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Aukes LC, Geertsma J, Cohen-Schotanus J, et al. The development of a scale to measure personal reflection in medical practice and education. Med Teach. 2007;29(2–3):177–82.
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van Vliet M, Jong M, Jong MC. Long-term benefits by a mind-body medicine skills course on perceived stress and empathy among medical and nursing students. Med Teach. 2017;39(7):710–9. Big breasted goddess sprawls her all natural figure after attractively baring it out of her swimsuit To make the experience that stress is a state [of mind] that can be changed and not something you have no control over at all— that already is a pretty cool thing. (FGWS14.M2) This study hasn’t shown a meaningful change in MBM course participants’ mental or physical health QoL, as assessed by the SF-12, whereas Esch et al. showed an improvement for mental QoL SF-12 levels in MBM group compared to control [ 13]. Yet it is possible that the SF-12 is not suitable for use in a sample of generally healthy medical students. The SF-36, and its short version SF-12, were originally developed to assess QoL changes in patients with reduced health [ 5, 35] and when tested within a sample of healthy patients, the original SF-36 sub-scales, MCS and PCS, were not always found to be independent [ 27]. Potential MCS changes in our healthy population sample may therefore have been masked. At baseline, participants scored about one standard deviation above the mean of the standard PSS for German students [ 21], indicating a high stress load (see Table 3).Ware J, Kosinski M, Turner-Bowker D, et al. How to score version 2 of the SF-12 Health Survey. Lincoln, US: Quality Metric Incorporated; 2002. Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland The qualitative and quantitative findings of this study suggest that an MBM course implemented at Charité may have been suitable for reducing stress and fostering self-care practices among medical students. These improvements were described qualitatively as both immediate benefits from practicing self-care and a gradually gained sense of empowerment, by acquiring a toolkit capable of sustainably self-regulating stress levels.
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Our qualitative analysis yielded four distinct main themes: “connections and relationships,” “well-being and stress reduction,” “self-awareness and personal growth,” and “mind-body-medicine in medical education.” Connections and relationshipsThis study was developed based on uncontrolled internal course evaluations conducted by the Institute of Social Medicine at Charité. We performed an exploratory mixed-method evaluation that combined pre-post within-subject quantitative assessments using questionnaires with qualitative semi-standardized focus group interviews. Focus groups were conducted in the same setting as a typical course session. Study participation was voluntary. The study was approved by the ethics committee at the Charité (EA1/159/12, 05.07.2012, amended 06.11.2019). All data collection, analysis, and storage processes were conducted in compliance with the European Directive of Data Protection guidelines. Procedure and participants Quek TT, Tam WW, Tran BX, et al. The global prevalence of anxiety among medical students: a Meta-analysis. Int J Environ Res Public Health. 2019;16(15):2735. An analysis of course motivation revealed that students’ desire for improved well-being and reduced perception of everyday life stress was a main motivator for participation. Anxiety was commonly reported among participants, brought on by exam periods, feelings of falling behind on academic achievement in a competitive environment, even causing strain on students’ personal lives. Some students complained of experiencing physical symptoms, such as nausea, tinnitus, high blood pressure, and insomnia. This safe space […] has played such an important part for me and […]I want to […] encounter other people, strangers, the way that we encountered each other here. (FGWS18.F3)
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Maclaughlin BW, Wang D, Noone AM, et al. Stress biomarkers in medical students participating in a mind body medicine skills program. Evid Based Complement Alternat Med. 2011;2011:950461. Participants showed improvement across most quantitative measures, including mindfulness, self-reflection, self-efficacy, and perceived stress. However, there were no changes in participant-reported QoL. Empathy, as an ability to take others’ perspective, showed improvement, as did the sense of distress at experiencing empathy. These outcomes were corroborated by focus groups reporting increases in students’ ability to self-regulate stressful experiences and improve their relationships with themselves and others. Participants also recognized the importance of MBM values in the doctor–patient relationship, patient care, and a more holistic view of medicine. Walach H, Buchheld N, Buttenmüller V, et al. Empirische Erfassung der Achtsamkeit - Die Konstruktion des Freiburger Fragebogens zur Achtsamkeit (FFA) und weitere Validierungsstudien. In: Heidenreich T, Michalak J, editors. Achtsamkeit und Akzeptanz in der Psychotherapie. Tübingen: dgvt; 2004. p. 727–65.
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Dyrbye LN, Harper W, Durning SJ, et al. Patterns of distress in US medical students. Med Teach. 2011;33(10):834–9. I tried to remember the thoughts that would come up [during meditation] and take them with me. I had the feeling, ‘What’s coming up in my mind there […] is really [what is] concerning me at the moment, even if I do not realize it usually’. And that has helped me a lot. (FGWS18.PF) Meanwhile, a rising interest in student welfare has sparked an increase in mental health resilience interventions [ 32]. The Mind-Body-Medicine (MBM) course was developed by Dr. Aviat Haramati and Nanci Hadzouk at Georgetown University of Medicine (GUSOM) to facilitate medical students’ self-care ability by promoting self-awareness and resilience. MBM belongs to the wider field of complementary and integrative medicine (CIM). It “focuses on the interactions among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health” [ 9]. MBM also aims to foster engagement with integrative medicine perspectives on health and healthcare [ 3]. Hilger-Kolb J, Diehl K, Herr R, et al. Effort-reward imbalance among students at german universities: associations with self-rated health and mental health. Int Arch Occup Environ Health. 2018;91(8):1011–20.
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Schwarzer R, Jerusalem M. Measures in Health psychology: a user’s portfolio. Causal and control beliefs. Causal and Control Beliefs. 1995;01(011):35–7. Sociodemographic variables and questionnaire scores were analyzed descriptively. Student’s paired t-test was used to investigate changes in the scores of the above-mentioned questionnaires. Due to its exploratory nature, this study does not determine statistical significance; instead, it attempts to draw conclusions based on a wider picture of quantitative and qualitative data, alongside a triangulation of these datasets. Computed two-sided p-values, where provided, should be regarded as exploratory and are not meant to imply levels of significance. All quantitative data were analyzed using SPSS (version 1.0.0.1406). Qualitative data and analysis After completing an MBM course, students reported reduced perceived stress, increased self-efficacy, mindfulness, empathy and positive engagement with integrative concepts of doctor–patient relationships. Further research with larger randomized confirmatory studies is needed to validate these benefits.
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Kraemer KM, Luberto CM, O’Bryan EM, et al. Mind-body skills training to improve distress tolerance in medical students: a pilot study. Teach Learn Med. 2016;28(2):219–28. Cute but seductive brunette Rosie slips out off her yellow dress and lingerie outdoors in the garden
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