Research ArticleOriginal Research

Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study

Luke Fortney, Charlene Luchterhand, Larissa Zakletskaia, Aleksandra Zgierska and David Rakel
The Annals of Family Medicine September 2013, 11 (5) 412-420; DOI: https://doi.org/10.1370/afm.1511

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Baseline Maslach Burnout Inventory (MBI) subscale mean scores for study sample (N = 30) compared with the MBI normative sample (N = 11,067).

    Notes: The MBI normative sample consists of the following occupational subgroups: teaching (K-12) subgroup is composed of 4,163 teachers of kindergarten through grade 12; postsecondary education subgroup is composed of 635 college and professional school educators; social services subgroup is composed of 1,538 social workers and child protective services workers; medicine subgroup is composed of 1,104 physicians and nurses; mental health subgroup is composed of 730 psychologists, psychotherapists, counselors, mental hospital staff, and psychiatrists; “other” subgroup is composed of 2,897 legal aid employees, attorneys, police officers, probation officers, ministers, librarians, and agency administrators.14

  • Figure 2
    Figure 2
    Figure 2
    Figure 2

    Means for the outcome measures assessed at baseline and postintervention (N = 30 at baseline).

Tables

  • Table 1

    Comparison of Modified MBSR Training With Typical MBSR Course

    FeatureModified MBSR TrainingTypical MBSR Course
    Length18 hours29–33 hours
    Training scheduleFriday evening: 3 hours
    Saturday: 7 hours
    Sunday: 4 hours
    Follow-up sessions: two 2-hour evening sessions    		Introduction: 2.5 hours
    Eight weekly sessions lasting 2.5–3 hours each
    Day of mindfulness lasting 6.5 hours
    ContentTraining in mindfulness practices (sitting, movement, speaking, listening, and compassion for self and others) and their application to practicing medicine and everyday lifeTraining in mindfulness practices (sitting, movement, speaking, listening, and compassion for self and others) and their application to everyday life
    Length of encouraged mindfulness practice10–20 minutes daily≥45 minutes daily
    ParticipantsPrimary care clinicians working ≥50% time in direct care of patientsGeneral public (may include clinicians)
    Class size158–17
    InstructorsInstructors from the UW-Health Mindfulness Program
    MD Family/Integrative Medicine faculty physicians    		Instructors from the UW-Health Mindfulness Program
    Resources providedAudio CDs for practice (Fourteen Essential Practices by S. Salzburg)
    Mindfulness Web site designed specifically for this study (www.fammed.wisc.edu/mindfulness)    		Audio CDs for practice (Guided Mindfulness Meditation, Series 1 and 2) and Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by J. Kabat-Zinn, PhD
    Cost to participantsNone$475 at time of study with scholarships or partial rebates available from some insurers

    • CD=compact disc; MD=medical doctor; MBSR=mindfulness-based-stress-reduction; UW=University of Wisconsin.

  • Table 2

    Participants’ Characteristics at Baseline (N = 30)

    CharacteristicTotal, No. (%)(N=30)Women, No. (%)(n=18)Men, No. (%)(n=12)P Value
    Ethnicity, No. (%).21
     Hispanic1 (3)0 (0)1 (8)
     White29 (97)18 (100)11 (92)
    Age
     Mean (SD), y40.5 (10.1)36.9 (7.2)45.9 (11.6).02
     Minimum272728
     Maximum635463
    Years in clinical practice
     Mean (SD)9.8 (10.5)6.7 (7.0)14.3 (13.2).09
     Minimum000
     Maximum332533
    Profession, No. (%).84
     Nurse practitioner1 (3)1 (6)0 (0)
     Physician assistant3 (10)2 (10)1 (8)
     Physician26 (87)15 (83)11 (92)
    Specialty, No. (%).14
     Family medicine26 (87)17 (94)9 (75)
     Internal medicine1 (3)0 (0)1 (8)
     Pediatrics2 (7)0 (0)2 (17)
     Other1 (3)1 (6)0 (0)
    Percentage of work time in clinical practice.50
     50%6 (20)4 (22)2 (17)
     51%–99%19 (63)10 (56)9 (75)
     100%5 (17)4 (22)1 (8)
    Percentage of work time in activities other than clinical practice (eg, teaching/research), No. (%).18
     None8 (27)7 (39)1 (8)
     15%–49%18 (60)9 (50)9 (75)
     ≥50%4 (13)2 (11)2 (17)
    Practice location, No. (%).51
     Rural2 (7)1 (5)1 (9)
     Suburban7 (23)3 (17)4 (33)
     Urban21 (70)14 (78)7 (58)
    Reasons for study participation,a No. (%)
     Health enhancement27 (90)17 (94)10 (83).32
     Disease management3 (10)2 (11)1 (8).80
     Spiritual growth20 (67)13 (72)7 (58).43
     Job satisfaction21 (70)13 (72)8 (67).75
     Curiosity15 (50)9 (50)6 (50)1.00
     Mindfulness/meditation training or refresher19 (63)12 (67)7 (58).64
     Recommended2 (7)0 (0)2 (17).07
     Other0 (0)0 (0)0 (0)–
    UW Mindfulness training in the past, No. (%).23
     Yes2 (7)2 (11)0 (0)
     No28 (93)16 (89)12 (100)
    Other meditation classes or retreats in past, No. (%).77
     Yes14 (47)8 (44)6 (50)
     No16 (53)10 (56)6 (50)
    Current regular contemplative/meditation practice of any variety, No. (%).77
     Yes2 (7)1 (6)1 (8)
     No28 (93)17 (94)11 (92)

    • UW=University of Wisconsin.

