A Brief Mindfulness-Based Intervention for Primary Care Physicians: A Pilot Randomized Controlled Trial

Abstract

Primary care physicians experience high rates of burnout, which results in diminished quality of life, poorer quality of care, and workforce attrition. In this randomized controlled trial, our primary aim was to examine the impact of a brief mindfulness-based intervention (MBI) on burnout, stress, mindfulness, compassion, and resilience among physicians. A total of 33 physicians completed the baseline assessment and were randomized to the Mindful Medicine Curriculum (MMC; n = 17) or waitlist control group (n = 16). Participants completed self-report measures at baseline, post-MBI, and 3-month follow-up. We also analyzed satisfaction with doctor communication (DCC) and overall doctor rating (ODR) data from patients of the physicians in our sample. Participants in the MMC group reported significant improvements in stress (P < .001), mindfulness (P = .05), emotional exhaustion (P = .004), and depersonalization (P = .01) whereas in the control group, there were no improvements on these outcomes. Although the MMC had no impact on patient-reported DCC or ODR, among the entire sample at baseline, DCC and ODR were significantly correlated with several physician outcomes, including resilience and personal achievement. Overall, these findings suggest that a brief MBI can have a positive impact on physician well-being and potentially enhance patient care.

Full text

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vol. XX • no X American Journal of Lifestyle Medicine
David A. Schroeder, MD, FACC, Elizabeth Stephens, MD, FACP,
Dharmakaya Colgan, MS, Matthew Hunsinger, PhD,
Dan Rubin, PsyD, and Michael S. Christopher, PhD
Abstract: Primary care physicians
experience high rates of burnout,
which results in diminished quality
of life, poorer quality of care, and
workforce attrition. In this randomized
controlled trial, our primary aim
was to examine the impact of a brief
mindfulness-based intervention (MBI)
on burnout, stress, mindfulness,
compassion, and resilience among
physicians. A total of 33 physicians
completed the baseline assessment
and were randomized to the Mindful
Medicine Curriculum (MMC; n = 17)
or waitlist control group (n = 16).
Participants completed self-report
measures at baseline, post-MBI,
and 3-month follow-up. We also
analyzed satisfaction with doctor
communication (DCC) and overall
doctor rating (ODR) data from patients
of the physicians in our sample.
Participants in the MMC group reported
significant improvements in stress
( P < .001), mindfulness ( P = .05),
emotional exhaustion (P = .004), and
depersonalization (P = .01) whereas
in the control group, there were no
improvements on these outcomes.
Although the MMC had no impact on
patient-reported DCC or ODR, among
the entire sample at baseline, DCC and
ODR were significantly correlated with
several physician outcomes, including
resilience and personal achievement.
Overall, these findings suggest that a
brief MBI can have a positive impact
on physician well-being and potentially
enhance patient care.
Keywords: mindfulness; burnout;
perceived stress; resilience
P
hysicians experience the highest
rates of burnout among health
care providers, with specialties on
the frontline, such as family medicine
and internal medicine, being at the
greatest risk.
1
Nearly 60% of physicians
have reported symptoms of burnout,
including emotional exhaustion,
depersonalization of patients, and lost
sense of personal accomplishment.
2,3
Ultimately, this leads to diminished
quality of care, increased medical errors,
poorer adherence to treatment plans, and
decreased satisfaction with care among
patients.
4,5
Furthermore, burnout is
linked to lower productivity, early
retirement, and higher rates of turnover,
which have profound financial impacts;
6,7
replacement costs are approximately
$250 000 per physician.
8
Therefore, there
is a clear need for evidence-based
methods to reduce burnout and mitigate
its negative impact among physicians.
One such approach may be mindfulness.
A form of mental training that
enhances one’s ability to
nonjudgmentally attend to the present
moment, mindfulness is often translated
as “to see with discernment.”
