A Multicenter Study of Physician Mindfulness and Health Care Quality

The recent papers by Fortney et al. and Beach et al. (1, 2) are at the vanguard of what many believe is a major educational direction for this century: training learners in personal awareness. In developing a comprehensive, behaviorally-defined patient-centered interview, our group recognized that simply teaching these skills was not always effective. Learners who knew the skills sometimes did not use them. We discovered why: they were not aware of negative reactions they had towards the patient and/or the dictates of patient-centered interviewing (3). We then demonstrated that progress in awareness of one's negative reactions was associated with improved learning of patient-centered interviewing (4), consistent with the findings of Beach et al. We continue to integrate personal awareness training with skills training (5). The teacher identifies negative emotions and behaviors at each observed interaction, and then works to help the learner change them (via increased awareness and practicing new, more suitable behaviors). But, this takes many sessions and direct observation.

In working extensively with Jon Kabat-Zinn, I became impressed that mindfulness was a powerful tool for developing personal awareness in doctors, and something they could do on their own, perhaps after a little training. We have incorporated mindfulness work into our training in patient-centered skills and personal awareness, and residents from many different cultures have almost universally liked it when presented in a secular way (non-religious; non-spiritual).

Systematic methods for mindfulness training exist, but it is not clear yet how training is best conducted; e.g., personal teacher of an individual or group; didactic exposition; from a CD or audiotape. Research would surely use the seminal work of Kabat-Zinn as a point of departure. As Fortney et al. indicate, another major task is studying mindfulness with rigorous research designs. We should also define what is educationally significant to the learner and their patient interactions -- not just statistical significance.

Now that Interviewing 101 courses in patient-centered communication are well-established, we can focus more on personal awareness. Systematically teaching mindfulness is likely to be a central element in Interviewing 202 courses. The field is moving ahead -- thanks to the basic work by these authors and others.

REFERENCES
1. Fortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., and Rakel, D. 2013. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med 11:412-420.
2. Beach, M.C., Roter, D., Korthuis, P.T., Epstein, R.M., Sharp, V., Ratanawongsa, N., Cohn, J., Eggly, S., Sankar, A., Moore, R.D., et al. 2013. A multicenter study of physician mindfulness and health care quality. Ann Fam Med 11:421-428.
3. Smith, R.C. 1984. Teaching interviewing skills to medical students: the issue of 'countertransference'. Journal of Medical Education 59:582-588.
4. Smith, R.C., Dorsey, A.M., Lyles, J.S., and Frankel, R.M. 1999. Teaching self-awareness enhances learning about patient-centered interviewing. Academic Medicine 74:1242-1248.
5. Smith, R.C., Dwamena, F.C., and Fortin, V.I.A. 2005. Teaching personal awareness. J. Gen. Intern. Med. 20:201-207.

Competing interests: None declared