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The Impact of Mind–Body Medicine Facilitation on Affirming and Enhancing Professional Identity in Health Care Professions Faculty

Talisman, Nicholas; Harazduk, Nancy MEd, MSW; Rush, Christina MA; Graves, Kristi PhD; Haramati, Aviad PhD

doi: 10.1097/ACM.0000000000000720
Innovation Reports
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Problem Georgetown University School of Medicine (GUSOM) offers medical students a course in mind–body medicine (MBM) that introduces them to tools that reduce stress and foster self-awareness. Previous studies reported decreases in students’ perceived stress and increases in mindfulness—changes that were associated with increased empathic concern and other elements of professional identity formation. However, no reports have described the impact of an MBM course on the facilitators themselves.

Approach To explore whether MBM facilitation is associated with changes in professional identity, self-awareness, and/or perceived stress, 62 facilitators, trained by the GUSOM MBM program, were invited to complete two validated surveys: the Freiburg Mindfulness Inventory (FMI) and the Perceived Stress Scale (PSS). Forty-two participants also completed a six-item open-ended questionnaire addressing their experience in the context of their professional identity.

Outcomes Facilitators’ scores were significantly lower on PSS and higher on FMI compared with normative controls (P < .05), and the two parameters were inversely correlated (−0.46, P < .01). Qualitative analysis revealed three main themes: (1) aspects of professional identity (with subthemes of communication; connections and community; empathy and active listening; and self-confidence); (2) self-care; and (3) mindful awareness.

Next Steps Preliminary findings will be extended with larger studies that examine longitudinal quantitative assessment of communication, connection, and self-confidence outcomes in MBM facilitators, and the impact of MBM facilitation on burnout and resilience.

N. Talisman is research assistant, Department of Psychiatry, Georgetown University School of Medicine, Washington, DC

N. Harazduk is assistant professor and director, Mind–Body Medicine Program, Georgetown University School of Medicine, Washington, DC

C. Rush is project director, Division of Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC

K. Graves is associate professor, Division of Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC

A. Haramati is professor of biochemistry and molecular and cellular biology and director, Center for Innovation and Leadership in Education, Georgetown University Medical Center, Washington, DC.

Funding/Support: This work was supported by the Georgetown University School of Medicine and the Institute for Integrative Health.

Other disclosures: None reported.

Ethical approval: The institutional review board of Georgetown University approved this study.

Correspondence should be addressed to Aviad Haramati, Georgetown University School of Medicine, Room 213 Basic Science Building, 3900 Reservoir Rd., NW, Washington, DC 20057; telephone: (202) 687-1021; e-mail: haramati@georgetown.edu.

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Problem

Since 2002, Georgetown University School of Medicine (GUSOM) has offered an 11-week elective course in mind–body medicine (MBM) that provides an introduction to mindfulness meditation, guided imagery, autogenic techniques, and movement, among other skills and experiences. The aims of the MBM program are to increase student self-awareness of emotional, physical, mental, social, and spiritual aspects in one’s life with the goal that enhanced self-awareness will lead to improved self-care, and to foster nonjudgmental, supportive, collegial relationships.1 Previous studies of the GUSOM MBM course indicate evidence of positive changes in mindfulness and physiological outcomes among student participants.2 However, to our knowledge, the impact of an MBM course on the course’s facilitators remains unknown. We sought to explore the impact of the MBM course on course facilitators’ professional identity3 and well-being to determine whether facilitation of MBM groups is associated with any changes in professional identity, self-awareness, and/or perceived stress in the faculty and staff facilitators.

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Approach

We used a mixed-methods cross-sectional design to obtain quantitative and qualitative responses from MBM facilitators. In March and April of 2014, selected MBM facilitators were e-mailed a link to a secure, one-time online survey that took approximately 15 minutes to complete. The Georgetown University institutional review board approved this study along with a waiver of written consent.

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Participants

We identified prospective participants from the pool of facilitators that were trained to facilitate the MBM course by two of the authors (A.H. and N.H.) by inviting those who were currently active facilitators of MBM courses at their institutions. Sixty-two individuals were identified as possible participants. Table 1 contains these individuals’ demographic characteristics.

Table 1

Table 1

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Survey instruments

Freiburg Mindfulness Inventory.

