Seven themes describing the lived experience and learning process of medical students that have just completed an MBSR class were found. Seven themes were described and organized into three superordinate themes describing a learning process towards three directions: oneself(1), others(2), and the academic system(3). The themes and superordinate themes have been synthesized in Figure.1 and verbatim are detailed in Appendix.3.
1 - Towards oneself:
To encounter oneself: an intimate, sensitive, unpredictable, and dynamic encounter
The experience was surprisingly above all a time with oneself as a human being and not only turned to the professional dimension. It appeared to be an intimate encounter that raised a lot of emotion during the interviews.
“I don't even know why I ... I mean I've been talking about it for a long time, and I've never cried like this, I don't know why I'm crying at all, it's weird” (O)
“therefore it was very personal, much more personal than I had imagined” (E)
Interestingly, students have difficulty expressing their experience clearly, as if the experience was primarily physical, or sensory, making it difficult to conceptualize one’s experience. It was an encounter with bodily sensation as if they discover one's body and its functioning.
“Finally the bodily dimension of the exploration, for me it was the most ... well the biggest discovery in fact.” (P)
They made a clear difference between thinking and feeling explaining the interoceptive awareness dimension of mindfulness.
“I honestly don't know how to explain it, it's so physical”... (O)
A dynamic encounter that fluctuates between pleasant and unpleasant experiences. At the beginning the encounter could be uncomfortable as an experience that can be either described as a surprise or induce confusion particularly the moment of awareness when the student becomes aware of certain habits, or aware of the lack of awareness.
“And, so sometimes turning to your body could be almost a little confusing or ... it scared me a little bit”(B)
Class after class the experience has changed as the learning process has progressed and gives step by step confidence. In fact, participating in a meditation group can be understood as a passive learning, or a moment of relaxation, but students testified to the active process through emotional and physical fatigue after class.
“... there were times when it made me ... There were times when it made me emotionally tired ... at the end of the session I was tired, really as if I had ... as when I was working in fact”(C)
To heal oneself: a transformative experience in daily life
Then the therapeutic dimension named “a transformative experience” was raised in a sense of a shifting experience. Students identified changes in their habits related to compulsive behaviors, impacting daily life. They became aware of ruminations and thoughts that seemed to be related to anxiety and stress. They explained that they can decrease or even stop the loop of rumination by redirecting their mind wandering to the “Now”.
“When I take a chocolate, I know I'm taking it because I enjoy it and I want it but it's not an impulse”(R)
“I am much more at peace, even things that I used to see in my behavior, for example hyperphagia attacks, well things like that, I practically don't have them anymore since the program”(G)
Other shifts have been identified according to emotion regulations. They seemed to better identify and understand one's emotions with a before and after shift reducing overwhelming emotions.
"I would say that it's the relationship that has changed, it's just the way I look at the emotions… I don't know the distance I can take on the things I feel are really different”(K)
On the other hand, shifts may lead to confusion and insecurity for some students. It is an experience that can shake up the individual's bearings. The experience leads to less control or less projection towards the future which can be destabilizing.
“I'm also discovering what it's like to sometimes let myself be carried along... well, to just live the experience without being all the time in the dynamic of... moving on to something else all the time, well, in fact I don't really know what my place is in all of this, it's... it's... it's a little confusing”(P)
2. Towards others
In the second level highlighting the dimension turned towards others we identify 2 themes. These themes are connected and experienced in daily life, during teaching or in care context by students.
A new listening attitudes
Almost all the interview underlined this dimension related to the experience of listening as a first time learning for some.
"I realized that I had never really listened"(Q)
Indeed, understanding and experimenting a new listening posture was at the heart of the experience. It allowed them to deconstruct beliefs about "the right posture" and attitudes during dialogue sessions. Some mention learning concrete communication skills, such as "valuing silence when listening to someone"(N) or paying attention to "the words I choose and the pause I put in my sentences". Others emphasize instead the importance of creating space, “to take breaks” for the other's speech without anticipating their responses or cutting or controlling them. The idea was to be in a more welcoming posture. This posture can be emphasized in the care relationship next to their patient.