    • Note: P values are for comparison of women vs men, and were calculated with the t test (for age and years in clinical practice) or the χ2 test (for all other variables).

    • ↵a Multiple responses were allowed.

  • Table 3

    Outcomes Scores at Each Survey With Comparison to Baseline (N = 30)

    Subscale (Possible Range)Time PointaChange,b Mean Difference (95% CI)
    Baseline (N=30)1 Day (n=28)8 Weeks (n=23)9 Months (n=23)
    MBI Emotional Exhaustion (0–54)c31.9 (28.4–35.4)28.9 (25.3–32.5)26.4 (22.6–30.1)26.0 (22.2–29.8)−5.90 (−10.29 to −1.52)
    –[.046][.006][.009]
    MBI Depersonalization (0–30)c12.6 (10.4–14.8)11.2 (9.0–13.5)10.3 (8.0–12.7)9.1 (6.8–11.5)−3.51 (−5.91 to −1.11)
    –[.07][.03][.005]
    MBI Personal Accomplishment (0–48)c38.5 (36.8–40.3)41.0 (39.2–42.8)41.6 (39.7–43.5)42.3 (40.4–44.2)3.76 (1.70 to 5.82)
    –[<.001][<.001][<.001]
    DASS-21 Depression (0–21)7.6 (5.7–9.5)4.8 (2.9–6.8)3.8 (1.8–5.8)3.4 (1.3–5.5)−4.16 (−6.56 to −1.77)
    –[<.001][<.001][.001]
    DASS-21 Anxiety (0–21)4.4 (3.2–5.6)2.9 (1.6–4.1)2.8 (1.5–4.1)1.9 (0.5–3.3)−2.51 (−4.27 to −0.76)
    –[.02][.052][.006]
    DASS-21 Stress (0–21)14.2 (11.8–16.6)12.2 (9.7–14.7)10.1 (7.5–12.7)9.0 (6.3–11.7)−5.20 (−8.47 to −1.92)
    –[.09][.007][.002]
    PSS (0–40)19.0 (16.9–21.0)16.0 (13.9–18.2)14.1 (11.9–16.4)14.7 (12.4–17.0)−4.29 (−6.91 to −1.67)
    –[.001][<.001][.002]
    RS-14 (14–98)79.9 (75.2–84.6)82.0 (77.1–86.8)83.2 (78.1–88.4)81.4 (76.2–86.6)1.51 (−4.79 to 7.81)
    –[.35][.26][.63]
    SCBC (5–35)27.6 (25.9–29.3)27.4 (25.6–29.1)27.9 (26.1–29.6)28.3 (26.5–30.1)0.67 (−1.06 to 2.39)
    –[.59][.77][.44]

    • MBI = Maslach Burnout Inventory; DASS-21 = Depression Anxiety Stress Scales-21; PSS = Perceived Stress Scale; RS-14 = 14-item Resilience Scale; SCBC = Santa Clara Brief Compassion Scale.

    • Notes: On the MBI, higher scores on the Emotional Exhaustion and Depersonalization subscales, and lower scores on the Personal Accomplishment subscale indicate greater burnout. On the DASS-21 subscales, higher scores indicate greater levels of that emotional state. On the PSS, higher scores indicate greater perceived stress. On the RS-14, higher scores indicating greater resilience. On the SCBC, higher scores indicate greater compassion. P values compare values at each time point with the baseline values.

    • ↵a Values shown are mean score (95% CI) [P value]. P values were calculated with the linear mixed effects models and denote the significance of β coefficients.

    • ↵b Change from baseline to 9 months.

    • ↵c Based on a normative sample of medical professionals, the cutoff points for a high range of experienced burnout is a score of greater than 26 on the Emotional Exhaustion subscale, a score of greater than 9 on the Depersonalization subscale, and a score of less than 34 on the Personal Accomplishment subscale.

Additional Files

  • The Article in Brief

    Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study

    Luke Fortney , and colleagues

    Background Physician burnout, as well as low job satisfaction, and its negative influence on patient care are pervasive problems. This study evaluates whether a short mindfulness training program can increase job satisfaction, quality of life, and compassion among 30 primary care clinicians.

    What This Study Found Participating in a brief mindfulness course consisting of a weekend immersion and 2 short follow-up evening sessions was associated with reduction in indicators of job burnout, depression, anxiety, and stress on 3 follow-up surveys at 1 day, 2 months, and 9 months postintervention. Specifically, at 9 months postintervention, participants had significantly better scores on all Maslach Burnout Inventory subscales, emotional exhaustion, depersonalization, and personal accomplishment, as well as on the depression, anxiety, and stress subscales of the Depression Anxiety Stress Scales-21 and perceived stress assessed with the Perceived Stress Scale.

    Implications

    • The effect was maintained over 9 months without formal intervention booster sessions, which suggests that even limited initial training may be enough to teach fundamental mindfulness practices.
    • Mindfulness training appears to be a low-cost, time-efficient tool to help support clinician health and well-being, which may have implications for patient care. The authors call for a randomized controlled trial to confirm these results.
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