Article Figures & Tables
Figures
- Figure 1:
Thematic map of key themes and subthemes.
Tables
Session Topic Content 1 Orientation and foundations for practice Administration (including consent forms)
Opening practice
Lecture: introduction to mindfulness/foundations of practice (including brief history of Applied Mindfulness and the Four Noble Truths)
Mindful eating
Practice: attending to bell/breath
Discussion
Take home activities: Practice: awareness of breath | Concept: journal/reflection on impact of “judgmental internal mental discourses”2 Identifying and transforming habits Opening practice
Take home activity check-in: discuss application between sessions
Lecture: habit energies
Mindful eating
Practice: mindful walking activity
Discussion
Take home activity: Practice: mindful walking | Concept: identify/examine strong “habit energies” (e.g., how do habit energies show up skillfully/unskillfully in daily life?)3 Nourishing our mind Opening practice
Take home activity check-in: discuss application between sessions
Lecture: the 4 nutriments and store consciousness
Mindful eating
Practice: body awareness practice
Discussion
Take home activity: Practice: mindful eating | Concept: identify/examine “store consciousness” (e.g., what “seeds” are watered based on daily activities/interactions)4 Skillful communication Opening practice
Take home activity check-in: discuss application between sessions
Lecture: interbeing (interconnection), empathy fatigue versus compassion
Mindful eating
Practice: loving kindness/kind intention
Discussion
Take home activity: application in daily life project/worksheet (integration assignment reviewing all practices/concepts from across the training)5 Integration and application Opening practice
Take home activity check-in: discuss application between sessions
Lecture: well-being/happiness as products of practice (eightfold path + program review)
Mindful eating
Practice: tea/coffee meditation and closing ceremony (presentations of take-home application projects from session 4)
Discussion
Closing circle/intention setting- Table 2:
Representative quotations showing the Applied Mindfulness Program for Medical Personnel was well received by participants
Participant Quotation Anesthesiology 36-year medical practice “I had a very positive experience. I think from pretty much the beginning session up until the end, I think it was a very comfortable, welcoming atmosphere. Kind of a safe space, and it was made very clear early on, so, it was very easy to just kind of lean into it.” Ophthalmology 5-year medical practice “I had been introduced to mindfulness before, but it was more mindfulness meditation and it was very structured. I learned many ways to integrate mindfulness more regularly into my routine, so things that I am doing anyway, like, walking or eating … I had kind of thought about that before, but never really tried it. So, I thought that was great. Those were my main takeaways.” Sports medicine 12-year medical practice “It was very content rich … I was wondering how much can you pack into 5 weeks and really pleasantly surprised at the quality of the content — it also broke things down into very manageable practices. I really felt like people left feeling like, yes, I can incorporate this from the get-go, from even from the first session.” Family medicine 8-year medical practice “The program was empowering, in that seeing other physicians who were dealing with anxiety and burnout and seeing that through meditation, I think, all of us were developing some skills to help with that stuff. It was an empowering experience.” - Table 3:
Theme 1: Mindfulness encourages behavioural and cognitive change that facilitates well-being
Subtheme Participant Quotation Subtheme 1: Leaving work at work Rheumatology 25-year medical practice “I end up at the end of the day with a happier day and that means I come home happier. I don’t bring back all of the frustration and stuff that was happening through the day.” Ophthalmology 5-year medical practice “I tried usually at the beginning of the day and at the end of the day, as I left work, to just take a few moments of quiet as I was walking or driving or taking the subway. I found that really nice just to set an intention for the day and then reset after a long day … and I felt more energized and had more clarity to do stuff that I had to do later on.” Subtheme 2: Permission to not rush Ophthalmology 5-year medical practice “There are many times in the day where the panic button can go off and then when you just take a breath for yourself you just tell yourself that everything is okay and it’s going to be fine, and then you take it from there again. You rework your thoughts and you mentally organize things in that moment and then you can start again. And then I think you are less anxious, or you are less worried, or you don’t panic as much.” Cardiology 14-year medical practice “The [mindful] walking was good because every day I walk from my office to another office for a meeting, or I walk to the clinic to see the patients … so instead of walking and thinking ‘what do I have to do next’, or ‘my day looks crazy’, I decided to just walk and think about the walking. When I was getting to the meeting or to the patient, I was more relaxed and more present in a way … not feeling this sort of frenetic energy, just feeling, more calm confident stance than wound up.” Emergency medicine 15-year medical practice “There will be 3 different hospitals on hold to talk to me, I’ll have 5 learners waiting individually to talk about different patients, the charge nurse, the bridge call comes in, there is literally one of me and 20 different things that all are a right now thing … but I can take a deep breath and just remember that I can only do what I can do and me freaking out and yelling at people being like, ‘can you just leave me alone’ [is] not going to help.” Subtheme 3: Being kinder toward oneself Ophthalmology 33-year medical practice “I think I am more forgiving with myself, with my patients. I don’t feel I have to give everything to every patient the way I had in the past … part of being mindful is recognizing that and instead of allowing that to go nurture the seed of compassion. Allowing [and] expressing that you feel bad that the patient feels that way, but not allowing them to consume you.” Psychiatry 20-year medical practice “I think the other part was that it is so important for my own mental health and well-being that I prioritize this given that the amount (of) stress, there is always going to be something to do and somewhere to go, but what’s critically important is that I am here and taking care of myself.” Subtheme Participant