9
Two
salient components of mindfulness are
(a) an intentional regulation of
attention and awareness of the present
moment and (b) a nonjudgmental and
curious willingness to experience the
content (thoughts, feelings, sensations)
of the present moment.
10
Ultimately,
this practice redirects us away from
habitual reactions to situations, and
teaches new ways to respond that are
more creative and less depleting.
Mindfulness-based interventions (MBIs)
have demonstrated effectiveness in
reducing burnout, depression, anxiety,
629121AJL
XXX10.1177/1559827616629121American Journal of Lifestyle MedicineAmerican Journal of Lifestyle Medicine
research-article2016
A Brief Mindfulness-Based
Intervention for Primary Care
Physicians: A Pilot Randomized
Controlled Trial
DOI: 10.1177/1559827616629121.
Manuscript received October 13, 2015; revised December 17, 2015; accepted January 6, 2016. From Providence Heart Clinic,
Portland, OR (DAS); Endocrinology–Medical Education, Providence Medical Center, Portland, OR (ES); Department of Internal Medicine, Oregon Health and Sciences University,
Portland, OR (ES); School of Professional Psychology, Pacific University, Hillsboro, OR (DC, MH, MSC); and Maitripa College, Portland, OR (DR). Address correspondence to:
Michael S. Christopher, PhD, School of Professional Psychology, Pacific University, 190 SE 8th Avenue, Suite 260, Hillsboro, OR 97123; e-mail: mchristopher@pacificu.edu.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2016 The Author(s)
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and perceived stress,
11-13
and increasing
well-being, resilience,
14,15
and
compassion for others
16
among clinical
and nonclinical populations.
Additionally, in a meta-analysis, Shapiro
etal
17
found that MBIs are an effective
and affordable way to reduce burnout
and enhance quality of life among
health care professionals, and in a
randomized controlled trial (RCT)
among primary care providers, an
8-week Mindfulness-Based Stress
Reduction (MBSR) course enhanced
mood, increased mindfulness and
empathy, and decreased burnout.
18
Although MBIs have been linked to a
number of positive outcomes among
health care professionals, a commonly
reported issue is high attrition rates due
to the intensive time requirement. To
address this barrier, Fortney etal
19
developed a substantially abbreviated
weekend immersion MBI with 2 brief
follow-up sessions for primary care
providers. In an uncontrolled pilot
study, 30 primary care providers
reported reduced burnout, depression,
anxiety, and perceived stress after
attending the weekend program, and
the effects were maintained over 9
months postintervention. These results
suggest that time-limited initial training
may be sufficient in teaching a
mindfulness practice to physicians.
One limitation noted in the study by
Fortney etal
19
was the lack of a control
group. Using an RCT design, we
assessed the efficacy of the brief MBI
developed by Fortney etal
19
among
primary care providers. Our primary
aim was to explore whether a brief
MBI, compared with a waitlist control
group, would reduce burnout and
stress and increase mindfulness,
compassion, and resilience from
baseline to 3-month follow-up in a
group of physicians. Our secondary
aim was to evaluate patient-reported
satisfaction with their primary care
physician—both its relationship to
physician self-reported characteristics
(burnout, stress, mindfulness,
compassion, and resilience) at baseline,
and how a brief MBI might affect these
characteristics at 3-month follow-up.
Method
Participants
Participants were primary care
physicians recruited from the family
medicine and internal medicine
departments at Providence Health and
Services in Portland, Oregon.
Recruitment emails were sent to all 204
physicians in these 2 departments.
Inclusion criteria were (a) employed as
a primary care physician by Providence
Medical Group (PMG), (b) working at
least 30% time in direct patient care, (c)
aged between 25 and 75 years, (d)
willing to be randomized to the
intervention or waitlist control group,
and (e) no prior participation in the
same MBI offered at PMG. The
Providence Health and Services
Institutional Review Board approved the
study and all participants provided
informed consent.
