Mindful medical practice: An innovative core course to prepare medical students for clerkship.

BACKGROUND: Medical students show a decline in empathy and ethical reasoning during medical school that is most marked during clerkship. We believe that part of the problem is that students do not have the skills and ways of being and relating necessary to deal effectively with the overwhelming clinical experience of clerkship. APPROACH: At McGill University in Montreal, starting in January 2015, we have taught a course on mindful medical practice that combines a clinical focus on the combination of mindfulness and congruent relating that is aimed at giving students the skills and ways of being to function effectively in clerkship. The course is taught to all medical students in groups of 20, weekly for 7 weeks, in the 6 months immediately prior to clerkship, a time when students are very open to learning the skills they need to take effective care of patients. EVALUATION: The course has been well accepted by students as evidenced by their engagement, their evaluations, and their comments in the essays that they write at the end of the course. In a follow-up session at the simulation centre one year later students remember clearly and enact what they were taught in the course. REFLECTION: The next steps will be to conduct a formal evaluation of the effect of our teaching that will involve a combination of qualitative methods to clarify the nature of the impact on our students and a quantitative assessment of the difference the course makes to students' experience and performance in clerkship.

Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice.

Recent calls for an expanded perspective on medical education and training include focusing on complexities of professional identity formation (PIF). Medical educators are challenged to facilitate the active constructive, integrative developmental process of PIF within standardized and personalized and/or formal and informal curricular approaches. How can we best support the complex iterative PIF process for a humanistic, resilient health care professional? How can we effectively scaffold the necessary critical reflective learning and practice skill set for our learners to support the shaping of a professional identity?The authors present three pedagogic innovations contributing to the PIF process within undergraduate and graduate medical education (GME) at their institutions. These are (1) interactive reflective writing fostering reflective capacity, emotional awareness, and resiliency (as complexities within physician-patient interactions are explored) for personal and professional development; (2) synergistic teaching modules about mindful clinical practice and resilient responses to difficult interactions, to foster clinician resilience and enhanced well-being for effective professional functioning; and (3) strategies for effective use of a professional development e-portfolio and faculty development of reflective coaching skills in GME.These strategies as "bridges from theory to practice" embody and integrate key elements of promoting and enriching PIF, including guided reflection, the significant role of relationships (faculty and peers), mindfulness, adequate feedback, and creating collaborative learning environments. Ideally, such pedagogic innovations can make a significant contribution toward enhancing quality of care and caring with resilience for the being, relating, and doing of a humanistic health care professional.

Teaching mindfulness in medical school: where are we now and where are we going?

OBJECTIVES: Mindfulness has the potential to prevent compassion fatigue and burnout in that the doctor who is self-aware is more likely to engage in self-care activities and to manage stress better. Moreover, well doctors are better equipped to foster wellness in their patients. Teaching mindfulness in medical school is gaining momentum; we examined the literature and related websites to determine the extent to which this work is carried out with medical students and residents. METHODS: A literature search revealed that 14 medical schools teach mindfulness to medical and dental students and residents. RESULTS: A wide range of formats are used in teaching mindfulness. These include simple lectures, 1-day workshops and 8-10-week programmes in mindfulness-based stress reduction. Two medical schools stand out because they have integrated mindfulness into their curricula: the University of Rochester School of Medicine and Dentistry (USA) and Monash Medical School (Australia). Studies show that students who follow these programmes experience decreased psychological distress and an improved quality of life. CONCLUSIONS: Although the evidence points to the usefulness of teaching mindful practices, various issues remain to be considered. When is it best to teach mindfulness in the trajectory of a doctor's career? What format works best, when and for whom? How can what is learned be maintained over time? Should mindfulness training be integrated into the medical school core curriculum?

Transitions in the lives of patients with End Stage Renal Disease: a cause of suffering and an opportunity for healing.

The treatment of End Stage Renal Disease (ESRD) successfully prolongs the survival of patients with kidney disease but requires that ESRD patients cope with frequent deleterious changes in their health and life situation, and shortened survival. Although the nephrology team is well-equipped to deal with the medical and technical aspects of care, it is less well-equipped to help patients with the impact of the difficult human transitions that come with dialysis and transplant treatment. Times of great challenge can also be opportunities for personal growth and healing but this often requires outside support. We need to develop new resources specifically aimed at helping ESRD patients complete important life transitions and more research on the frequency and impact of these events.