Epstein Ronald M, Marshall Frederick, Sanders Mechelle, Krasner Michael S
Mr. Epstein: Professor of Family Medicine, Oncology and Medicine (Palliative Care), and American Cancer Society's Clinical Research Professor, Codirector, Center for Communication and Disparities Research, Departments of Family Medicine and Medicine and the Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Marshall: Professor, Department of Neurology, Division of Geriatric Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Sanders: Senior Instructor, Department of Family Medicine, Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Krasner: Professor of Clinical Medicine and Clinical Family Medicine, Departments Medicine and Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
J Contin Educ Health Prof. 2022 Jan 1;42(1):19-27. doi: 10.1097/CEH.0000000000000379.
Mindfulness-based interventions for health professionals have been linked to improvements in burnout, well-being, empathy, communication, patient-centered care, and patient safety, but the optimal formats and intensity of training have been difficult to determine because of the paucity of studies and the heterogeneity of programs. A 4-days residential "Mindful Practice" workshop for physicians and medical educators featuring contemplative practices, personal narratives, and appreciative dialogs about challenging experiences may hold promise in improving participants' well-being while also improving compassionate care, job satisfaction, work engagement, and teamwork.
We collected baseline and 2-month follow-up data during four workshops conducted in 2018 to 2019 at conference centers in the United States and Europe. Primary outcomes were burnout, work-related distress, job satisfaction, work engagement, patient-centered compassionate care, and teamwork.
Eighty-five of 120 participants (71%) completed both surveys (mean age was 49.3 and 68.2% female). There were improvements (P < .01) in two of three burnout components (emotional exhaustion and depersonalization), work-related distress, job satisfaction, patient-centered compassionate care, work engagement and meaning, teamwork, well-being, positive emotion, mindfulness, somatic symptoms, and spirituality. Effect sizes (standardized mean difference of change) ranged from 0.25 to 0.61. With Bonferroni adjustments (P < .0031), teamwork, general well-being, and mindfulness became nonsignificant.
An intensive, multiday, mindfulness-based workshop for physicians had clinically significant positive effects on clinician well-being, quality of interpersonal care and work satisfaction, and meaning and engagement, all important indicators of improved health and sustainability of the health care workforce. Future iterations of the program should increase the focus on teamwork.
针对健康专业人员的基于正念的干预措施已被证明与职业倦怠、幸福感、同理心、沟通能力、以患者为中心的护理以及患者安全的改善有关，但由于研究匮乏和项目的异质性，难以确定培训的最佳形式和强度。为期四天的住宿式“正念实践”研讨会，面向医生和医学教育工作者，包含沉思练习、个人叙事以及关于挑战性经历的欣赏性对话，可能有望改善参与者的幸福感，同时提升关怀式护理、工作满意度、工作投入度和团队合作能力。
我们在2018年至2019年于美国和欧洲会议中心举办的四次研讨会上收集了基线数据和两个月后的随访数据。主要结果指标包括职业倦怠、工作相关困扰、工作满意度、工作投入度、以患者为中心的关怀式护理以及团队合作。
120名参与者中有85名（71%）完成了两项调查（平均年龄为49.3岁，女性占68.2%）。在职业倦怠的三个组成部分（情感耗竭和去个性化）中的两个、工作相关困扰、工作满意度、以患者为中心的关怀式护理、工作投入度和意义、团队合作、幸福感、积极情绪、正念、躯体症状和精神性方面均有改善（P < .01）。效应大小（变化的标准化平均差异）范围为0.25至0.61。经邦费罗尼校正（P < .0031）后，团队合作、总体幸福感和正念变得不再显著。
为医生举办的为期多天的强化正念研讨会对临床医生的幸福感、人际护理质量和工作满意度以及意义和投入度产生了具有临床意义的积极影响，这些都是医疗保健劳动力健康状况改善和可持续性的重要指标。该项目的未来版本应更加注重团队合作。