Procedures
Recruitment and data collection
occurred between December 2014 and
May 2015. Potential participants were
recruited via email for 3 weeks prior to
the first MBI group (January 2015).
Participants responded to the recruitment
email by directing their browser to the
study website, which was housed on
Qualtrics, a secure web-based survey
system. At baseline participants created
unique identification codes based on
responses to 2 innocuous questions to
allow for tracking of responses over
time. After completing the baseline
measures, participants were randomized
1:1 into the intervention or a waitlist
control.
Intervention
The intervention used in this study,
Mindful Medicine Curriculum (MMC), is
similar to the protocol used by Fortney
etal
19
MMC is a modified version of
MBSR, with added elements of
compassion skills training, brief
mindfulness techniques designed to be
used at work, and “SLO conversation”
exercises where participants practice
applying mindfulness to the core clinical
skills of speaking, listening, and
observing (SLO). Key to the MMC is an
introduction to mindfulness that is
relevant to the professional contexts in
which physicians work, hence
emphasizing the physicians’ ability to
incorporate mindfulness and
compassion into interpersonal
relationships. Instructors present the
MMC using secular, accessible language,
and they have extensive experience in
secular MBIs and familiarity with the
culture of physicians. MMC is a 13-hour
weekend training program plus 2-hour
follow-up sessions scheduled at 2 and 4
weeks after the weekend.
Measures
Physician Self-Report. The Mindful
Attention Awareness Scale
20
(MAAS) is a
15-item measure of mindfulness in which
respondents indicate, on a 6-point
Likert-type scale, their level of awareness
and attention to present events and
experiences
20
; higher scores indicate
greater mindfulness. The MAAS has good
internal consistency (α = .87; present
sample at baseline = .92) and test-retest
reliability (r = .81).
The Brief Resilience Scale
21
(BRS) is a
6-item measure designed to assess the
ability to bounce back or recover from
stress. Items are rated on a 5-point
Likert-type scale; higher scores indicate
greater resilience. The BRS has good
internal consistency (α = .83; present
sample at baseline = .92), a single factor
structure, and demonstrated expected
correlations with a variety of constructs,
including perceived stress.
The Perceived Stress Scale–10
22
(PSS-10) was used to assess the degree
to which situations in life are perceived
as stressful, and how unpredictable,
uncontrollable, and overloaded
participants find their lives. Items are
rated on a 5-point Likert-type scale;
higher scores indicate greater stress.
The PSS-10 has good internal
consistency (α = .88; present sample at
baseline = .84) and has demonstrated
expected correlations with a variety of
constructs.
The Santa Clara Brief Compassion
Scale
23
(SCBCS) is a 5-item scale
designed to measure compassion. The
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SCBCS is a brief version of the
Compassionate Love Scale
24
, in which
compassionate love is defined as an
attitude toward others that is “focused on
caring, concern, tenderness; and an
orientation toward supporting, helping,
and understanding others” (p. 630). Items
are rated on a 7-point Likert-type scale;
higher scores indicate greater
compassion. The SCBCS has good
internal consistency (α = .90; present
sample at baseline = .88) and has
demonstrated expected correlations with
a variety of constructs.
The Maslach Burnout Inventory
3
(MASL)
is a 22-item scale designed to measure
burnout and job satisfaction. The MASL
consists of 3 subscales: emotional
exhaustion, depersonalization, and
personal accomplishment. Items are rated
on a 7-point Likert-type scale; higher
scores on each subscale indicate more of
the construct. Each of the 3 subscales has
adequate internal consistency: emotional
exhaustion (α = .90; present sample at
baseline = .88), depersonalization (α =
.76; present sample at baseline = .78),
and personal achievement (α = .76;
present sample at baseline = .77).
