Posted 09.19.2016 | by AMRA

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Physician compassion is a key element in good doctor-patient relationships. Nevertheless, nearly 50% of doctors and patients feel that medical care is often insufficiently compassionate. Between 20-70% of physicians suffer from compassion fatigue, a state of emotional exhaustion and diminished empathy brought on by the unceasing demands of patient care. As a consequence, medical educators are interested in finding ways to enhance compassion in medical students who are in training to become future physicians.

Fernando et al. [Mindfulness] tested whether a set of audio-guided mindfulness exercises could increase medical students’ compassionate behaviors, and whether the exercises had differential effects depending on the students’ self-compassion levels.

The researchers recruited 83 medical students (54% female, average age=21) for what they were told was a study of “emotional and clinical decision making.” The students completed a self-report measure of self-compassion, a personality disposition that involves self-kindness, recognition of one’s common humanity, and mindful awareness.

The students were then randomly assigned to listen to 10-minute audio recordings of either experiential mindfulness exercises or a speech on civic service. The mindfulness recording included an explanation of mindfulness and exercises involving mindfulness of the breath and of emotions. The students completed the Toronto Mindfulness Scale (TMS) after hearing the recordings.

Participants were then presented with a series of hypothetical clinical scenarios involving interactions with “difficult” patients. Participants rated how much they liked, wanted to help, and felt caring towards the patients, and their degree of subjective closeness to them. They also decided how much consultation time to allot to each of the patients. After being told the study was finished, the research assistant requested participants to help with an unrelated administrative task. The participants’ willingness to help with the task served as an objective measure of compassionate behavior.

Listening to the mindfulness recording resulted in higher TMS Decentering scores (a measure of one’s ability to disidentify from thoughts and feelings) than did listening to the civic service speech (partial η2=0.13). Self-compassion scores were positively associated with liking the hypothetical patients (partial η2=0.05), but listening to the mindfulness recording was not. However, students who listened to the civic service speech and were higher in self-compassion liked the patients more than those who listened to the speech and were low in self-compassion; there was no similar difference based on self-compassion for the students who listened to the mindfulness recording (partial η2=0.05).

The mindfulness recording increased their caring when students were low in self-compassion, and reduced their caring when they were high in self-compassion (partial η2=0.08). Feelings of emotional closeness were associated with higher self-compassion for those who heard the civic service speech, but the mindfulness recording increased feelings of closeness for students who were lower in self-compassion (partial η2=0.09). The mindfulness recording increased the likelihood of helping the research assistant when students were high in self-compassion, but not when they were less self-compassionate (partial η2=0.09).

The study shows that brief mindfulness exercises can enhance decentering in medical students. The effects of the brief mindfulness recording on compassion to others seem to be moderated by pre-existing levels of self-compassion. While the exercises facilitated caring for and liking the hypothetical patients when the students were low in self-compassion, it decreased aspects of compassion towards the patients when the students were high in self-compassion.

The mindfulness exercises increased the likelihood of the students helping the research assistant, but only when the students were high in self-compassion. The study is limited by the very brief nature of its mindfulness recording.

Reference:

Fernando, A. T., Skinner, K., & Consedine, N. S. (2016). Increasing compassion in medical decision-making: Can a brief mindfulness intervention help? Mindfulness.

[Link to abstract]