Presence, Resilience, and Compassion Training in Clinical Education (PRACTICE): A Follow-Up Evaluation of a Resident-Focused Wellness Program.

Background: Graduate medical education is demanding, and many residents eventually experience a reduced sense of well-being. Interventions are in development, but knowledge gaps remain in terms of time commitment and efficacy. Objective: To evaluate a mindfulness-based wellness program for residents-PRACTICE (Presence, Resilience, and Compassion Training in Clinical Education). Methods: PRACTICE was delivered virtually by the first author in the winter and spring of 2020-2021. The intervention totaled 7 hours delivered over 16 weeks. An intervention group of 43 residents (19 primary care and 24 surgical) participated in PRACTICE. Program directors electively enrolled their programs, and PRACTICE was integrated into residents' regular educational curriculum. The intervention group was compared to a non-intervention group of 147 residents whose programs did not participate. Repeated measure analyses were conducted before and after the intervention using the Professional Fulfillment Index (PFI) and Patient Health Questionnaire (PHQ)-4. The PFI measured professional fulfillment, work exhaustion, interpersonal disengagement, and burnout; the PHQ-4 measured depression and anxiety symptoms. A mixed model was used to compare scores between the intervention and non-intervention groups. Results: Evaluation data were available from 31 of 43 (72%) residents in the intervention group, and from 101 of 147 (69%) residents in the non-intervention group. Significant and sustained improvements were demonstrated in professional fulfillment, work exhaustion, interpersonal disengagement, and anxiety in the intervention group versus the non-intervention group. Conclusions: Participation in PRACTICE resulted in improvements in measures of resident well-being that were sustained over the 16-week duration of the program.

Presence, resilience, and compassion training in clinical education (PRACTICE): Evaluation of a mindfulness-based intervention for residents.

Background: Residents' well-being tends to decline in the course of training, yet research on preventive and restorative interventions for residents is limited. Mindfulness-based interventions have been successfully employed to support well-being in practicing physicians, but their impacts on residents are not well established. Objective: This paper describes the structure, content, and evaluation of a pilot mindfulness-based intervention program designated PRACTICE (presence, resilience and compassion training in clinical education) that was designed specifically to support resident well-being. Methods: A combined sample of 14 postgraduate year one residents from two residency training programs participated in a four-session (8 h) mindfulness-based intervention in the Fall/Winter of 2018. Participants were surveyed before, after, and at 3 months postintervention, on measures of wellness (Professional Fulfillment Index) and mental health (Patient Health Questionnaire-4), along with measures of program engagement. Results: Participants demonstrated a significant reduction in burnout at the conclusion of the program. Depression and anxiety screening scores also trended toward improvement. However, participants were not able to sustain these gains. Three months after the conclusion of the program wellness measures had returned to preintervention levels. Conclusions: The results of this study support the use of mindfulness-based interventions in resident wellness programs. The lack of an enduring effect indicates the need for a maintenance phase intervention.