Meditation Practice Questionnaire
(MPQ): We developed 4 items to
measure how much participants
continued the practices they learned in
the MMC. We asked participants: (a)
how often they do formal mindfulness
practices (eg, sitting meditation, yoga,
body scan); (b) average duration of each
formal mindfulness practice; (c) how
often they do informal mindfulness
practices (eg, mindfulness of daily
activities like eating, walking, speaking,
listening, journaling, etc); and (d) when
engaged in daily activities (eg, eating,
walking, speaking, listening, journaling,
etc) what percent of the time they do
them mindfully. All 4 items were rated
on a 7-point Likert-type scale, and the 2
formal and 2 informal meditation items
were summed to form a formal and
informal meditation index, respectively.
All physician self-report measures
were administered at baseline, post-
MMC (within 7 days of the weekend-
long MBI), and 3 months after the
MMC, with the exception of the MPQ,
which was only administered at
3-month follow-up.
Patient Self-Reported Satisfaction With
Primary Care Physician. To examine
patient self-reported satisfaction with
their primary care physicians, we
assessed archival Consumer Assessment
of Healthcare Providers and Systems–
Clinician and Group Adult Visit
(CG-CAHPS) survey data. The CAHPS
surveys were developed to elicit reports
from consumers about their health care
experiences. The CG-CAHPS Adult Visit
Survey contains 42 items; we used the
Doctor Communication Composite (DCC;
6 items), which asks patients whether the
doctor explained things clearly, listened
carefully, gave easy to understand
instructions, knew important medical
history about the patient, showed
respect, and spent enough time with the
patient. These questions reference the
most recent visit and use a 3-point
response scale (1 = no; 2 = yes,
somewhat; 3 = yes, definitely). We also
used the single item Overall Doctor
Rating (ODR), which asks the patient to
rate the doctor on a scale from 0 (worst
doctor possible) to 10 (best doctor
possible). The DCC has demonstrated
adequate internal consistency (α = .82)
and is significantly correlated with the
ODR (r = .52).
25
At PMG, every month 10
surveys per provider are mailed to a
randomly selected group of patients after
a visit. In addition, all patients with an
email on file (who have not been
surveyed within the past 90 days) receive
an email with the invitation to complete
a survey online. The response rate for
both is approximately 20%. We included
all available CG-CAHPS surveys for each
physician in the study (per physician
M = 95.24, SD = 47.59, range = 20-189),
and calculated average DCC and ODR
scores for the 12-month period preceding
the intervention (January-December
2014) to get a baseline. To examine
pre- to post-MMC change, we also
calculated average DCC and ODR scores
for the 3-month period following the
intervention (February-April 2015; per
physician number of CG-CAHPS surveys
M = 23.24, SD = 10.74, range = 3-52).
Data Analysis
We used a multilevel modeling
(MLM) approach with restricted
maximum likelihood estimation (REML)
to examine linear change in our
physician self-report outcomes over
time as a fixed effect. Outcome
variables were treated as random
effects that could vary within person
and across time. MLM with REML
allows for more accurate estimates
with small sample sizes and missing
data that are missing at random or
completely at random.
26,27
To test
whether changes in mindfulness,
stress, compassion, resilience, and
burnout (emotional exhaustion,
depersonalization, and personal
achievement) occurred after the MMC,
we conducted 2 (Group: control and
intervention) by 3 (Time: baseline,
post-MMC, 3-month follow-up) Mixed
analyses of variance with each
outcome as the dependent variable
using the MLM framework with a first-
order autoregressive covariance
structure (with the exception of
CG-CAHPS data, which had 2 time
points). Significant Group × Time
interaction effects indicated the
effectiveness of MMC, compared with
the waitlist control group. Follow-up
analyses of variance using the MLM
approach and a symmetric covariance
structure were used to test hypotheses
about within-group changes from pre-
to 3-month postintervention scores
among the MMC and control groups
separately. Given the very brief nature
of the intervention (2 days), we chose
the 3-month follow-up as the
postintervention outcome time point.
Effect sizes were calculated using
Cohen’s d (small effect = .20, medium
effect = .50, and large effect = .80).
