Attending To Presence: Improving Physicians’ Interpersonal and Professional Well-Being through Mindfulness Training Meliss...
Introduction <ul><li>Primary Care Physicians report widespread personal and professional dissatisfaction. </li></ul><ul><l...
Krasner, et al. Findings* <ul><li>After completing a year-long mindfulness training program,  p racticing Primary Care Phy...
Research Question <ul><li>What led to the observed changes in physician’s professional attitudes or perceptions of how the...
Methods <ul><li>A convenience sample of 70 PCP’s Participated in a year-long continuing education program in mindfulness t...
Methods <ul><li>20 randomly selected physicians were solicited by phone to be interviewed after  6 months of completing th...
Results Most Frequent Themes 1 – Being together in a community was most meaningful; having the chance to talk about the co...
Results – Thematic Clusters <ul><li>1 – Physicians expressed a compelling desire to re-establish a sense of community amon...
Theme One: A Compelling Desire to  Re-establish a Sense of Community <ul><li>“ The most meaningful part was being with oth...
Theme Two: A profound desire to improve personal and professional presence  <ul><li>“ One of the things that comes out of ...
Theme Three: Conflict between the desire for personal time and space and guilt in taking that time <ul><li>“ You’d leave h...
<ul><li>“ Medicine and my practice had become very stressful and it was getting extremely difficult to try and find ways t...
Conclusions <ul><li>1 –  Sharing personal experiences with colleagues is meaningful to physicians’ and addresses feelings ...
Implications <ul><li>The profound value physicians’ placed on community suggests that there is merit in creating a structu...
Next Research Questions <ul><li>As physicians embark on the Patient Centered Medical Home should consideration be given to...
<ul><li>Thank You! </li></ul><ul><li>Melissa Wendland </li></ul><ul><li>Rochester Individual Practice Association </li></u...
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Attending To Presence: Improving Physicians’ Interpersonal and Professional Well-Being through Mindfulness Training by Wendland, Mooney, Krasner, Beckman

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  • Thank you; I’m very excited to be here and share some of the work that we’ve done over the past couple of years. First I’d like to acknowledge and introduce our research team; Christopher Mooney and Dr. Michael Krasner could not be with us today; Christopher Mooney is the University of Rochester School of Medicine and Dentistry, and Dr. Michael Krasner is Associate Professor of Clinical Medicine at the University of Rochester. In the back, Dr. Howard Beckman many of you know as one of the Academy’s founding Fathers, he is the Medical Director of RIPA, Clinical Director of Medicine and Family Medicine at the University of Rochester. It’s truly a privilege for me to have the opportunity to be surrounded by such an accomplished group of professionals that I can learn from
  • The biopsychosocial approach to medical education and training is longstanding however integrating these skills into every day practice is not apparent. An alarming 60% of practicing primary care physicians report dissatisfaction describing emotional exhaustion, lack of a meaningful connection, a low sense of accomplishment where the joy of doctoring is lost and they feel very alone amidst the stressful, chaotic complexities and administrative burdens of clinical life.
  • Last week the JAMA published results about researcher conducted by Drs. Krasner, Beckman and colleagues about the effects of intensive training in mindful communication; reduce the psychological distress and burnout and promote a more patient centered orientation to care. Mindfulness speaks to improving the quality of attention, awareness is purposeful; making the conscious choice to be fully present, in the moment; having the ability to be open with a curious mind, observing attentively and non-judgmental. It includes the capacity for lowering ones own reactivity to challenging experiences with an enhanced ability to be aware of thoughts and feelings and acting with intentionality.
  • Guided experiential meditation exercises included the body scan; giving attention to sensations and their cognitive reactions without trying to change them, guided meditation – awareness of thoughts and feelings – all foster interpersonal self awareness, AI where physicians explored strategies in which they successfully worked with challenging clinical situations and identified personal qualities that promoted their success.
  • Over 75% reported that sharing personal experiences with colleagues….When asked about initial hopes and expectations upon registering, 20% explicitly stated their desire to share the curriculum with colleagues, and although the importance of sharing was not anticipated, those interviewed became acutely aware of the absence of meaningful peer interactions in their practice lives.
  • We took all of the themes that we heard and these were the most common
  • The most recent model in the redesigning practice and payment in health care is the PCMH is a model whereby the physician works within a team who have roles of soliciting, understanding and responding to the patients needs and ensuring appropriate services . EARLY STUDIES have shown this to be more complex than originally anticipated.
  • Attending To Presence: Improving Physicians’ Interpersonal and Professional Well-Being through Mindfulness Training by Wendland, Mooney, Krasner, Beckman

