The Body in Mind: Understanding Cognitive Processes (Cambridge Studies in Philosophy)

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Greeson JM, Toohey MJ, Pearce MJ. An adapted, four-week mind-body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care. Explore (NY). 2015;11(3):186–92. Our results support those of previous studies on MBM programs for medical students at both American and European universities, which used either PSS [ 14, 20], distress tolerance [ 22], or salivary cortisol levels [ 23] to measure stress reduction. While decreased stress and increased self-care were also among the main results of qualitative MBM course evaluations [ 13, 14, 29], other quantitative studies could not replicate these effects on stress reduction using the PSS [ 7, 13, 33]. Reith TP. Burnout in United States Healthcare Professionals: a narrative review. Cureus. 2018;10(12):e3681. This study included quantitative and qualitative data, each gathered from 11 MBM courses conducted between October 2012 and February 2019. However, between 2013 and 2014, quantitative and qualitative data collection was not upheld for two consecutive courses. Demographic characteristics and SF−12 scores were introduced from October 2015 onwards. A total of 112 medical students were included in the quantitative data analysis. Since the first evaluation of demographic characteristics in 2015, there were 48 female (70.1%) and 20 male (29.9%) participants with a mean age of 26.2 years (range = 19–42, SD = 4.9). Qualitative data were collected from 11 focus groups comprising 87 participants (62 females, 25 males), with an average interview duration of 52.8 min. 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.

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In her paper on problems with psychometric evaluation of health based QoL, Güthlin [ 15] expands on the confounding effect of “response shift”. Outcomes of QoL measurements may reflect real changes or they may be the consequence of “response shift” - a cognitive change in the reference system of the patient or changes in the values and concepts held about health and disease [ 15, 30]. After course participation students reported an increased awareness of the connection between stress, well-being, and self-care practices. However, they also described their difficulties to implement and sustain MBM practices both personally and in the face of a wider academic and medical system often perceived as largely uncaring about self-care practices. Thus, while both qualitative data and a reduction in quantitative stress measure (PSS) support a beneficial effect of course participation on students’ well-being, the overall experience may also have resulted in a shift of values and views that adversely affected QoL appraisal. The strengths of this evaluation include its rich dataset, compiled over eight years, and its mixed-methods approach, which allowed for multiple angles of triangulation between quantitative and qualitative data. However, several limitations emerged as a result of its exploratory nature. Under a pre-post evaluation study design, no control group was established. Furthermore, students voluntarily applied to the course, resulting in self-selection bias, and were selected for admission by faculty members. Within these constraints, sample randomization was not possible and participating students may have held certain beliefs or exhibited traits that predisposed them to benefit from MBM programs. Moreover, a continuous collection of data was not upheld for all courses, as quantitative and qualitative data were unavailable for two consecutive courses. Saunders PA, Tractenberg RE, Chaterji R. Promoting self-awareness and reflection through an experiential mind-body skills course for first year medical students. Med Teach. 2007;29(8):778–84. Learning about MBM and CIM as disciplines of modern medicine was reported as a primary motivation for course enrollment. Some participants sought to acquire proficiency in MBM techniques as tools for their future patient care. Students reported increased knowledge of MBM techniques as a main benefit of the course, emphasizing the value of practical experience. New perspectives on the value of MBM and CIM gained through the course led to what students described as a broader, “more holistic” view of the scope of medical practice and the relationship between healthcare professionals and their patients. Triangulation—experiences of self and the other 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.

Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274–82. Karpowicz SH, Haramati N. Using mind-body medicine for self-awareness and self-care in medical school. J Holist Healthc. 2009;6(Issue 2):p19-22. This 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 Brinkhaus B, Witt C. Making better doctors - using mind-body medicine skills as a self-care element in medical education at the Charite University Medical School. Forsch Komplementmed. 2012;19(1):4–6. During 2012–2019, uncontrolled quantitative and qualitative data were gathered from 112 student participants. Outcomes including changes in perceived stress (PSS), mindfulness (FMI/MAAS), self-reflection (GRAS), self-efficacy (GSE), empathy (SPF), and health-related quality of life (SF-12) were measured between the first (T0) and last sessions (T1). Qualitative data were obtained in focus groups at course completion and triangulated with quantitative data.

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Chen AK, Kumar A, Haramati A. The effect of mind body Medicine course on medical student empathy: a pilot study. Med Educ Online. 2016;21: 31196. Ishak W, Nikravesh R, Lederer S, et al. Burnout in medical students: a systematic review. Clin Teach. 2013;10(4):242–5.Dyrbye LN, Thomas MR, Huntington JL, et al. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81(4):374–84. 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) BiMGirls | Eraudica | PhotoDromm | Superbe.com | Gallery of Nudes | A-M-O-C | OnlyTease | This Year's Model | Zishy.com | Emily Bloom

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Quantitative data were collected through printed and online questionnaires. Participants were asked to complete them before the first and after the last course session. Due to the exploratory nature of this study, no primary or secondary outcomes were predefined; furthermore, no sample size calculation was performed.At a relational level, students` descriptions of group discourse reflect qualities of individual mental states fostered by MBM mindfulness practices such as openness, non-discursiveness and non-judgemental attitude.

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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. 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. 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.Quantitative outcomes showed decreases in perceived stress and increased self-efficacy, mindfulness, self-reflection, and empathy. In focus groups, students reported greater abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. Triangulation grounded these effects of MBM practice in its social context, creating an interdependent dynamic between experiences of self and others. At an organizational level, the MBM course structure alternates between individual exercises and shared group reflections. 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. Hsieh H-F, Shannon SE. Three Approaches to qualitative content analysis. Qual Health Res. 2005;2005(11/01):1277–88.