28
Zero-order Pearson’s correlations were
used to examine the relationship
between meditation practice and
physician self-report outcomes at
3-month follow-up, and to examine the
relationships between patient-reported
satisfaction with their physician and
physician self-report variables at
baseline. For all analyses, 2-tailed tests
were used and α was set at .05.
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Results
Thirty-five potential participants
responded to the recruitment email; 1
person was excluded due to working less
than 30% in direct patient care and 1 other
endorsed already having participated in
the MBI at PMG. The 33 baseline
participants had a mean age of 42.76 ±
8.43 years (range 32-61 years); 73% (n =
24) of the sample was female. The mean
number of years licensed as a physician
was 13.27 ± 8.09 (range 3-31 years) and
12% (n = 4) endorsed a current meditation
practice (3 waitlist control and 1 MBI).
There were no significant differences
between the intervention (n = 17) and
waitlist control (n = 16) group on any
demographic variables (all Ps >.05).
Figure 1 shows the participant flow. A
total of 33 physicians provided written
consent to enroll in the study, completed
the baseline assessment, and were
randomized to the MBI or waitlist control.
Two participants (1 MBI and 1 waitlist
control) withdrew (citing lack of time or
scheduling conflicts) after randomization.
Two waitlist control group participants
withdrew from the study before
postintervention assessment, and 2 MBI
participants and 1 waitlist control group
participant did not complete 3-month
follow-up.
Change in Physician Self-
Reported Outcomes
Over Time
The intervention and control groups
did not differ on any outcome
Figure 1.
Participant flow. MMC, Mindful Medicine Curriculum.
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measures at baseline (all Ps >.05).
MLM analyses revealed significant
Group × Time interactions for stress,
mindfulness, emotional exhaustion,
and depersonalization (see Table 1 and
Figure 2). Participants in the MMC
group reported significant
improvements in stress (P < .001),
mindfulness (P = .05), emotional
exhaustion (P = .004), and
depersonalization (P = .01) at 3-month
follow-up relative to baseline;
however, there was no significant
improvement in resilience (P = .14),
compassion (P = .66), or personal
achievement (P = .06). In the control
group, there were no statistically
significant improvements on any
physician self-report outcomes
(Ps >.20).
Patient-Reported Satisfaction
With Primary Care Physician
As shown in Table 2, among the entire
sample (n = 33), baseline CG-CAHPS
patient-reported DCC and ODR were
significantly correlated with several
baseline physician self-reported
outcomes. However, as shown in Table
3, there were no significant Group ×
Time interactions for CG-CAHPS patient-
reported DCC. Thus, the MMC had no
impact on patient-reported satisfaction
with their primary care physician at the
3-month follow-up.
Ongoing Meditation Practice
As shown in Table 4, a large majority of
the MMC group (92%; n = 12) endorsed
ongoing formal (92%; n = 12; eg, sitting
meditation, yoga, body scan) and
informal (92%; n = 12; eg, mindfulness of
daily activities like eating, walking,
speaking, listening, journaling, etc)
meditation practice at 3-month post-
MMC. As shown in Table 5, there were a
number of significant correlations
between formal/informal meditation
practice and physician self-report
outcomes among MMC group
participants at 3-month follow-up.
Discussion
Results from this RCT demonstrated
that brief mindfulness training for
primary care physicians reduced stress
and burnout and increased mindfulness.
Similar to Fortney etal,
19
the current
study utilized an abbreviated format—a
mindfulness weekend retreat plus 2
Table 1.
Physician Self-Reported Outcomes by Group.