    1. 1. Attending To Presence: Improving Physicians’ Interpersonal and Professional Well-Being through Mindfulness Training Melissa Wendland, BS, Christopher Mooney, MA Michael Krasner, MD, FACP Howard Beckman, MD, FACP, FAACH ICCH -Miami October 3, 2009
    2. 2. Introduction <ul><li>Primary Care Physicians report widespread personal and professional dissatisfaction. </li></ul><ul><li>They describe feelings of : </li></ul><ul><ul><ul><ul><ul><li>Burnout </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Loss of Professional Meaning </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Isolation </li></ul></ul></ul></ul></ul>
    3. 3. Krasner, et al. Findings* <ul><li>After completing a year-long mindfulness training program, p racticing Primary Care Physicians’ self-reported statistically significant: </li></ul><ul><ul><ul><ul><ul><li>Decreased Levels of Burnout </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Increased Empathy </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Reduced Stress Levels </li></ul></ul></ul></ul></ul><ul><li>*JAMA, September 23/30, 2009-Vol 302, No.12 </li></ul>
    4. 4. Research Question <ul><li>What led to the observed changes in physician’s professional attitudes or perceptions of how they relate to themselves, their patients, colleagues, </li></ul><ul><li>family and others ? </li></ul>
    5. 5. Methods <ul><li>A convenience sample of 70 PCP’s Participated in a year-long continuing education program in mindfulness training : </li></ul><ul><li>8-weekly intensive 2 ½ hour session </li></ul><ul><li>monthly sessions for 10 months </li></ul><ul><li>one-day silent retreat </li></ul><ul><li>The program included Guided Meditation, Appreciative Inquiry and Narratives </li></ul>
    6. 6. Methods <ul><li>20 randomly selected physicians were solicited by phone to be interviewed after 6 months of completing the mindfulness program </li></ul><ul><li>A semi-structured interview of open-ended questions was used to seek experiences and perceptions </li></ul><ul><li>Interviews were audio taped and underwent individual and group review for thematic analysis </li></ul><ul><li>Reviews continued until saturation occurred </li></ul>
    7. 7. Results Most Frequent Themes 1 – Being together in a community was most meaningful; having the chance to talk about the complexities of practice with colleagues 16 2 – Appreciation for dedicated time to think, reflect and communicate 9 3 – Improved listening skills; without assuming the responsibility to fix something 8 4 – Extended silence was valuable in deepening self-awareness 8 5 – Becoming more self-aware improved communication with self and others 8 6 – Feeling less rushed and more focused and present in the moment 6 7 – Exploring own issues after the course concluded 6
    8. 8. Results – Thematic Clusters <ul><li>1 – Physicians expressed a compelling desire to re-establish a sense of community among peers </li></ul><ul><li>2 –Physicians expressed a profound desire to improve personal and professional attention and presence </li></ul><ul><li>3 – Physicians were troubled by the conflict between the desire for personal time and space and guilt in taking that time </li></ul>
    9. 9. Theme One: A Compelling Desire to Re-establish a Sense of Community <ul><li>“ The most meaningful part was being with other physicians, sharing and discussing some of our experiences and being able to have the immediate understanding of peers with respect to the struggles that we all have.” </li></ul><ul><li>“… Simply gathering, especially primary physicians who tend to be isolated in their practices; Gathering them together into a meeting place where they were invited to reflect more deeply; Just that is tremendous, and that it happened over a year’s time, I think, was very significant. It takes time for those stories to unfold. That seemed to me, a real engine for both developing community and fostering introspection.” </li></ul><ul><li>  </li></ul>
    10. 10. Theme Two: A profound desire to improve personal and professional presence <ul><li>“ One of the things that comes out of this too, is that when you establish a practice of thinking more honestly, thinking more clearly, speaking more honestly, that definitely leaks out into your work everyday...it certainly opens you up to being more ready with patients, colleagues, family, to have those kinds of conversations and to have that kind of a more intimate, more honest interaction with people and that certainly was the case for me that came out in the rest of my work...It certainly made it much more immediate and easy to do in {my} practice” </li></ul><ul><li>  </li></ul>
    11. 11. Theme Three: Conflict between the desire for personal time and space and guilt in taking that time <ul><li>“ You’d leave his course at night and you’d feel pretty good………..I felt this guilt about being there and not being at home, and my wife didn’t even make me feel guilty, it’s just me” </li></ul><ul><li>“ For that brief period of time, I felt more wholly me...it wasn’t about anybody else.” </li></ul><ul><li>“ The reality is that I was stepping back and just assessing my life, which is really probably what we doctors need to do” </li></ul><ul><li>  </li></ul><ul><li>“ It’s just helpful to have time to reflect and I tend to just go, go, go, and I don’t take a moment to pause. And when I have tried in the past to deliberately create those times I’m not, I do much better with a group.” </li></ul>
    12. 12. <ul><li>“ Medicine and my practice had become very stressful and it was getting extremely difficult to try and find ways to cope with the stress that didn’t either add more stress or was rarely successful at alleviating it. I felt like I was caught up in a negative circle of action and and reaction to what was going on in the office and a true sense of a loss of enjoyment of practicing medicine.” </li></ul>
    13. 13. Conclusions <ul><li>1 – Sharing personal experiences with colleagues is meaningful to physicians’ and addresses feelings of isolation </li></ul><ul><li>2 – Mindfulness skills training improve physicians’ perception of their ability to listen and respond more effectively </li></ul><ul><li>3 - There is a prevailing contradiction between physicians’ feeling isolated and guilt in taking time they need. </li></ul>
    14. 14. Implications <ul><li>The profound value physicians’ placed on community suggests that there is merit in creating a structured venue to share experiences and receive support and guidance from colleagues. In parallel, regularly scheduling time and space for personal reflection might increase physicians’ resilience or tolerance for change; adaptive reserve. </li></ul>
    15. 15. Next Research Questions <ul><li>As physicians embark on the Patient Centered Medical Home should consideration be given to improving adaptive reserve? </li></ul><ul><li>At what point might that be initiated? </li></ul>
    16. 16. <ul><li>Thank You! </li></ul><ul><li>Melissa Wendland </li></ul><ul><li>Rochester Individual Practice Association </li></ul><ul><li>[email_address] </li></ul><ul><li>(585)-242-2057 </li></ul>

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