Mindfulness-Based Training Improves Technical Skills and Emotional Regulation for Surgical Residents

Mindfulness is defined as moment-to-moment awareness cultivated by paying attention in a specific way, nonreactively and nonjudgmentally, to the unfolding of an experience.1 Many surgeons naturally practice a form of mindfulness while performing surgery.2 Yet few studies focus on mindfulnessbased practices for surgeons. Lebares et al3 previously demonstrated the feasibility of a formal mindfulness-based stress reduction program for postgraduate year 1 surgery residents. This involved weekly 2-hour sessions and 20-minute daily home practice over an 8-week period. In their follow-up study “Efficacy of Mindfulness-Based Cognitive Training in Surgery: Additional Analysis of the Mindful Surgeon Pilot Randomized Clinical Trial,”4 the authors report their study outcomes at baseline, postintervention, and at 1 year using validated questionnaires and magnetic resonance imaging. Twelve interns participated in the mindfulness group and 9 participants were randomized to the control group, which offered an alternative self-care program. Although this pilot trial was underpowered, preliminary evidence revealed improved well-being and performance after mindfulness training. Magnetic resonance imaging after the intervention showed unique activation in brain regions associated with executive function and emotional regulation in the mindfulness group. During residency, simulation and repetitive hands-on experience are mechanisms to cultivate the attention required to maintain focus during long, complex procedures; the composure to deal with bleeding and unexpected intraoperative events; and the equanimity to navigate medical emergencies. However, the current surgical training paradigm does not uniformly or consistently address the emotional consequences of life-and-death decision making or the impact of surgical complications on surgeon well-being.5 The intensity of surgical training leaves little time to understand oneself or navigate interpersonal relationships. Restrictions on resident work hours do not translate into less perceived work-related stress or meaningful use of time. Burnout, as defined by “prolonged response to chronic emotional and interpersonal stressors of the job,”6 is an ongoing epidemic reported in 69% of surgery residents. Mechanisms to improve surgical resident work-life balance are under critical evaluation by the Accreditation Council for Graduate Education, but the optimal resident well-being curriculum has yet to be determined. Riall et al7 demonstrated that implementation of a formalized well-being program during surgical resident training has intangible benefits, creating a sense of community and culture that encourages self-care. Mindfulness meditation provides an alternative approach to the way one perceives and relates to stress. Organized meditation programs have been successfully applied to high-performing groups such as professional athletes, military personnel, and Google executives. Mindfulness can be cultivated through understanding the principles and by practicing awareness using tools such as breathing, meditation, and yoga. Mindfulness is distinct from other forms of self-care such as exercise, which improves the body’s physical condition, or television binging, vacation, and alcohol use, which are methods used to escape, forget, or avoid uncomfortable experiences. Through the formal process of directly observing the workings of one’s own mind, the mind becomes more disciplined, more accepting, and less reactive. By offering a formalized mindfulness program to trainees, Lebares et al3,4 provided skills translatable to both personal and professional capacities. Unfortunately, burnout scores increased in both the mindfulness and control groups, which can be attributed to small sample size or lack of + Related article