Mindfulness in Surgical Training (MiST): A Modified Mindfulness Curriculum for Surgical Residents

Elizabeth Miazga; Brenna E Swift; Madalina Maxim; Monica Pearl; Anna R Gagliardi; Janet Bodley; Michèle Farrugia; Hava Starkman; Anna Kobylianskii; Julie Maggi; Carol-Anne Moulton; Dana Soroka; Andrea N Simpson

doi:10.1016/j.jsurg.2024.103351

Mindfulness in Surgical Training (MiST): A Modified Mindfulness Curriculum for Surgical Residents

J Surg Educ. 2024 Nov 30;82(1):103351. doi: 10.1016/j.jsurg.2024.103351. Online ahead of print.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, Trillium Health Partners, Mississauga, ON, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada. Electronic address: elizabeth.miazga@utoronto.ca.
² Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada; Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³ Department of Medicine, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Toronto General Hospital Research Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁶ Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada; Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada.
⁷ Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada.
⁸ Department of Psychiatry, St. Michael's Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada.
⁹ Department of Surgery, University Health Network, Toronto, ON, Canada; Department of Surgery, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada.
¹⁰ Department of Obstetrics and Gynaecology, University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada; Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON, Canada.

PMID: 39616974
DOI: 10.1016/j.jsurg.2024.103351

Abstract

Objectives: Residents experience numerous work-related and personal stressors that make it difficult to focus in the operating room, negatively impacting learning and surgical performance. Mindfulness-based cognitive therapy decreases anxiety and improves memory and learning. This study aimed to create a feasible and desirable modified mindfulness curriculum for surgical residents.

Design: This was a prospective cohort study using multiple methods design to assess a 12-week modified mindfulness curriculum tailored to busy surgical trainees involving a 30 min group session weekly and 15 minutes home practice daily. The main outcomes were program feasibility and desirability. Focus groups explored how mindfulness techniques were used in the operating room. Secondary outcomes were measured in a pre- and post- intervention design assessing surgical performance, anxiety, confidence and burnout using validated assessment scales. Outcome measures were collected at baseline, immediately following the course and at 3 months postintervention.

Setting: Academic obstetrics and gynecology residency program.

Participants: Obstetrics and gynecology residents in postgraduate years 2-5 at the University of Toronto were invited to participate in Mindfulness in Surgical Training.

Results: Twelve (20%) out of 61 eligible residents enrolled in the program and 8 (67%) completed the course. There was a statistically significant decrease in anxiety (p < 0.001) and increase in surgical confidence (p = 0.007) following the mindfulness curriculum using validated survey tools. There was no change in burnout or surgical performance evaluations. Thematic analysis identified that mindfulness tools were beneficial and regularly utilized by participants in the operating room with sustained use 3 months post intervention. The biggest barrier to participation in the mindfulness curriculum was time. Participants felt the residency program should support ongoing mindfulness training to promote a positive culture shift.

Conclusions: A modified mindfulness curriculum designed for surgical trainees is feasible, desirable, reduces anxiety and increases surgical confidence.

Keywords: Curriculum; Medical education; Medical residency; Mindfulness.