A.T. Still University, School of Osteopathic Medicine in Arizona, Mesa, AZ, USA.
Department of Research Support, A.T. Still University, Kirksville, MO, USA.
J Osteopath Med. 2023 Jul 12;123(10):485-492. doi: 10.1515/jom-2022-0246. eCollection 2023 Sep 1.
Medical education is stressful and can adversely affect the health and well-being of students. Although mindfulness-based interventions (MBIs) have been successfully utilized in other settings, little is known about the use of student-led interventions in undergraduate medical education.
The objectives of this study are to assess student satisfaction with four student-selected and student-led mindfulness activities incorporated into mandatory small-group sessions, the immediate impact of these activities on student stress levels, and student use of these activities outside the mindfulness sessions.
First-year osteopathic medical students voluntarily participated in weekly student-selected and student-led mindfulness activities once a week for 8 consecutive weeks during regularly scheduled class time. Activities included yoga postures, the 4-7-8 breathing technique, progressive muscle relaxation (PMR), and values affirmation. Each activity was completed twice during the 8 weeks. After each session, students could anonymously complete an electronic survey assessing participation, change in stress level, satisfaction with the activity, and mindfulness activities practiced outside the session. Survey questions included dichotomous, Likert-like, and multiple-choice responses. A chi-square test was utilized to analyze student responses from each week about the decrease in stress level, and satisfaction with the mindfulness activity, and student use of the activities outside the classroom. Wilcoxon rank sum tests were utilized to determine associations between outcomes, and a logistic regression model was utilized to determine relationships between the change in stress levels and other outcomes.
Of the 154 first-year medical students initially enrolled in the 2021-2022 academic year, 14 (9.1 %) to 94 (61.0 %) actively participated in the weekly mindfulness activities. Students indicated that the 4-7-8 breathing technique was the activity most practiced outside the mindfulness sessions (32.3 %, 43/133 total responses) across all weeks. The mindfulness activity with the highest percentage of reported decrease in stress level was the yoga postures in week 5 (94.8 %, 36/38), and both weeks of the yoga activities had the highest reported student satisfaction (95.7 %, 90/94 for week 1; 92.1 %, 35/38 for week 5). For students who answered the change in stress level question, the stress level decrease was related to participation in the weekly activity for weeks 1 through 7 (all p<0.03). For students who participated in mindfulness sessions, the odds of reporting a reduction in the stress level were 16.6 times (95 % CI, 6.8-47.2; p<0.001) that of students who did not participate. For those satisfied with the activities, the odds of reporting a reduction in stress level were 6.7 (95 % CI, 3.3-13.9; p<0.001).
Results suggested that the student-selected and student-led mindfulness activities may successfully reduce medical student stress in students who actively participate. However, additional research is needed to determine how to optimize mindfulness curricula implementation.
医学教育压力大,会对学生的健康和幸福产生不利影响。虽然基于正念的干预措施(MBIs)已成功应用于其他环境,但对于在本科医学教育中使用学生主导的干预措施知之甚少。
本研究的目的是评估学生对纳入强制性小组会议的四项学生选择和学生主导的正念活动的满意度、这些活动对学生压力水平的即时影响,以及学生在正念课程之外使用这些活动的情况。
154 名一年级整骨医学专业学生自愿参加,每周一次,为期 8 周,在规定的上课时间内进行学生选择和学生主导的正念活动。活动包括瑜伽姿势、4-7-8 呼吸法、渐进性肌肉松弛(PMR)和价值观肯定。8 周内每项活动各进行两次。每次课后,学生可以匿名完成一份电子调查,评估参与度、压力水平变化、对活动的满意度以及在课堂外进行的正念活动。调查问卷包括二项式、类李克特式和多项选择题。利用卡方检验分析每周学生对压力水平降低的反应和对正念活动的满意度,以及学生在课堂外使用活动的情况。利用 Wilcoxon 秩和检验确定结果之间的关联,利用逻辑回归模型确定压力水平变化与其他结果之间的关系。
在 2021-2022 学年最初注册的 154 名一年级医学生中,有 14 名(9.1%)至 94 名(61.0%)积极参加了每周的正念活动。学生们表示,4-7-8 呼吸法是所有周数中最常在正念课程之外练习的活动(32.3%,133 次总回复中有 43 次)。报告压力水平降低百分比最高的正念活动是第 5 周的瑜伽姿势(94.8%,38 次中有 36 次),第 1 周和第 5 周的瑜伽活动报告的学生满意度最高(第 1 周 95.7%,94 次中有 90 次;第 5 周 92.1%,38 次中有 35 次)。对于回答压力水平变化问题的学生,压力水平的降低与第 1 至 7 周的每周活动有关(均 p<0.03)。对于参加正念课程的学生,报告压力水平降低的可能性是未参加学生的 16.6 倍(95%CI,6.8-47.2;p<0.001)。对于对活动满意的学生,报告压力水平降低的可能性是不满意学生的 6.7 倍(95%CI,3.3-13.9;p<0.001)。
结果表明,学生选择和学生主导的正念活动可能会成功降低积极参与的医学生的压力。然而,需要进一步研究来确定如何优化正念课程的实施。