1. MINDFULNESS and REFLECTIVE NARRATIVE
Workshop for 3rd Yr. Medical Students
Department of Family Medicine
Millaray Sanchez-Campos MD, CCFP, FCFP
Lynn Bloom, MSW RSW
Contributors: Dr. C. Gonsalves and Dr. H. MacLean
Acknowledgements: Donna Williams
Watch link to begin presentation:

3. WORKSHOP OBJECTIVES Learning self-awareness Improving communication
Learning self-awareness
Improving communication
Learning how to build resilience
“To cure sometimes, To relieve often, To comfort always”
Hippocrates
“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your mind”
Sir William Osler

4. “The practice of medicine is an art, not
a trade; a calling, not a business; a calling in which your heart will be exercised equally with your mind”
Sir William Osler
“To cure sometimes,
To relieve often,
To comfort always”
Hippocrates

5. MEDICINE, THE FACTS Physician Distress
Burnout in 47% of specialists and GP
Medicine associated with burnout, depression, anxiety, substance abuse, divorce and broken relationships
1. Shanafelt et al. Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172 (18):
2. Shanafelt et al. The Well-Being of Physicians. The American Journal of Medicine. 2003;114:

6. PHYSICIAN SUICIDE
Of all the occupations, physicians nearly at the top of all occupations with the highest risk of death.
The results of depression and other mental illness. Physicians are reluctant to ask for help and to take into their own advice.
Same rate or higher than average population, 12% for males, 19.5% for females.
Higher in students and residents 15-30%
Same in female and males.

7. BURNOUT AND MEDICAL ERRORS
Of 7905 American College Surgeons, 700 (8.9%) reported concern they had made a major error in last three months
Over 70% attributed error to individual factors
Error reporting had statistically significant adverse relationship with mental quality of life
Burnout and depression were independent predictors of reporting a recent major medical error
Shanafelt et al; Burnout and Medical Errors among American Surgeons. Ann. Sur 2009;XXX:

8. BURNOUT AND SELF-REPORTED CARE IN AN INTERNAL MEDICINE RESIDENCY PROGRAM
Of 115 (76%) responding residents, 87 (76%) met the criteria for burnout (Maslach burnout inv.)
Burnout residents were significantly more likely to self report suboptimal patient care at least monthly (53% vs. 21%; p=0.004).
Shanafelt et al. Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program. Ann Inter Med. 2002; 136:
Burnout: Depersonalization, cinicism, lack of professional accomplishment

9. Physician Wellness/Burnout
Shanafelt et al. 2009; Wallace JE, LemaireJB, Ghali WA. Physician
Wellness. Lancet 2009; Physician Burnout, 2014 CMAJ

10. EMPATHY IN MEDICAL SCHOOL
Medical students from a university-based medical school surveyed yearly from 2007 through 2010, using Jefferson Scale of Physician Empathy-Student Version (JSPE-S)
Empathy scores of students in pre-clinical years were higher than in clinical years
Gender was a significant predictor of empathy, women > men
Chen et al. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305-11

11. Reflective Writing Is good for our health (Pennebaker et al.)
Helps us contain and share experience, rather than flooding us (Frank, 2010)
Illuminates 4 of medicine’s “central narrative situations”: physician and patient, physician and self, physician and colleague, physicians and society (Charon, 2001)
As part of a Mindfulness program, it improves physician wellness and enhance the physician-patient relationship by focusing on personal reflection, expression and communication, through story (Krasner, 2009)
Deepens perspective both for the writer, and for those who listen and respond to the work (Devlin et al, 2014).

12. Mindfulness Definition Jon Kabat-Zinn
Paying Attention
On Purpose
In the Present Moment
Without Judgement

13. “...A human mind is a wandering mind, and a wandering mind is an unhappy mind. The ability to think about what is not happening is a cognitive achievement that comes at an emotional cost.”
Killingsworth MA, Gilbert DT. A wandering mind is an unhappy mind. Science. 2010:330

14. Brain Default System

15. Default System: Busy, Wandering Mind

16. CREATIVE AND ORIGINAL THINKING
THINK BETTER, THINK LESS
Less obsessive rumination
Less preoccupations or “mental load”
Baror and Bar; Associative Activation and its Relation with Activation and Exploitation in the Brain; Psychological Science, Feb 2016

17. MINDFULNESS PRACTICE

18. “May you Live Everyday of your Life” Jonathan Swift

19. The HUMAN stress response curve Modified from Nixon, practitioner 1979

20. RESILIENCE
An ability to recover from or adjust easily to misfortune or change (Webster Dictionary)
Capacity to learn from difficulties and mistakes
Self confidence, capacity to get help
Perseverance albeit difficulties
Self control

21. “A connection made or not made”

22. Now take 5 minutes to reflect with a partner on what you just learn
What are your comments and impressions?
Any resolutions for the future? If so, what

23. MINDFULNESS AND REFLECTIVE NARRATIVE CONCLUSIONS

24. Mindfulness Physician Quality of care well-being (safety –errors)
(resilience –
burnout)
Mindfulness
The objectives of these sessions are to:
Understand the concept of mindful practice and how it is related to quality of care and physician well-being
Demonstrate how to cultivate mindfulness during everyday practice
Quality of caring
(empathy -
detachment)
©Mindful Practice Programs, University of Rochester, 2010 24

25. Greater Satisfaction with Work/Life
Improved
Performance
Reduced Stress
More Empathy
Greater Satisfaction with Work/Life

26. Mindfulness Practice Reflective Narrative

27. Starting a mindfulness practice
Stop, breath and be: take few moments during the day to take 3-5 breaths
Before starting a new activity
Before seeing patients
Red/yellow lights
Before getting up and at bedtime
Meditation
2-5 minutes of sitting meditation in morning or evening
Walking meditation
RESOURCES
smiling mind

28. Resources
smiling mind

29. Resources
Kabat-Zinn, Jon. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 1994.
Kabat-Zinn, Jon. Full Catastrophe Living. Bantam Dell. New York. 1991
Tolle, Eckhart. The Power of Now. Novato, CA: New World Library, 1999
Hanh, Thich Nhat. You Are Here. Boston: Shambhala Publications, 2001

30. Reflective Writing Resources
Charon,R. Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press,2006.
Frank, A. Why doctor’s stories matter. Canadian Family Physician 2010; 56:51-57.
Peterkin A. Using reflective writing with students: ten tips. CAME Newsletter , Special Editions: May, 2010.

31. Submission of your Creative Writing
(remember confidentiality - either written permission or patients should not be recognizable)
Crawford, A. et al. Eds. Ars Medica: A Journal of Medicine, The Arts and Humanities. To contribute, check the following website:
Canadian Medical Association Journal : words under “Humanities Encounters”

32. Submission of your Creative Writing (Cont’)
Dzwonek, A. et al. (2016) Murmurs: The Journal of Art and Healing, v.III. University of Ottawa, Faculty of Medicine. Available at To contribute contact:
OMA Medical Student Publication. Scrub In.

33. Thank you! msanchez@uottawa.ca CITATIONS:
Kabat-Zinn, Jon. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 1994.
Kabat-Zinn, Jon. Full Catastrophe Living.
Bantam Dell. New York
Tolle, Eckhart. The Power of Now. Novato, CA: New World Library, 1999.
Hanh, Thich Nhat. You Are Here. Boston: Shambhala Publications, 2001.