The Freiburg Mindfulness Inventory–Short Form (FMI) is a validated 14-item measure that assesses participants’ experience of mindfulness over the past week. Items ask respondents to estimate how frequently they experience components of mindfulness on a scale from 1 (rarely) to 4 (always). To score the FMI, item 13 (“I am impatient with myself and others”) is reverse coded, then individual item responses are summed to create a total score.4 Reliability of the FMI responses compared favorably to those in normative samples (α = .78).4

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Perceived Stress Scale.

The Perceived Stress Scale (PSS) is a 10-item validated measure that assesses participants’ perceived stress over the last month on a scale from 0 (never) to 4 (very often). To score the PSS, four items are first reverse coded, and then all item scores are summed to create a total score.5 Responses on the PSS had strong reliability (α = .83).

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Qualitative questions.

Participants were also asked to answer six open-ended items related to their experience in the MBM program, specifically in the context of their professional identity (see Appendix 1).

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Data analysis

Quantitative data.

We collected and managed data using REDCap electronic data capture tools (Vanderbilt University, Nashville, Tennessee) hosted at Georgetown–Howard Universities Center for Clinical and Translational Science. We analyzed demographic variables using descriptive statistical methods and calculated correlations between scores on the quantitative measures. One-sample t tests were used to compare sample mean scores on quantitative measures with appropriate normative means.

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Qualitative data.

We analyzed the written qualitative item responses using thematic analysis and qualitative description approaches.6,7 Two raters (K.G. and C.R.) reviewed the content and separately identified preliminary themes found in the qualitative responses. The raters then shared preliminary themes with the entire research team for discussion and to discern commonalities among facilitators’ responses. The same two raters then used an iterative process to refine the themes until they reached consensus. Once data saturation was achieved, the research team identified quotes that exemplified the themes.

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Outcomes

Quantitative results

Of the 62 individuals invited to participate, 50 provided informed consent and completed some (n = 42) or all (n = 39) of the qualitative and quantitative survey measures; 29 (60%) were female. Participants had a mean of 3.5 years (2.8 SD) experience as MBM facilitators. Twenty-three (49%) had completed the training within the last two years, whereas 10 had completed training five or more years ago. Thirty-three respondents (69%) reported participating in an MBM group as a member in addition to their experience as a facilitator.

Facilitators had an average score of 41.9 (4.9 SD) on the FMI, which was significantly higher (t = 8.79, P < .001) than the normative mean of 34.5.4 The mean score on the PSS was 13.0 (4.4 SD), which was significantly lower (t = −2.4, P = .02) than the normative score of 14.7 for individuals with advanced degrees.8 Further, there was a significant negative correlation between the PSS and FMI scores (−0.461, P < .01), indicating that the higher the mindfulness score, the lower the perceived stress score.

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Qualitative results

We identified three primary themes from the written responses to the open-ended items: (1) aspects of professional identity (with subthemes of communication; connections and community; empathy and active listening; and self-confidence); (2) self-care; and (3) mindful awareness. Below, we describe each theme and provide exemplar quotes, and more representative quotations can be found in Table 2.

Table 2

Table 2

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Aspects of professional identity (subtheme: communication).

A number of participants reported that their experience as an MBM facilitator impacted their professional identity through increased communication and deepened empathy. One faculty member responded, “I have experienced better communication with my colleagues, more empathy for their challenges, and our working relationships have therefore been improved.” Added another, “[Being an MBM facilitator] has allowed me to express things that I cannot say in any other setting.”

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Aspects of professional identity (subtheme: connections and community).

Many facilitators commented on the sense of connection derived from facilitating the MBM course. One noted: “I feel like the work that I do as a mind–body medicine facilitator is the most important work that I do on campus. It has made more people connect with me about harmony and balance.… My professional identity has expanded and has made me more true to myself.” Another wrote, “[T]he connections I have made with other mind–body facilitators [have] enriched my professional life and, in turn, my personal life as well.” Yet another facilitator noted, “I fear rejection much less and have a strong sense that my connections with colleagues are meaningful.”

In addition to an increased sense of connection, many participants experienced a broadened sense of community. One facilitator wrote: “Professionally, being a facilitator has allowed me to meet people from a different part of the campus—people I would not normally interact with.… It has truly broadened my horizons.” Another facilitator noted: “It has enabled me to make teaching residents and faculty [mind–body] skills and building community and peer support … my primary academic focus. It has also enhanced my interactions with patients, colleagues, trainees, staff, [and] housekeeping.”

