Why Mindfulness in Medical School Is Not Just Hokey Self-care

Ramie Fathy

I read the description of the "Mindfulness and Mind-Body Medicine" course with a raised eyebrow, doubting that a 12-week course could actually help medical students manage stress, cope with challenge, improve patient care, and enhance relationships, as it promised.

To a senior medical student like myself, I thought this was probably just another instance of a school-sponsored wellness program that would ultimately be just another undertaking to balance along with coursework, rotations, research, and residency interviews.

My initial skepticism reflected the general medical student sentiment toward wellness programming at medical schools. These often-mandatory events typically reminded us that burnout is rampant in medicine and that we should start to meditate to pre-empt it. For medical students like myself, these events became something of a meme, as we joked about having to attend another wellness lecture that interrupted our study time.

But as we progressed through medical school, my peers and I bonded over our shared symptoms of what I ultimately began to refer to as "medical student overstimulation syndrome" (MSOS). As we adjusted to the heavy workloads of medical school, we struggled to find a healthy balance between school and life.

Watching recorded lectures at three times the playback speed left us with our minds buzzing and urged us to speed up our Netflix shows as well, detracting from our enjoyment in the process. Having our heads in our books or UWorld questions made it difficult to be present with each other when not studying and, at times, less able to empathize with our patients.

For me, at one point, studying all day interrupted my sleep in the form of endless anatomy review with completely made-up body parts ("the beamur is connected to the caligula is connected to the stenogus"), which was simultaneously frustrating and exhausting.

With this in mind, when the mindfulness course invitation arrived in my email inbox, I figured it might be worth a shot to spend some time during my fourth year exploring mindfulness practice and seeing if it could help offset the symptoms of MSOS. I figured that, at the very least, it would allow me to better understand and connect with my future patients who engaged in mindfulness practice.

Over the course of the 12-week mindfulness elective, I found that regularly practicing short daily exercises provides much more than just relief from the stressors of being a medical student. It offers a range of personal, interpersonal, and clinical benefits. Ultimately, I was left feeling that mindfulness courses are an ideal option for medical schools that aim to produce graduates who are resistant to burnout; capable of deep, close connections to their patients; and aware of how nontraditional interventions can supplement typical clinical therapies.

Benefits of Mindfulness

Many of the personal benefits of mindfulness practice are what make it an antidote of sorts to MSOS. Within a few weeks of beginning our daily 15- to 40-minute exercises in which we primarily focus on our breath, my classmates and I perceived improvements in our abilities to maintain focus and avoid becoming distracted.

Halfway through the course, we'd noticed that we were able to be more present in the moment and that we were less stressed and reactive to situations that might usually upset us. These outcomes were in line with those predicted by our course readings, Fully Present and Full Catastrophe Living, as well as with the latest research on the impacts of mindfulness.

In addition to these improvements in our personal lives, we shared a common reflection: We wished we'd discovered mindfulness earlier, and we were grateful that we had the chance to begin to explore the practice in medical school.

Mindfulness practice can also enhance interpersonal relationships and interactions, including those with our patients. Because the practitioner grows better able to remain present in the moment — a key aspect of the focus on the breath — they are also more likely to focus on conversation partners and their emotional state.

Indeed, people who engage in mindfulness practice, including my classmates, often report that they become better listeners, develop deeper relationships, and grow more patient and empathetic.

In the clinical setting, these skills can allow healthcare providers to be more receptive to how their patients are coping with their diagnosis, how they react to different parts of the clinical encounter, and what their personal treatment goals may be. At the same time, because mindfulness practitioners are more attuned to their own thoughts and reactions while interacting with others, they are often better able to learn about themselves through these interactions.

Over the past several decades, research on mindfulness has skyrocketed, with more than 1000 articles published in the past 40 years. Many of the articles investigated the potential applications of mindfulness in medicine. Some studied clinical benefits such as reduced stress, anxiety, or depression, decreased pain, enhanced decision-making ability, and increased motivation for lifestyle changes. The latter includes those related to diet, exercise, or smoking cessation, and, possibly, alterations in neurobiological pathways such as the autonomic nervous system and the immune system.

Need for More Mindfulness Classes

Mindfulness practice represents a tool to introduce some space into one's life for greater reflection, healthier emotions, more meaningful experiences, and deeper relationships, and it has a lot to offer to medical students who may be struggling to adjust to the demands of medical school.

Medical schools should feel greatly incentivized to incorporate such programs into their curriculum as optional electives or informal extracurricular activities. However, it's also worth noting that mindfulness programs don't have to be school-organized, as student-led initiatives have also proven successful.

Given the ongoing pandemic, much of my mindfulness course had to be conducted virtually, but it was still surprisingly effective and engaging. As a result, there may be a great opportunity for a coordinated, student-run, cross-institutional mindfulness program that is offered fully virtually, and which also could facilitate connections between medical schools and future research on the topic of mindfulness.

Students who are interested in learning more about mindfulness practices could pick up a copy of Full Catastrophe Living, which supplements discussions of the individual experience and benefits of mindfulness with reviews of the scientific literature supporting those claims. Alternatively, those on-the-go could tune in to Dan Harris' Ten Percent Happier podcast.

For those who may not have a formal program available at their medical school but who want to begin a mindfulness practice, there are a number of options available, many of which are discounted for healthcare workers. For one, a Headspace subscription is free with an American Medical Association membership, while access to Down Dog's meditation app is currently free for healthcare workers.

It may not be easy when first starting out with mindfulness practice; our wandering minds can feel like we're trying to rein in an unruly animal just when trying to stay focused on the breath. But with patience and regular practice, you too may find that mindfulness really can produce beneficial results.

Ramie Fathy is a fourth-year medical student at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

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