Enhancing Resiliency in Health Professions Students:

Transcription

1 Enhancing Resiliency in Health Professions Students: The Impact of Mind-Body Skills Training Rachel Wasson, BA Kristen Kraemer, MA Harini Pallerla, MS Erica Mysinger, BA Sian Cotton, PhD University of Cincinnati College of Medicine Department of Family and Community Medicine Division of Integrative Medicine

2 Background Health professions students face rigorous academic and healthcare environments that can lead to: High levels of stress, depression, and anxiety 1-2 Decreased well-being 2 Burnout and suicidal ideation 3 Resilience, defined as the capacity to bounce back from stressful situations 1 Dahlin, et al, 2005; 2 Dyrbye, et al, 2006; 3 Dyrbye, et al, 2008

3 Background & Aims Mind-body skills training has been successful in enhancing psychological well-being, empathy, and selfcare in medical students 4-6 Unclear whether this program is effective for improving resilience more broadly Study Aims 1. To examine the effects of an established mind-body skills training program on developing resiliency in health professions students 2. To examine the relationship between changes in resilience and changes in stress 4 Saunders, et al, 2007; 5 Sharpio, et al, 1998; 6 Erogul, et al, 2014

4 Methods sent to all eligible students in College of Medicine and College of Allied Health Sciences Students self-enrolled by sending a paragraph of interest Maximum of 10 per group Control students were identified with similar offering a $5 gift for completing on-line surveys after 2 nd survey Waitlist

5 Methods: Study Design Mind Body Group n=14 M age =23.9; 79% female; 79% white COM n=7 CAHS n=7 Peer Non Intervention Control Group n=16 M age =23.4; 69% female; 81% white COM n=7 CAHS n=9 Pre Surveys Brief Resiliency Scale (BRS) Perceived Stress Scale (PSS) 11 Week Intervention Post Surveys Brief Resiliency Scale (BRS) Perceived Stress Scale (PSS) Post Intervention Qualitative Survey 11 Week Control Brief Resiliency Scale (BRS) Perceived Stress Scale (PSS)

6 Methods: Measures Post Intervention Perceived Brief Resiliency Stress Qualitative Scale (BRS) (PSS) Survey 87 1 = Strongly Disagree In the 2 = last Disagree month, 8 items 3 how = Neutral often have 4 = Agree you 5 = Strongly Agree Open Ended Questions 0 = Never 1 = Almost Never 6 items, 2 = Sometimes Self rated 3 = Fairly Often 4 = Very Often Do you feel Total as if score your ability ranges to from bounce 1 5 back from difficulties 10 items, Self rated and stressors Higher score (i.e., indicates be resilient) more has resilience changed after taking this Total score ranges from 0 40 course? And if so, please describe how. Example I tend Higher to bounce score back indicates quickly more after stress hard times What can your College/University do to further develop your Questions: It Felt is hard nervous for me and to snap stressed? back when something bad happens Example resiliency? Felt that you were on top of things? Questions: How did this course impact you as a student and as a person, if at all? Been able to control irritations in your life? 7 Cohen and Williamson,1988; 8 Smith, et. al, 2008

7 Methods: Mind-Body Skills Training Mind-Body Skills Training 9 Developed at Georgetown University 11 weeks of 90-minute sessions led by 2 faculty Strategies focused on self-care and reflection: Meditation (e.g., mindfulness, forgiveness) Biofeedback Breathing exercises Relaxation Guided imagery Autogenic training Students were encouraged to practice skills at home 9 Saunders, et al., 2007

8 Methods: Data Analytic Plan 1. Examine baseline differences of resilience and stress between groups (Independent-samples t-test) 2. Observe changes in resilience and stress prepost in both groups (Paired-samples t-test) 3. Examine associations between changes in resilience and changes in stress for both groups (Pearson correlation) 4. Evaluate themes in qualitative data from the open-ended qualitative survey

9 Results: Resilience 1. Control group had significantly higher levels of resilience at baseline compared to the mind-body group (p<.01) 2. Only the mind-body group reported significant increase in resilience ( M =.59, p<.01) Higher score indicates more resilience * *

10 Results: Stress 1. No significant difference in baseline levels of stress 2. Only the mind-body group reported significant decrease in perceived stress ( M = -3.36, p=.011) Higher score indicates more stress *

11 Changes in Resilience & Changes in Stress 3. Improvements in resilience were significantly associated with improvements in stress in the mindbody group (r = -.536, p <.05) There was no significant association between changes in resilience and changes in stress in the control group (r = -.328, p =.232)

12 Theme: Changes in Resilience I feel that my ability to cope in the moment has improved. For example, when constantly ruminating past painful experiences while trying to sleep, mindfulness meditation has helped me calm myself and clear my head a bit. [Mind-body skills training] has given me the tools to regulate myself and my emotions when I become anxious about a particular event or exam. I don't know in that sense, but it has allowed me to realize what the stressors are that I have, and how to accept them and just do the best I can.

13 Theme: College s Role in Supporting Resilience Perhaps a workshop or two can be incorporated into school to help students deal with stress, especially with the crazy workload demand and the pressure of exams/ practicals. I would love to see programs like this offered each semester. Consider incorporating these skills into the curriculum and at the least, continue to offer these workshops these skills are immensely valuable. Develop more meditation groups for continued learning (i.e. a "level 2" course, etc).

14 Theme: Professionalism & Productivity I think that my ability to function throughout a given work day has improved with the incorporation of 10 minute meditations per day. During this workshop s time period, I felt more excitement when working with people. I also believed that I was better able to control stressful situations. This course will greatly enhance my professional work. I will have numerous tools (i.e., mindful breathing, guided visualization, etc.) to use while counseling challenging patients as well as myself during difficult moments. I felt more productive and excited to work with people due to lessons from this group.

15 Limitations Self-enrolled course (selection bias) Did not assess academic or professional performance One academic institution in one geographic region Primarily white, female population Small sample size

16 Conclusions 1. Mind-body group had significantly lower resilience levels at baseline 2. Mind-body skills training significantly improved resilience and stress 3. Improvements in resiliency were significantly associated with improvements in stress in the mind-body group 4. Primary qualitative themes: Students felt more resilient, self-aware, and productive Support continuation and expansion of the program

17 Future Directions Critical to explore ways to integrate mindbody skills training into curriculum to improve resilience Future studies should assess for long-term effects and expand to other health professions Local foundation support for: Launching mind-body groups in the College of Nursing and College of Pharmacy Expanding College of Medicine and College of Allied Health Sciences current mind-body groups

18 Acknowledgements Mind-Body Skills Facilitators, University of Cincinnati John Sacco, MD Keith Wilson, MD Geraldine Wu, MD Tina Whalen, PhD Sarah Couch, PhD Division of Integrative Medicine, University of Cincinnati Sian Cotton, PhD Kristen Kraemer, MA Harini Pallerla, MS Erica Mysinger, BA Georgetown University Aviad Haramati, PhD Nancy Harazduk

19 Thank You Questions or Comments? Rachel Wasson University of Cincinnati Center for Integrative Health and Wellness