Title: Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians
Abstract: RIMARY CARE PHYSICIANS REport alarming levels of professional and personal distress.Up to 60% of practicing physicians report symptoms of burnout, 1-4 defined as emotional exhaustion, depersonalization (treating patients as objects), and low sense of accomplishment.][10] Burnout can occur early in the medical educational process.Nearly half of all third-year medical students report burnout 2,11 and there are strong associations between medical student burnout and suicidal ideation. 12e consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the sta-For editorial comment see p 1338. CME available online at www.jamaarchivescme.com and questions on p 1374.Context Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care.Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.Design, Setting, and Participants Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008.The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion.An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo). Main Outcome MeasuresMindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months. ResultsOver the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [⌬], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; ⌬=-6.8;95% CI, -4.8 to -8.8; depersonalization, 8.4 to 5.9; ⌬=-2.5;95% CI, -1.4 to -3.6; and personal accomplishment, 40.2 to 42.6; ⌬=2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; ⌬=4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; ⌬=-4.1;95% CI, -1.8 to -6.4); total mood disturbance (33.2 to 16.1; ⌬=-17.1;95% CI, -11 to -23.2), and personality (conscientiousness, 6.5 to 6.8; ⌬=0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; ⌬=0.5; 95% CI, 0.3 to 0.7).Improvements in mindfulness were correlated with improvements in total mood disturbance (r=-0.39,PϽ.001), perspective taking subscale of physician empathy (r=0.31,PϽ.001), burnout (emotional exhaustion and personal accomplishment subscales, r=-0.32 and 0.33, respectively; P Ͻ .001),and personality factors (conscientiousness and emotional stability, r=0.29 and 0.25, respectively; PϽ.001).Conclusions Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patientcentered care.Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.