Time ×
Group
Interaction
F-value,
P-value
Pre-MMC
CON M (SD)
(n = 17)
MMC M (SD)
(n = 16)
Post-MMC
CON M (SD)
(n = 14)
MMC M (SD)
(n = 15)
3-Month Follow-
up
CON M (SD)
(n = 13)
MMC M (SD)
(n = 13)
CON Pre-MMC to 3-Month
Follow-up ES, Percent Change
(CI)
MMC Pre-MMC to 3-Month
Follow-up ES, Percent Change
(CI)
MAAS 3.98, .05 3.32 (0.76)
3.42 (0.96)
3.08 (0.76)
3.62 (0.89)
3.18 (0.58)
4.04 (1.02)
–.23, –4.21% (–0.30, 0.41)
1.01, 18% (–1.18, –.47)
BRS 1.45, .23 18.70 (5.13)
21.62 (4.45)
19.42 (4.21)
22.33 (4.74)
18.28 (5.32)
24.15 (5.47)
–.10, –2.24% (–2.36, 2.50)
.51, 11.70% (–5.72, .49)
PSS 3.94, .05 21.64 (4.52)
19.43 (5.30)
20.14 (5.99)
17.93 (5.27)
20.21 (6.65)
13.23 (5.19)
–.27, –6.60% (–1.83, 4.54)
–1.30, –31.90% (3.96, 9.87)
SCBCS 1.29, .25 27.00 (4.97)
26.31 (4.51)
26.07 (4.73)
27.66 (3.22)
25.07 (5.85)
27.84 (4.09)
–.59, –7.14% (–1.31, 2.70)
.57, 5.81% (–2.10, 2.26)
MASL-DEP 5.76, .02 19.47 (7.90)
20.87 (8.42)
21.07 (5.94)
16.80 (9.95)
21.0 (7.52)
13.0 (8.14)
.24, 7.85% (–3.24, 3.81)
–1.12, –37.70% (3.15, 11.61)
MASL-EE 6.15, .02 24.52 (10.57)
26.68 (8.48)
24.42 (8.97)
22.46 (10.66)
26.35 (8.06)
17.15 (9.0)
.31, 3.25% (–4.14, 3.14)
–1.57, –35.71% (6.24, 13.44)
MASL-PA 1.15, .28 37.52 (6.43)
40.25 (5.92)
38.21 (6.49)
42.73 (5.44)
38.14 (6.08)
44.15(4.33)
.18, 1.65% (–2.80, 1.22)
1.09, 9.68% (–7.06, –2.16)
Abbreviations: CON, control group; MMC, Mindful Medicine Curriculum; ES, effect size; CI, difference score confidence interval; MAAS, Mindful Attention
Awareness Scale; BRS, Brief Resiliency Scale; PSS, Perceived Stress Scale; SCBCS, Santa Clara Brief Compassion Scale; MASL-DEP, Maslach Burnout
Inventory–Depersonalization; MASL-EE, Maslach Burnout Inventory–Emotional Exhaustion; MASL-PA, Maslach Burnout Inventory–Personal Achievement.
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follow-up sessions. The abbreviated
format was intended to facilitate
enrollment that might be detrimentally
affected by a more traditional 8-week
MBSR course. Physicians who completed
the MMC reported enhanced mindfulness
and reduced stress, emotional
exhaustion, and depersonalization from
baseline to 3-month follow-up when
compared with the control group. Also
notable, at baseline, physicians in this
study reported lower mindfulness
scores
29
and higher depersonalization
scores
19,30
when compared with
previously published psychometric data.
This is concerning, considering that
burnout is a significant threat to
physician well-being and is associated
with lower patient satisfaction and
reduced adherence to treatment plans.
31
Patients may also benefit from
physician mindfulness training. Previous
studies have noted that MBIs improve
provider empathy and build
communication and rapport between
doctor and patient, which can lead to
better patient satisfaction.
25
Our results
provide tentative support for this
association; baseline correlations
suggest that physicians who are more
resilient and who cope better with
stress—which are common outcomes of
MBIs—are rated more positively by their
patients. We did not find any significant
differences over time in patient
satisfaction between the MMC and
control groups; however, the baseline
scores on the CG-CAHPS were quite
high, leaving little room for
Figure 2.
Means of outcome variables assessed at baseline, postintervention, and 3-month follow-up.
