=0.38，p=0.08），消极情绪评分（NAS）无变化（21.62±7.85；Cohen's d=-0.15，p=NS）。在混合效应多元模型中，PAS 和 FMI 评分均随智能手机应用程序使用量的增加而显著增加（PAS，0.31（95%CI 0.03-0.57）；FMI，0.38（95%CI 0.11-0.66）），而 NAS 无显著变化。
研究局限性包括自我指导的应用程序使用、同质的研究对象人群、进行专业对研究结果的影响的分层分析的样本量不足、缺乏对照组以及可能受到霍桑效应的影响。本研究表明，通过智能手机应用程序进行短期正念干预可以提高正念和相关住院医师健康参数，这是可行且有效的。