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Aspects of professional identity (subtheme: empathy and active listening).

Respondents commented on the impact of their MBM facilitation on their perceived level of empathy and ability to actively listen to colleagues and students. For example, one facilitator said: “Being a mind–body medicine facilitator has been a gift … to learn from [MBM participants] has been a joy. I have improved my own listening skills … which has increased my openness, empathy, and understanding with my colleagues.” Another noted: “I feel like I am more empathetic to students’ needs. I always felt that way in the past, but didn’t actually always show it or act on it in my interactions.” Still others indicated, “I know that I am a better listener,” and “I feel very protective and proud of the students in my group … their well-being is [at the] forefront in my mind.… Being a mind–body facilitator has made me more aware and sensitive to the struggles, triumphs, and joys of medical training.”

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Aspects of professional identity (subtheme: self-confidence).

Facilitators also commented on their self-confidence in their identity and how they communicate with other people in academic medical settings. “This work has created more space for me—both personally and professionally—to grow and expand. I am more confident in my identity.” Another said, “I have more confidence in sharing my knowledge with my patients and colleagues.” Another facilitator noted: “As an administrator, this experience has given me more confidence and a sense of kinship with faculty members. It’s a way that I can connect with the academic mission of the university—in partnership with other faculty members.”

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Self-care.

Self-care was a second major theme in the facilitators’ comments: “[Being a mind–body facilitator] has helped me to deal with stress better, [and] be more compassionate with others and with myself.…” Similarly, the sense of an expanded community around self- and patient care was also recognized by one facilitator: “[Being an MBM facilitator has led to] more connections around [a] self-care community created from facilitation; more mindful patient care practices [are] perceived.” Finally, another facilitator commented, “It’s been an important personal reminder to ‘practice what I preach’ … each time I teach I remember why these practices are so important to me and to others.”

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Mindful awareness.

One definition of mindfulness is “the state of being attentive to and aware of what is taking place in the present.”9 Facilitators commented on mindful awareness, or increased understanding of the perspectives of others and oneself. One facilitator said, “I don’t always achieve the work/life balance I strive for, but I have more self-awareness around this and feel more in control of the decisions I make.” Another said, “It is helping me to gain insight into my own personal priorities and make significant life decisions.” Increased awareness of both self and others was noted by another facilitator who wrote, “Being a mind–body facilitator reminds me to be more patient, that everyone has issues they are dealing with, and that my problems and challenges are just that: challenges to deal with—not things that define me.” Likewise, one other facilitator indicated, “I am more attentive to what is being said with words and body language.”

For some facilitators, increased awareness and mindfulness led to increased emotional unrest. For example, one noted:

The bonds are profound.… At times it can actually be too much with a faculty member or two, as if they really need the community support and they need to decompress.… The overwhelming issues faced by my colleagues—and now my good friends—can color my view. I am the lone facilitator in the faculty group, and I just realized I need to find another facilitator to help me debrief.

And, “(Facilitating) … encourages me to dig deeper, which is not always easier. It has actually caused more disruption than ease in my personal life.”

The experience of being a mind–body facilitator may introduce more awareness and engagement with complex issues, which may cause some unease. However, the participants’ comments suggest that this unease can accompany new insights and more profound understanding of oneself and others. As one facilitator expressed, “[Being an MBM facilitator] hasn’t made it [professional life] any easier, but it has made it easier to cope with the ‘slings and arrows of outrageous fortune.’”

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Next Steps

The results from this pilot study suggest that MBM facilitators within such an experiential teaching paradigm also experience benefits in terms of affirmed and enhanced professional identity, self-care, and mindful awareness. Indeed, quantitative data analyses provided evidence of benefits related to mindfulness and physician wellness: Mindfulness scores were found to be above the normative mean and perceived stress scores below the normative mean. Furthermore, among the facilitators, higher mindfulness scores were significantly correlated with lower perceived stress scores. The impact of MBM facilitation on affirming and enhancing professional identity appears to be driven by improvements in communication between colleagues, increased sense of connection with both students and colleagues, increased empathy, and heightened self-confidence. Specific next steps for research include:

  1. Comparing mindfulness and perceived stress outcomes between MBM-facilitator and nonfacilitator faculty.
  2. Conducting longitudinal assessments before and after facilitator training and MBM facilitation.
  3. Completing quantitative assessments of communication, sense of connection, and self-confidence in MBM facilitators, and of the impact on burnout and resilience of MBM facilitation.

