Sample description
Forty-seven medical students (54% of the year cohort) were recruited into the study via email following a mid-semester introductory lecture about mindfulness. Their baseline characteristics are described in Table 3 Of these, 34 (72 %) provided data at week 8 and 28 (60%) at four months. Thirteen participants (27%) who completed the MTP submitted a reflective essay. Students who completed the 8-week program and provided their weekly practice data (‘completers’) did not statistically differ from ‘non-completers’ with respect to baseline characteristics.
Frequency and duration of mindfulness practice
The boxplots in Figure 1a show that at least half the participants practiced mindfulness a minimum of three days a week in the first three weeks, but practice then dropped over the following five weeks. Figure 1b shows that the median and mean duration of total mindfulness practice remained relatively stable over the weeks; by Week 8, about half of the students were practicing for approximately 30 minutes in total per week. At 4-month follow-up, 11 (32%) participants continued to practice at least weekly. Most (n=25, 89%) practiced for 10 minutes or less per session. (Insert Figure 1a and Figure 1b here)
Changes in PSS, SCS, and CS scores
Table 4 shows the participants’ PSS scores were significantly reduced at 4-month follow-up, compared to baseline (estimate -2 points, CI -3.9, -0.1). Participants’ SCS scores also increased significantly at both eight weeks (estimate +6.3, CI 1.2, 11.5) and four months (estimate +5.5 points, CI 1.0, 9.9). Changes in CS scores were not significant.
Predictors of PSS, SCS, and CS score changes
Frequency and duration of mindfulness practice did not predict changes in PSS, SCS or CS. There was a strong baseline effect for stress and self-compassion score changes. Those reporting higher stress at baseline observed greater stress reduction at 4-month follow-up. Similarly, lower self-compassion at baseline was associated with greater improvement in self-compassion at four months (see Table 4).
There was a gender effect for PSS score change, with males reporting on average 4.8 points (CI 0.9. 8.8) less stress reduction than females. However, when baseline effect was concurrently considered, the gender effect disappeared (p=0.2646), whereas the baseline effect persisted (p=0.0055). Note that these results are not shown in Table 5.
Qualitative assessment of students’ reflections on the MPT
Two main themes were identified: how the participants engaged with the mindfulness program (including motivation for and barriers to engagement plus perception of content); and the impact of mindfulness practice on personal and professional attitudes, beliefs and behaviours.
- Engagement
A number of the participants commented that they found the program “beneficial”, “valuable” and “enjoyable”. Some noted that they were motivated to learn techniques that would improve their performance and to develop coping strategies to manage stress and anxiety:
“Prior to beginning the mindfulness program, I did not have a set of core coping strategies for accepting any anxious or distressing thoughts….Pracitising mindfulness meditations and watching the teachings has motivated me to continue to build my mindfulness skills.” (P1)
It was challenging for some to remain engaged. Participants reported feeling overloaded by tasks and assessments, both in the medical curriculum and extra-curricular activities; difficulty prioritising mindfulness over other tasks; not enjoying some of the mindfulness practices; struggling to find a particular time of day to complete the practice; and not feeling like they need to practise every day especially when they were feeling “happy”. Despite these barriers, most went on to acknowledge the value of mindfulness and the benefits that they perceived even if their practice was irregular.
The content of the intervention appeared to influence participants’ interest and consequent practice. One mentioned that they “related well to a couple of the mindfulness recordings” which in turn raised their awareness of “the discussed concepts in day to day life” and “extended to interactions with patients” (P6). Another participant commented “I really enjoyed the ‘body scan’, ‘awareness of breathing’ and ‘tuning into your surroundings’ meditations” and found these easier to complete on a daily basis, however “found the last four meditations very difficult… hence struggled to complete the meditation…and was not as compliant when it came to the second half of the program.” (P2) This participant acknowledged “I should have persisted and tried to improve, but instead chose not to complete the meditation some days because I found it too frustrating.”
- Impact
Many participants reported that practising mindfulness impacted on self-awareness of thoughts, emotions and behaviour. Participants described an increased awareness of the nature of the mind, including mind-wandering, the arising of emotions and habitual reactions to these emotions, self-criticism, stress and anxiety about doing things correctly, judgement of others, procrastination and constant thinking and analysis.
Mindfulness practice was described as providing opportunities to acknowledge thoughts and emotions non-judgementally and consequently chosing to respond in a more controlled way. For example, one participant said “when I was more mindful, I felt more in control of myself” (P1) whilst another explained “I have been working towards pausing before reacting and understanding that emotions are transient, but the impact of our behaviour as a result of these emotions can have a lasting effect. This change in attitude and behaviour has allowed me to remain calm when in situations that are potentially volatile.” (P5)
Some recognised that mindfulness practice was helpful in developing self-compassion:
“The Mindfulness Program helped me look at my situation objectively and think about how I would judge someone else in the same circumstances. This made me more forgiving of how I was performing, which in turn made me aware of how tiring and self-defeating it was to be expending energy on self-criticism, when in fact I could be expending the same energy on looking forward and working towards achieving my goals.” (P11)
Increased compassion for others was also reported by participants. One described how the loving kindness meditation helped “to identify personal judgement towards patients” and consciously “maintain compassion towards them”(P8). Another commented how their increased awareness of “I’m too busy” self-talk allowed them to make more time to help others.
Stress reduction was another outcome identified in the essays, as a consequence of becoming more aware of their anxious thoughts and emotions and having access to tools that allowed them to become present. One participant reported “Through the mindfulness program, I have become more aware of acknowledging my thoughts in a state of non-judgemental awareness. I am now acknowledging my thoughts and choosing to redirect my focus. No longer do I feel annoyed with myself if these thoughts return, I simply acknowledge them and refocus.” (P1)
Most described using mindfulness reactively when they were under acute stress and feeling overwhelmed. For example, one participant reported “in situations where I feel overwhelmed, for any reason, I have found that focussing on my breathing has been the most useful technique to helping me to return to a state of calm” (P1). Another participant described their practice as “my daily escape” that “took my mind off the daily stressors, even if just for 5 minutes”.(P7) Conversely, a small number reported that their daily mindfulness practice altered their experience of stress and allowed them to embrace life more fully. One participant stated “Through becoming more aware of the emotions I am experiencing, I have been able to recognise how my body is responding to these emotions... In recognising when I am stressed or experiencing an emotion… I am able to stop myself, acknowledge that I’m feeling that way and accept the emotion without converting it to an unwanted action.” (P9). One participant commented that “I was more inclined to practice mindfulness when I was relaxed. At times when I was stressed…I was too wound up to sit and relax” (P2).
Some participants mentioned that practising mindfulness led to improved performance and productivity, as a consequence of increased self-awareness of thoughts and emotional regulation and new techniques for managing tasks and focussing their attention. One participant explained “when I am in the hospital and I have deadlines…focusing on my breathing has helped me to calm my mind enough to break down my larger tasks into smaller ones. In this way, I am able to apply what was taught in the mindfulness videos and focus more on the process of completing my tasks rather than the outcome. I have found this to be extremely effective in increasing my productivity and decreasing my stress levels.”(P1) .
