Department of Surgery, University of California, San Francisco.
Osher Center for Integrative Medicine, University of California, San Francisco.
JAMA Surg. 2018 Oct 1;153(10):e182734. doi: 10.1001/jamasurg.2018.2734. Epub 2018 Oct 17.
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.
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.
Weekly 2-hour, modified MBSR classes and 20 minutes of suggested daily home practice over an 8-week period.
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.
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]).
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.
ClinicalTrials.gov identifier: NCT03141190.
在外科受训者中，倦怠和困扰很普遍，但正念已被证明可以降低抑郁、自杀意念、倦怠和压倒性压力的风险。在其他高压人群中，正式的正念训练已被证明可以改善心理健康，但这种方法尚未在外科中尝试过。
测试改良正念减压（MBSR）培训在外科住院医师培训中的可行性和可接受性。
设计、地点和参与者：这是一项在一家三级学术医疗中心的住院医师培训项目中进行的改良 MBSR 与积极对照组的随机临床试验，共有 21 名外科住院医师参与，研究时间为 2016 年 4 月 30 日至 2017 年 12 月。
每周 2 小时的改良 MBSR 课程和 20 分钟建议的家庭日常练习，为期 8 周。
通过焦点小组、访谈、调查、出勤率、日常练习时间和主观自我报告经验，从 6 个方面评估可行性，包括需求、实施、实用性、可接受性、适应性和整合。
在分析中包括的 21 名住院医师中，有 13 名是男性（62%）。干预组的平均（SD[范围]）年龄为 29.0（2.4[24-31]）岁，对照组的平均（SD[范围]）年龄为 27.4（2.1[27-33]）岁。通过培养利益相关者的支持，正式的应激弹性培训是可行的。改良 MBSR 是可以接受的，因为没有人员流失；出勤率高（干预组 96 次缺勤中有 12 次缺勤[13%]，对照组 72 次缺勤中有 11 次缺勤[15%]）；两组之间每周练习天数无显著差异；两组的平均（SD）日常练习时间相似，只有在第 1 周（对照组，28.15[12.55]分钟；干预组，15.47[4.06]分钟；P=0.02）、第 2 周（对照组，23.89[12.93]分钟；干预组，12.61[6.06]分钟；P=0.03）和第 4 周（对照组，26.26[13.12]分钟；干预组，15.36[6.13]分钟；P=0.04）有显著差异；课程满意度（基于访谈和焦点小组反馈）；以及培训后的可信度（对照组，18.00[4.24]；干预组，20.00[6.55]；P=0.03）。正念技能被整合到个人和专业环境中，并且在 12 个月的随访中继续独立练习正念技能（每周正式练习的平均天数[SD]，3[1.0]）。
在三级学术中心，外科住院医师的正式 MBSR 培训是可行和可接受的。住院医师认为这些概念和技能既对个人有用，也对专业有用，并且参与对他们的外科培训或患者护理没有不利影响。
ClinicalTrials.gov 标识符：NCT03141190。