Abbreviations: CON, control group; MMC, Mindful Medicine Curriculum group; MASL-EE, Maslach Burnout Inventory–Emotional Exhaustion; MASL-DEP,
Maslach Burnout Inventory–Depersonalization; MASL-PA, Maslach Burnout Inventory–Personal Achievement.
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vol. XX • no X American Journal of Lifestyle Medicine
improvement. Despite our null findings,
the hypothesis that mindfulness training
can enhance patient-provider
relationships and ultimately lead to
improved health outcomes needs further
investigation using higher powered
RCTs.
In addition, participants in the MMC
group were able to maintain their
practices over a 3-month period,
confirming that a brief weekend
introduction to mindfulness practice is
sustainable with minimal ongoing
support. Furthermore, self-reports of
formal meditation practice were
significantly correlated with
improvements in mindfulness, stress,
and depersonalization, while self-reports
of informal practices were significantly
correlated with improvements in
mindfulness, resilience, emotional
exhaustion, and personal achievement.
Additionally, most of the participants in
this cohort were able to achieve these
improvements with less than 10 minutes
of formal meditation daily. This is
noteworthy, as most MBIs among health
care providers lack information
regarding adherence to formal and
informal practices conducted outside
the weekly sessions. These results
enhance our understanding of the
differential effects of formal and
informal practices among health care
providers and provide more information
regarding the frequency and intensity of
mindfulness practice required to and
sustain effects. This is especially
important given the time constrictions of
this population.
This study had a number of
limitations. First, the small sample size
reduced statistical power and multiple
comparisons may have increased the
likelihood of type I errors. The medium
to large effect sizes for changes in
nonsignificant outcomes (ie,
compassion, resiliency, and personal
Table 3.
Patient-Reported Satisfaction With Primary Care Physician (CG-CAHPS) by Group.
12-Month Aggregate Baseline
Pre-MMC 3 Month Aggregate Post-MMC
CON M (SD)
(n = 17)
MMC M (SD)
(n = 16)
CON M (SD)
(n = 13)
MMC M (SD)
(n = 13) F P
CG-CAHPS—Doctor
Communication
17.23 (1.90) 17.48 (1.40) 17.29 (1.92) 17.37 (1.65) 1.30 .27
CG-CAHPS—Overall Doctor
Rating
9.01 (1.29) 9.12 (1.36) 9.04 (1.23) 9.19 (1.44) 0.77 .44
Abbreviations: CON, control group; MMC, Mindful Medicine Curriculum Group; CG-CAHPS—Doctor Communication, Consumer Assessment of Healthcare
Providers and Systems–Clinician and Group Adult Visit—Doctor Communication Composite, Consumer Assessment of Healthcare Providers and Systems–
Clinician and Group Adult Visit—Overall Doctor Rating.
Table 2.
Zero-Order Correlations between Physician Self-Report Measures and Patient-Reported Satisfaction with Primary Care Physician
(CG-CAHPS) at Baseline (n= 33).
MAAS PSS BRS SCBCS MASL-EE MASL-DEP MASL-PA
CG-CAHPS—Doctor
Communication
.22 –.33* .49** –.03 –.10 –.04 .37*
CG-CAHPS—Overall
Doctor Rating
.11 –.27
†
.48** .12 –.05 –.07 .39*
Avvreviations: CG-CAHPS—Doctor Communication, Consumer Assessment of Healthcare Providers and Systems–Clinician and Group Adult Visit—Doctor
Communication Composite, Consumer Assessment of Healthcare Providers and Systems–Clinician and Group Adult Visit—Overall Doctor Rating; MAAS,
Mindful Attention Awareness Scale; BRS, Brief Resiliency Scale; PSS, Perceived Stress Scale; SCBCS, Santa Clara Brief Compassion Scale; MASL-DEP,
Maslach Burnout Inventory–Depersonalization; MASL-EE, Maslach Burnout Inventory–Emotional Exhaustion; MASL-PA, Maslach Burnout Inventory–Personal
Achievement.
