Department of Surgery, University of California, San Francisco.
Department of Neuroradiology, University of California, San Francisco.
JAMA Netw Open. 2019 May 3;2(5):e194108. doi: 10.1001/jamanetworkopen.2019.4108.
Mindfulness meditation training has been shown to be feasible in surgical trainees, but affective, cognitive, and performance benefits seen in other high-stress populations have yet to be evaluated.
To explore potential benefits to stress, cognition, and performance in postgraduate year 1 (PGY-1) surgery residents receiving modified mindfulness-based stress reduction (modMBSR).
DESIGN, SETTING, AND PARTICIPANTS: This follow-up study is an analysis of the Mindful Surgeon pilot randomized clinical trial of modMBSR (n = 12) vs an active control (n = 9), evaluated at baseline (T1), postintervention (T2), and 1 year (T3), took place at an academic medical center residency training program among PGY-1 surgery residents. Data were collected between June 2016 and June 2017 and analyzed from June 2017 to December 2017.
Weekly 2-hour modMBSR classes and 20 minutes of daily home practice during an 8-week period vs an active control (different content, same structure).
Preliminary evidence of efficacy was explored, primarily focusing on perceived stress and executive function and secondarily on burnout, depression, motor skill performance, and changes in blood oxygen level-dependent functional neuroimaging during an emotion regulation task. Group mean scores were calculated at T1, T2, and T3 and in linear mixed-effects multivariate analysis. Effect size for analysis of covariance is presented as partial η2 with the following cutoff points: small, less than 0.06; medium, 0.06 to 0.14; large, greater than 0.14.
Postgraduate year 1 surgery residents (N = 21; 8 [38%] women) were randomized to a modMBSR arm (n = 12) or an active control arm (n = 9). Linear mixed-effects modeling revealed differences at T2 and T3 in perceived stress (mean [SD] difference at T2: modMBSR, 1.42 [5.74]; control, 3.44 [6.71]; η2 = 0.07; mean [SD] difference at T3: modMBSR, 1.00 [4.18]; control, 1.33 [4.69]; η2 = 0.09) and in mindfulness (mean [SD] difference at T2: modMBSR, 3.08 [3.63]; control, 1.56 [4.28]; η2 = 0.13; mean [SD] difference at T3: modMBSR, 2.17 [3.66]; control, -0.11 [6.19]; η2 = 0.15). Burnout at T2 (mean [SD] difference: modMBSR, 4.50 [9.08]; control, 3.44 [6.71]; η2 = 0.01) and T3 (mean [SD] difference: modMBSR, 5.50 [9.96]; control, 5.56 [9.69]; η2 = 0.01) showed similar increase in both groups. Working memory increased more at T2 in the modMBSR arm (mean [SD] difference, 0.35 [0.60]) than in the control arm (mean [SD] difference, 0.21 [0.74]; η2 = 0.02) and at T3 (modMBSR, 0.68 [0.69]; control, 0.26 [0.58]; η2 = 0.20). Cognitive control decreased more in the control arm at T2 (mean [SD] difference at T2: modMBSR, 0.15 [0.40]; control, -0.07 [0.32]; η2 = 0.13) and at T3 (mean [SD] difference: modMBSR, 0.07 [0.59]; control, -0.26 [0.53]; η2 = 0.16). Mean (SD) circle-cutting time improved more at T2 in the modMBSR arm (-24.08 [63.00] seconds) than in the control arm (-4.22 [112.94] seconds; η2 = 0.23) and at T3 in the modMBSR arm (-4.83 [77.94] seconds) than in the control arm (11.67 [145.17] seconds; η2 = 0.13). Blood oxygen level-dependent functional neuroimaging during an emotional regulation task showed unique postintervention activity in the modMBSR arm in areas associated with executive function control (dorsolateral prefrontal cortex) and self-awareness (precuneus).
In this pilot randomized clinical trial, modMBSR in PGY-1 surgery residents showed potential benefits to well-being and executive function, suggesting a powerful role for mindfulness-based cognitive training to support resident well-being and performance, as mandated by the Accreditation Council for Graduate Medical Education.