The MBM program offers faculty and students the rare opportunity to experience a curriculum intended to stimulate personal and professional growth as peers, a design that has elicited positive responses from faculty and students alike in several programs that have been evaluated.

Although not directly assessed by the present study, our results suggest the possibility that, as the number of MBM facilitators increases at an institution, other faculty members, staff, and administrators outside of the MBM program may begin to see the impact of improved communication and sense of connection. The potential for positive “spillover” from the smaller MBM community to larger academic medicine communities is exciting and highlights opportunities for organizational culture change—that is, an acculturating positive influence of this explicit rather than hidden curriculum.10

The findings of the present study suggest that participation as a facilitator in an MBM program has tangible positive outcomes for the professional identity of facilitators through improved communication, connection, empathy, and self-confidence. Moreover, the significant impact of MBM facilitation to reduce perceived stress and enhance mindful awareness provides a strong rationale for inclusion of such relationship-centered educational offerings in the training and/or core academic experience of physicians and other health professionals. Such teaching experiences may significantly contribute to attenuating potential burnout by supporting healthy personal and professional formation and increasing professional satisfaction among faculty and staff within academic health centers.

Acknowledgments: The authors wish to thank the facilitators who participated in this study, and S. Ray Mitchell, MD, dean of medical education, Georgetown University School of Medicine, for his support of the mind–body medicine program and of the present study. They also gratefully acknowledge the Institute for Integrative Health for helping to support the mind–body medicine training program for non–Georgetown University facilitators. The authors thank Hedy Wald, PhD, for her very helpful comments and edits that improved the manuscript, and the Arnold P. Gold Humanism Foundation for providing funding to enable Dr. Wald to serve as a visiting professor to Georgetown University School of Medicine.

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References

1. Karpowicz S, Harazduk N, Haramati A. Using mind–body medicine for self-awareness and self-care in medical school. J Holist Healthc. August 2009;6:19–22
2. Saunders PA, Tractenberg RE, Chaterji R, et al. Promoting self-awareness and reflection through an experiential mind–body skills course for first year medical students. Med Teach. 2007;29:778–784
3. Holden M, Buck E, Clark M, Szauter K, Trumble J. Professional identity formation in medical education: The convergence of multiple domains. HEC Forum. 2012;24:245–255
4. Walach H, Buchheld N, Buttenmüller V, Kleinknecht N, Schmidt S. Measuring mindfulness—the Freiburg Mindfulness Inventory (FMI). Pers Individ Dif. 2006;40:1543–1555
5. Cohen S, Williamson GMSpacapan S, Oskamp S. Perceived stress in a probability sample of the United States. In: The Social Psychology of Health. 1988 Thousand Oaks, Calif Sage Publications, Inc.:31–67
6. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101
7. Sandelowski M. Focus on research methods combining qualitative and quantitative sampling, data collection, and analysis techniques. Res Nurs Health. 2000;23:246–255
8. Cohen S, Janicki-Deverts D. Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. J Appl Soc Psychol. 2012;42:1320–1334
9. Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822–848
10. Haramati A. A perspective on health professions education. Explore (NY). 2013;9:272–273
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Open-Ended Items on a 2014 Survey of Mind–Body Medicine (MBM) Facilitatorsa

  1. Please describe how being an MBM facilitator has impacted your professional life—consider different aspects of your professional life including connections or interactions with others, knowledge sharing, work environment or how you think and feel about yourself in terms of your professional identity.
  2. In what ways, if any, has being an MBM facilitator affected how you interact with other faculty members?
  3. In what ways, if any, has being an MBM facilitator affected how you interact with the students in your group?
  4. In what ways, if any, has being an MBM facilitator affected how you interact with other students (i.e., students not in your MBM group)?
  5. In what ways, if any, has being an MBM facilitator affected how you see yourself as a faculty member in an academic medical center?
  6. Please describe how being an MBM facilitator has impacted your personal life.

aIndividuals were invited to participate if they were trained as MBM facilitators by faculty at Georgetown University School of Medicine and were currently active facilitators of MBM courses at their institutions.

© 2015 by the Association of American Medical Colleges