Mindfulness in Medical Schools

Mindfulness is currently taught in some medical schools as part of the curriculum, some as an elective, and at others not at all. Mindfulness has increased in popularity over the past decade, particularly in the corporate world. Just like anything else that enters the mainstream, it polarises people. It seems to create a visceral reaction for some people, like someone coming up to you and saying “namaste”, strangling you with meditation necklaces, spraying crystal-infused mist in your face, and force feeding you activated almonds.

There are a lot of misunderstandings when it comes to mindfulness. It is not synonymous with yoga or meditation, although both practices can enable mindfulness. I have personally participated in many yoga classes without thinking at all about what I was doing. Partly it may have been me thinking about other things, partly the teacher may not have encouraged us to focus on our breath and movements. Mindfulness is about being in the present moment. There are many techniques that allow us to get there, for example progressive muscle relaxation, or body scanning, which are both part of mindfulness based stress reduction. I learnt these skills when I was in high school, and still find them useful now.

As well as reducing stress, mindfulness also has other benefits such as increasing concentration, productivity, and general enjoyment of life. By being more present, it can also mean that you give people more of your attention, therefore enhancing interpersonal interactions and relationships. It can also have physical health benefits such as lowering blood pressure and improving sleep. Overall, this means that individuals can really relish the activities that bring joy to their lives, achieve more from their daily tasks (whether work-related or not), and are able to come down more quickly from states of discomfort or distress.

What upsets people when mindfulness comes up in the context of a toxic workplace such as a hospital, is that they think this blame-shifts to the individual. Teaching mindfulness or resilience is not about putting any blame on the individual. Mindfulness and resilience are both life skills that benefit people, but it does not remove responsibility from institutions. It is still necessary for hospitals to ensure that employees are working safe hours, and in a safe environment.

Teaching mindfulness is not an easy task – what do you teach? How do you teach it? Who teaches it? These are all valid questions. One thing that must be made clear is that we are not giving students therapy. Yes, mindfulness is a component of psychotherapy models such as cognitive behavioural therapy, dialectical behavioural therapy and acceptance and commitment therapy. However, when teaching mindfulness to students it is not taught with the intent of giving them therapy – this is inappropriate because people have different therapeutic needs. There were some concerns that teaching mindfulness may trigger some students and that we have to be sensitive to those who may have a background of psychiatric illnesses, (complex) trauma, or other bad past experiences.

The proposal of teaching mindfulness at universities has not been about intervention, but about equipping students with skills that can enhance their quality of life and sense of wellbeing. This is something that I want to make clear. Mindfulness can be as simple as planning and eating a meal. In times of stress, I have shoved down two packets of double coated Tim Tams in one go, one biscuit after the other. This is an example of not being mindful. Mindful cooking and eating is something that I have been exposed to since childhood because it’s part of the Japanese culture.

It starts with planning a meal. You bring awareness to what you want out of your meal – flavours, nutrients, proportion – setting your intention. The cooking process can be a joy to the senses. The sound of chopping something crunchy, appreciating the colours of your different ingredients, smelling the aromas, and taste-testing it to make sure you got the salt/sweet/sour balance just right. When it comes to eating, it’s important not to do other things at the same time, like watching TV. In Japan, we take pride in how we present food – it is as much a visual feast as it is a gastronomical one. We take in all the colours on the plate, eat small amounts at a time, and really savour the flavours. By eating slowly and enjoying your meal, you are also less likely to overeat.

Other examples of mindfulness might be lying down on a rug and mindfully listening to music with a scented candle lit – you may notice how soft the rug feels on your back, perhaps you notice the different instruments and notes in the music, and how lovely the candle smells. As such, there are ways in which mindfulness can enter daily life in a benign way without having it thrown in your face like a bunch of yogis chanting “om” around you and making you feel awkward.

As well as increased enjoyment of activities, relaxation, and increased productivity, mindfulness also makes us more self-aware and in-tune with our bodies. This can be an important skill in preventing psychological distress. Early intervention is key. The more self-aware individuals are, the quicker they will notice if they are on the road to burn out, for example. Again, it is not saying that it is solely the individual’s responsibility to do something about it, but it may encourage that person to consider environmental factors, and then talk to his or her senior colleagues or administration. It is then the responsibility of the organisation to respond to the individual’s concerns and ensure that he or she is working in safe, humane conditions.

As to whether it should be part of the curriculum or offered as an elective is another argument. I’d like to say, “don’t knock it till you’ve tried it.” If you offer mindfulness as an elective, the likelihood is that those who already know the benefits of mindfulness and enjoy practising it will be enthused to attend, whilst people who don’t know about it or have a negative impression of it may miss out on skills that they may benefit from. I would therefore argue that it should be introduced to all students. Whether they then decide to employ the techniques taught in their everyday lives is up to the individual student. However, we have an obligation to educate students about ways in which they can improve their wellbeing.

Building healthy habits can be hard, especially when we lead busy lives. By exposing students to mindfulness techniques, it can encourage them to incorporate it into their lives early in their careers. How do we make something a routine? By doing it frequently, and making it a habit. Thus my suggestion would be to integrate the teaching throughout the duration of medical school rather than as a condensed course. By re-introducing mindfulness to students each term, it reminds them of the importance and benefits of mindfulness throughout their medical education. Whilst I consider myself to be fairly mindful nowadays, I still need reminders. Habit trackers can be useful, either as part of a bullet journal or in an app. It may also benefit students to reflect on what techniques worked or didn’t work for them – perhaps by chatting about it with a mentor or keeping a diary/log – which can then help him or her create an individualised routine that utilises the techniques that they prefer.

Mindfulness is just one of the many ways in which we can lead healthier lifestyles. It would make sense to teach mindfulness techniques as part of an overall wellness program, which also teaches students about nutrition, exercise, sleep hygiene, and other self-care strategies. After all, how can we look after patients if we can’t look after ourselves?

To summarise my thoughts, as well as some of the discussions I’ve had about mindfulness on Twitter (I am new to Twitter, using account name @mindbodymiko):

• Mindfulness is not just about yoga and meditation
• There are many ways in which mindfulness can be practised
• It may be useful to teach mindfulness as part of an overall wellbeing program (including nutrition, exercise, sleep)
• The benefits of mindfulness include: increased concentration, self-awareness, productivity, enjoyment of activities, improved interpersonal interactions and relationships, stress reduction, and maintenance of good physical and psychological health
• Mindfulness should be taught as part of the medical curriculum to educate students on what it is, its benefits, and how it can be incorporated into daily life
• To receive the full benefits of mindfulness, it should ideally be practised frequently. Therefore, it may be more useful to teach it longitudinally rather than via a single, condensed course
• Monitoring and evaluating the usefulness and effectiveness of a particular technique for each person is helpful in creating an individualised routine that suits him or her
• Mindfulness is a useful life skill
• Whilst mindfulness may reduce burnout, it does not place the responsibility on the individual to prevent it from happening
• Burnout prevention is an institutional responsibility – teaching mindfulness does not remove the necessity to ensure that employees have safe working conditions (including rostering)

Take care,

Miko xx