†
P < .10; *P < .05; **P < .01.
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8
Mon • Mon XXXXAmerican Journal of Lifestyle Medicine
achievement) in the MMC group from
baseline to 3-month follow-up suggest
the possibility that our sample size was
too small to detect improvements on
these outcomes. Second, the
generalizability of the findings is limited
because participants volunteered to
participate in the study, introducing
selection bias. Third, a potential variable
that was not controlled for, but may
have been influential, was enhanced
social support. The mindfulness retreat
provided an opportunity for
practitioners to come together and
discuss topics unique to patient care
issues, which can be very depleting.
Support from a group of like-minded
physicians is likely partly responsible
Table 5.
Zero-Order Correlations Between Formal and Informal Mindfulness Practice and Outcomes among MMC Group at 3-Month Follow-
up (n = 13).
MAAS PSS BRS SCBCS MASL-EE MASL-DEP MASL-PA
Formal mindfulness practice .53* –.56* .26 .08 –.46
†
–.55* .11
Informal mindfulness practice .56* –.46
†
.49* .34 –.50* –.34 .49*
Abbreviations: MMC, Mindful Medicine Curriculum; MAAS, Mindful Attention Awareness Scale; BRS, Brief Resiliency Scale; PSS, Perceived Stress Scale;
SCBCS, Santa Clara Brief Compassion Scale; MASL-DEP, Maslach Burnout Inventory–Depersonalization; MASL-EE, Maslach Burnout Inventory–Emotional
Exhaustion; MASL-PA, Maslach Burnout Inventory–Personal Achievement.
†
P < .10; *P < .05.
Table 4.
Formal and Informal Mindfulness Practice at Three-Month Follow-up Among Mindful Medicine Curriculum Group Participants
(n = 13).
Formal Practice Frequency
Average Formal Practice Duration (in
Minutes)
Never 8% (n = 1) 0-10 (n = 10)
<1 day per month 15% (n = 2) 11-20 (n = 2)
1-10 days per month 46% (n = 6) 21-30 (n = 0)
11-20 days per month 23% (n = 3) 31-40 (n = 0)
21-29 days per month 8% (n = 1) 41-50 (n = 0)
Every day 0% (n = 0) 51-60 (n = 0)
Informal Practice Frequency
Percentage of Time Engaged in Daily
Activities Mindfully
Never 8% (n = 1) 0-10 (n = 4)
<1 day per month 0% (n = 0) 11-20 (n = 2)
1-10 days per month 54% (n = 7) 21-30 (n = 0)
11-20 days per month 0% (n = 0) 31-40 (n = 0)
21-29 days per month 30% (n = 4) 41-50 (n = 3)
Every day 8% (n = 1) 51-60 (n = 1)
61-70 (n = 1)
71-80 (n = 1)
81-90 (n = 0)
91-100 (n = 0)
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9
vol. XX • no X American Journal of Lifestyle Medicine
for some of the benefits, and may be
more difficult to measure. While this is a
separate component from traditional
MBI teaching, the group interaction was
considered an integral part of the
practices and follow-up.
32
In summary, burnout is a common
consequence of the ever-increasing
demands made of practicing physicians.
Mindfulness is a promising approach to
managing this concern. Among a group
of primary care physicians, who at
baseline endorsed relatively high
burnout and low mindfulness, we found
that a very brief MBI led to significant
improvements in burnout, stress, and
mindful awareness. Most of these
physicians also maintained a mindfulness
practice 3 months after the training.
Physician burnout is a complex
phenomenon with multiple causes.
Medical systems contending with high
physician burnout rates might consider
offering brief mindfulness training as one
potential remedy.
Acknowledgments
The authors thank the Providence Health System Clinical
Transformation Council for funding this study (Principal
Investigator: David A Schroeder).
AJLM
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