Quotation Subtheme 1: Enhanced self-awareness during challenging patient and colleague interactions Psychiatry 13-year medical practice “I think in patients and [with] irritability it’s a two-way street. Maybe they’re [the patient] doing something that bugs me, but it’s probably also where I’m at that’s overreacting. So, I feel that that awareness lets me step out of it.” Emergency medicine 32-year medical practice “ … it’s just someone who might be highly anxious and doesn’t know how to deal with things in that situation. Mindfulness helps with that I think, being able to remember to empathize and that your reactions are sometimes these learned defense mechanisms and that instead of just going through the motion you pause and remember that and I think that, well I would hope that helped in the long-term with stress and burnout.” Psychiatry 20-year medical practice “A couple of colleagues in the room were challenging, but one [leader] in particular …wanted to put the workload onto my team … and I remember feeling like I felt compassion towards her … usually that would’ve fired me up where I can’t really think straight … but I think with being able to remain sort of calm and grounded and just be aware [that] this is a difficult time and people are stressed out and how do we work towards solutions for the greater good?” Subtheme 2: Decreased reactivity during challenging patient and colleague interactions Emergency medicine 3-year medical practice “Difficult patients are ones that you might tell them one thing and they disagree with you and they just tell you, this is what I want … . And sometimes you end up getting in arguments with them … I think it’s mindfulness in general, being aware of what’s happening … . I think normally it will just escalate but then I think in many cases now I will try to kind of step away and approach it in a more empathetic way.” Surgery 15-year medical practice “You come back to your mindfulness breathing and it helps you to cope with almost every situation. Like, you have that interaction with a patient. You can immediately react or you can just pause … and you take a breath and you do it twice and then it gives you some time to think. And then if you’re relaxed, it gives you immediately the way to react differently, better.” Emergency medicine 7-year medical practice “… just being relaxed and in that [mindful] mode it enabled people I think to just deal with those frustrations or some of those pent-up feelings and get it out, which is sometimes the most important thing because if you’re not doing that then you’re just, expressing it in other ways like being angry with a co-worker or a patient.” Emergency medicine 15-year medical practice “I feel like there is a lot of negativity that doesn’t come out of my face as a result [of mindfulness]. It’s not like I’m bottling … instead, it’s like dissipating. So, I don’t need to be that person that is the telephone for the negative starting, because someone cut me off in traffic and then I bring it with me and then it goes through like 10 different people because we all are just being unkind to each other. If I just take that mindful moment when it’s happening … as a result I am not coming [into work] in that bad mood.” Subtheme 3: Increased presence and focus during patient interactions Ophthalmology 5-year medical practice “With patients I think I try to listen more. I try to not worry too much about how many patients I have to see, because when I am down in the clinic, when you are really busy and there are a lot of patients to see, you just want to get it done with so that you can go and see the next one, so your mind is actually on the next patient when you’re actually seeing this one.” Surgery 40-year medical practice “Going from one patient to the next I [now] take time to breathe so that I am able to start over and give my full to the next patient that I am going to meet and, it just helps so I don’t have any residue or any effects of the previous interaction lingering on and I can start afresh with a fresh patient.” Anesthesiology 14.5-year medical practice “… anesthesia is one of the fields where it’s important that you remain calm and composed because mostly things are small, but when something happens you have to act in a matter of seconds. So this has helped me become more calm, composed and more, I am focusing on the case better and if some complication happens I am focusing on that better … .” Subtheme 4: Increased perspective taking and awareness of personal biases Ophthalmology 5-year medical practice “I think because you listen more and you don’t already make decisions in your head before you’ve actually heard them [the patient] out … sometimes you have already made a diagnosis up in your head and you are already ready with what you want to write down on the chart before even seeing the patient … so I try to do that more now rather than the other way around.” Cardiology 14-year medical practice “I changed my listening in a way — when the patients talk to you sometimes, when you’re in a busy clinic, you look for keywords because the key words are going to help you make the diagnosis and decide the best way of action. And sometimes you become kind of a machine … and then you rely on those keywords because those are what they train you for and it’s very important for you. And I think that’s a good skill to have. At the same time, you miss a little bit of the human interaction.” Ophthalmology 24-year medical practice “I did try and think of the patients as people if that makes sense. It does happen more than it used to. So, that’s been very, that’s been very helpful … you can become very mechanical, you can treat a patient, but your mind doesn’t have to be there. It’s not a very nice thing … so, I think it [mindfulness] brought me back and probably being more compassionate, which would then make me a better kind of doctor, a whole doctor.” Gynecology 36-year medical practice “The main difference for me is, I try to acknowledge and consider better the people that are around me, this whole thing that we were telling about listening before speaking, making space for others — this I try to do.” Psychiatry 20-year medical practice “One of the leaders who I’ve had serious challenges with, with all the cuts that have been made, who I’ve had very difficult interactions with, I was able to be sort of compassionate towards her … I think I was able to even sort of say at the end to the person who I have significant difficulty with, that was a really good meeting, I appreciate that. And, you know, I felt it came from a genuine place and I felt good about saying that.”
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