#Study finds ‘significant reduction’ in GP trainee burnout following mindfulness program

Medics training to become general practitioners reported a significant positive improvement in their mental wellbeing after participating in a specially-designed mindfulness program, a study from University of Warwick researchers shows.

The results show that incorporating mindfulness into training for GPs could help them cope better with the pressures of the profession and the challenges of practicing medicine during the pandemic.

The conclusions are drawn from a new study in the BMC Medical Education by a team from Warwick Medical School and funded by Health Education England focusing on a sample of 17 GP trainees working in Coventry and Warwickshire.

Mindfulness is defined as a capacity for enhanced and sustained moment-to-moment awareness of one’s own mental and emotional state and being, in the context of one’s own immediate environment. For their study, the researchers used the Mindful Practice Curriculum, an intervention designed for doctors in that it is structured and addresses issues that are specific to their profession. It has been widely tested in the United States but the researchers are currently evaluating its effectiveness in the UK.

For this study, 17 GP trainees took part in weekly 1.5-hour group sessions over a six-week period led a fully trained Mindful Practice tutor. Prior to starting, they completed questionnaires based on validated measures for wellbeing, burnout, stress, mindfulness and resilience. They then completed the same questionnaires after they finished the program and their scores on both were compared.

Analyzing the results, the researchers found significant change for the better in participants scores for all five categories. There were significant reductions in emotional exhaustion (24.2%) and disengagement (17.7%), measures of burnout and stress (23.3%) reported amongst the trainees, and similarly improvements in resilience (15.8%) and wellbeing (22%). In addition, 16 trainees (94%) scored above the threshold for emotional exhaustion pre-course, but only 9 (53%) afterwards.

Lead author Dr. Manuel Villarreal, Honorary Clinical Research Fellow at Warwick Medical School and a practicing GP, said, “As a medic, these are important qualities when engaging in consultations and making decisions. Strengthening all those qualities will help them to be better clinicians, engage better with patients, and it will benefit them at a personal level. The key thing is how you incorporate this type of program into their training, how we put this in place so that GP trainees acquire these skills.

“It will also allow them to better navigate the challenges of COVID. The pandemic has entailed doing lots of telephone consultations and GP trainees are now having to make different decisions in new scenarios. That comes with additional stress.”

Co-author Dr. Petra Hanson, Ph.D. student at the University of Warwick and Clinical Research Fellow at University Hospitals Coventry and Warwickshire NHS Trust, said, “This was such a positive and encouraging improvement, even in a small study, that this will hopefully lead to bigger and longer studies. This kind of intervention is feasible and is practical. We have shown that it can work as part of postgraduate training and it should now be tested in other areas.”

A previous study by the team showed that GP trainees experienced similar levels of burnout to experienced GPs, but that the majority were willing to use mindfulness as a method to reduce its impact.

Co-author Professor Jeremy Dale, Professor of Primary Care at Warwick Medical School, said, “General practitioners at all stages of their career experience considerable stress, often leading to exhaustion and burnout, early retirement and career change. Training to become a GP must not only include focusing on the clinical knowledge and skills needed to care for patients effectively, but also needs to support development of the personal skills needed to cope with being a GP. This is essential to ensuring the sustainability of the profession. As this study shows, mindfulness training offers a readily applicable approach, which it is feasible to deliver as part of GP vocational training. Preventing or relieving emotional exhaustion, stress and burnout is unarguably good for GP trainees. Trainees’ wellbeing will almost certainly have an impact on their patients, colleagues and the wider NHS, and so should be a priority in vocational training.”