ClinicalTrials.gov identifier: NCT03141190.
重要性：正念冥想训练已被证明在外科受训者中是可行的，但在其他高压人群中观察到的情感、认知和表现方面的益处尚未得到评估。
目的：探索对研究生一年级（PGY-1）外科住院医师的压力、认知和表现产生潜在益处的方法，这些住院医师接受了改良的基于正念的减压疗法（modMBSR）。
设计、地点和参与者：本随访研究是对 modMBSR 的一项前瞻性临床试验的分析（n=12），与主动对照组（n=9）进行比较，在基线（T1）、干预后（T2）和 1 年（T3）进行评估，该研究在学术医学中心住院医师培训计划中的 PGY-1 外科住院医师中进行。数据收集于 2016 年 6 月至 2017 年 6 月，分析于 2017 年 6 月至 2017 年 12 月进行。
干预措施：每周 2 小时的 modMBSR 课程和 8 周期间每天 20 分钟的家庭练习，与主动对照组（不同内容，相同结构）进行比较。
主要结果和措施：初步探索了疗效的证据，主要集中在感知压力和执行功能上，其次是职业倦怠、抑郁、运动技能表现以及在情绪调节任务期间血氧水平依赖性功能神经影像学的变化。T1、T2 和 T3 的组平均得分进行了计算，并在多元线性混合效应分析中进行了分析。协方差分析的效应大小表示为部分η2，以下列截断点表示：小，小于 0.06；中，0.06 至 0.14；大，大于 0.14。
结果：PGY-1 外科住院医师（N=21；8[38%]名女性）被随机分配到 modMBSR 组（n=12）或主动对照组（n=9）。线性混合效应模型显示，在 T2 和 T3 时感知压力存在差异（T2 时 modMBSR 组的平均[SD]差异：1.42[5.74]；对照组：3.44[6.71]；η2=0.07；T3 时 modMBSR 组的平均[SD]差异：1.00[4.18]；对照组：1.33[4.69]；η2=0.09）和正念（T2 时 modMBSR 组的平均[SD]差异：3.08[3.63]；对照组：1.56[4.28]；η2=0.13；T3 时 modMBSR 组的平均[SD]差异：2.17[3.66]；对照组：-0.11[6.19]；η2=0.15）。T2 时职业倦怠（modMBSR 组的平均[SD]差异：4.50[9.08]；对照组：3.44[6.71]；η2=0.01）和 T3 时职业倦怠（modMBSR 组的平均[SD]差异：5.50[9.96]；对照组：5.56[9.69]；η2=0.01）显示两组均有相似的增加。在 modMBSR 组，T2 时工作记忆增加更多（平均[SD]差异，0.35[0.60]），而在对照组，T2 时工作记忆增加更多（平均[SD]差异，0.21[0.74]；η2=0.02），T3 时工作记忆增加更多（modMBSR 组，0.68[0.69]；对照组，0.26[0.58]；η2=0.20）。在 T2 和 T3 时，对照组的认知控制下降更多（T2 时 modMBSR 组的平均[SD]差异：0.15[0.40]；对照组：-0.07[0.32]；η2=0.13；T3 时 modMBSR 组的平均[SD]差异：0.07[0.59]；对照组：-0.26[0.53]；η2=0.16）。在 T2 时，modMBSR 组的圆切时间改善更多（-24.08[63.00]秒），而对照组的改善更多（-4.22[112.94]秒；η2=0.23），在 T3 时，modMBSR 组的改善更多（-4.83[77.94]秒），而对照组的改善更多（11.67[145.17]秒；η2=0.13）。在情绪调节任务中，血氧水平依赖性功能神经影像学显示，modMBSR 组在与执行功能控制（背外侧前额叶皮层）和自我意识（楔前叶）相关的区域中存在独特的干预后活动。
结论和相关性：在这项初步随机临床试验中，PGY-1 外科住院医师的 modMBSR 显示出对幸福感和执行功能的潜在益处，这表明正念认知训练在支持住院医师的幸福感和表现方面具有强大的作用，这是研究生医学教育认证委员会的要求。
试验注册：ClinicalTrials.gov 标识符：NCT03141190。
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