Mindful Mental Training for Surgeons to Enhance Resilience and Performance Under Stress
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|ClinicalTrials.gov Identifier: NCT03141190|
Recruitment Status : Completed
First Posted : May 5, 2017
Last Update Posted : June 18, 2019
Burnout and overwhelming stress are growing issues among surgeons and are associated with mental illness, attrition and diminished patient care. Among surgical trainees, burnout and distress are alarmingly prevalent but high inherent mindfulness has been shown to decrease the risk of depression, suicidal ideation, burnout and overwhelming stress by more than 75%. In other high-stress populations formal mindfulness training has been shown to improve mental health and buffer overwhelming stress and yet this approach has not been tried in surgery.
The aim of this study is to evaluate feasibility and acceptability of modified mindfulness-based stress reduction (MBSR) training among PGY-1 surgery residents and to obtain initial evidence of efficacy in regard to well-being and performance.
Design: A pilot randomized clinical trial of modified MBSR versus an active control.
Setting: Residency training program, tertiary academic medical center.
Participants: PGY-1 surgery residents.
Weekly two-hour modified MBSR classes (compared to an active control) and 20 minutes of suggested daily home practice over an eight-week period.
Main Outcomes and Measures:
Primary outcome is feasibility, assessed along six domains (demand, implementation, practicality, acceptability, adaptation and integration), using focus groups, interviews, surveys, attendance, daily practice time and subjective self-report of experience.
Secondary outcomes include perceived stress, mindfulness and executive function (specifically working memory capacity), followed by psychosocial well-being (burnout, depression, resilience), performance (motor skills testing) and functional brain scans focused on areas associated with reappraisal as a surrogate for emotional control.
This study seeks to demonstrate the feasibility of mindfulness training in surgery PGY-1s while simultaneously providing preliminary quantitative data on the effects of mindfulness training in a randomized, controlled setting. Data will inform modifications to the MBSR curriculum that enhance feasibility and inform sample size calculations for subsequent, adequately-powered RCTs which will likely need to be multi-center trials.
Results could potentially impact formal medical training, the mental health of providers at every level, and the overall quality of patient care.
|Condition or disease||Intervention/treatment||Phase|
|Burnout Syndrome Surgery Stress||Behavioral: Mindfulness Based Stress Reduction - modified Behavioral: Active listening and reading||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||21 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||Randomized, partially-blinded|
|Masking:||Double (Participant, Outcomes Assessor)|
|Masking Description:||Participants do not know we are testing mindfulness only that they will be learning stress-reduction skills for surgeons|
|Official Title:||Mindfulness Training to Improve Mental Health, Stress and Performance In Physicians|
|Actual Study Start Date :||June 2016|
|Actual Primary Completion Date :||December 31, 2017|
|Actual Study Completion Date :||December 31, 2017|
Experimental: Mental Training for Surgeons
Mindfulness-Based Stress Reduction (MBSR, as published elsewhere extensively) slightly modified by shortening the eight weekly classes to 2 hours each and the home practice requirement to 20 minutes. Taught by a veteran MBSR teacher with greater than 10,000 hours of personal practice and nearly 10 years of formal MBSR teaching experience.
Behavioral: Mindfulness Based Stress Reduction - modified
Other Name: MBSR
Active Comparator: The Mind of a Surgeon
8 weekly classes of 2 hours each with group reading and discussion of selected articles and stories about the ethos and experience of becoming a surgeon. Designed and administered by a surgical faculty member with extensive experience in surgical education and scholarly work in the area of the 'surgical personality'.
Behavioral: Active listening and reading
group reading, listening and discussion of articles pertaining to the development and experience of the surgical personality
- Change in Stress [ Time Frame: baseline, 8wks (post-intervention),12-month follow-up ]Cohen's Perceived Stress Scale (PSS)
- Change in Executive Function [ Time Frame: baseline, 8wks (post-intervention),12-month follow-up ]Executive function as assessed via working memory capacity, cognitive control and executive composite components of the NIH EXAMINER battery.
- Change in Motor skills [ Time Frame: baseline, 8wks (post-intervention),12-month follow-up ]Performance as assessed by the Fundamentals of Laparoscopic Surgery (FLS) modules
- Change in Functional neuroanatomic changes [ Time Frame: baseline, 8wks (post-intervention),12-month follow-up ]Functional changes in areas associated with reappraisal/emotional regulation (amygdala, hippocampus, reward circuitry, appraisal pathway) as evidenced by fMRI BOLD and DTI brain scans analyzed by whole brain and a prior region of interest approaches.
- Change in Psychological well-being [ Time Frame: baseline, 8wks (post-intervention),12-month follow-up ]burnout (Maslach burnout inventory), depression (PHQ-9), resilience (ER89), Grit (GRIT-S), mindfulness (CAMS-R)
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03141190
|United States, California|
|University of California San Francisco|
|San Francisco, California, United States, 94143|
|Principal Investigator:||Carter Lebares, MD||University of California, San Francisco|