Experiencing empathy
Through this training, students described the ability to feel the concept of empathy as an experience-based learning. It was an amazing experience to be aware of being resonant with the emotions of others. In fact, astonishment was the tone used in front of this discovery. They have underlined that it was not necessary to belong to the intimate relational sphere of the other to be concerned by the other. They allowed themselves to feel. Meantime, they were more able to distinguish themself from the other and offered themself perspective taking in order to avoid the emphatic fusion.
“I rarely talked to people individually but I still felt close to everyone”(C)
“as a caregiver, it allows me to better ... put myself more easily in the place of the other person in order to exchange more healthily, and not necessarily enter into conflict, and to better understand the other person”(L)
They learned to be aware also of their limits and abilities moment to moment to feel concerned. Some clinical situations in which the acceptance of the suffering of the other is not possible can also be expressed as shame.
“it's complicated to put yourself in people's shoes and to know what it's like to feel pain”(F)
“ ... in fact there are certain patients where in fact I felt ... it's not an aversion but I don't know ... in any case I felt something in my body in fact when I start to listen to them it rises up in me in fact... I'm a little ashamed of it in fact to feel this kind of thing ... (laughs)”(N)
Finally, they underlined the complexity of empathy in the dimension of care from their experience. They expressed the need to preserve a space of distance in order not to feel emotionally contaminated and sometimes they pointed out the need to control their emotions in front of patients. More specifically they mention with clarity the dynamic dimension of empathy including the connection to self and others. When engaged in the empathic process, the physician is aware of both her feelings and reactions as well as the patient’s feelings and reactions.
“I thought "I am someone who has to take care so I have to take care of myself" and the fact of hearing it like that in the third person in this sentence there, I still said to myself that I have to apply it to myself and that it is ... a necessary generosity”(P).
3. Towards the academic system
In the third level highlighting the dimension turned towards the academic system, three themes were described.
Purpose of time: “I have time to take time”
In line with academic expectations, time is seen as a precious space, with an organized agenda leaving little time for free time. The feeling of running out of time was often experienced by the students. We noted a shift in relationship to time, particularly academic time. Students learned how to reinvest their time with low productivity and more time for selfcare. In fact, results raised the question of individual and societal time conditioning.
“I feel like I was always saying that I didn't have time, because I had to work and the time I had left, I had to sleep”(J)
“I was going to all the sessions, so in fact it shows that I had the time. It's just that I chose to ... distribute it differently, and that's it”(J)
Moreover, these moments of "pause" seem to be applied in daily clinical situations, showing the reciprocity of care.
“in fact this time that we take, this little time that we take to stop, well in fact it allows us to ... how can I put it, to how to say, to refresh our resources for the next person in fact”(E)
Connected with other students: loneliness vs community
The experience has been described as a process that creates connections between students. In balance with the competitive world, they described the importance of other students’ experiences as a mirror that limits the feeling of loneliness or isolation that can be described in the student population. This sense of belonging as “being part of the same body of caregivers”(Q) has been described as inspiring and joyful. In fact, the experience allowed them to move from the individual to the collective dimension of learning medicine.
“I remember, from the beginning, I went out, even the first session, it was really a joy”(J)
The university’s commitment
Mostly, they described the importance of feeling supported by the university in this process of more human need. They come back on the challenge of the studies but also on the suffering of the care system leaving little room for the care dimension. They share the importance of training being offered by the university, both as a validation and as a recognition of the human dimension of care.
“I think it's just great that we have the opportunity to do this, that we have the opportunity to do this already with the university, so it's not so much about the experience but about the idea ... because once again I find that these studies are complicated, where we are confronted with ourselves all the time (F)
“And it's really this dynamic of something other than what we are sold, that the hospital is horrible, that there are no means, no things, and there to say good we have a dynamic where we want to move things forward” (I)
Finally, all the transformative dimensions and learnings have been summarized in Figure.2.