Medical and psychology students' knowledge of and attitudes towards mindfulness as a clinical intervention.

BACKGROUND: Mindfulness is a technique for training people to pay full attention and to fully accept the reality of what they are paying attention to. The clinical efficacy of mindfulness has been increasingly demonstrated during the last two decades. Very little research, however, has been undertaken on health professionals' and students of health professions' knowledge of and attitudes towards mindfulness. These may affect the current and future level of use of a technique that offers important clinical advantages. OBJECTIVES: We aimed to compare knowledge of and attitudes towards mindfulness of medical students without exposure to it in their training with psychology students without exposure and with medical students with exposure to mindfulness in their training. METHODS: A total of 91 medical students from Monash University, 49 medical students from Deakin University, and 31 psychology students from Deakin University were given a questionnaire that elicited quantitative and qualitative responses about level of knowledge of mindfulness and willingness to administer or recommend it to their future patients. RESULTS: Psychology students without exposure to mindfulness in their training have a greater knowledge of it and are more likely to administer it or recommend it than are medical students without exposure to it in their training. Medical students with exposure to mindfulness in their course have a greater knowledge of it and are more likely to administer it or recommend it than are medical students without exposure. Knowledge of mindfulness is positively correlated with students' willingness to use or recommend it. CONCLUSIONS: Possible implications of the findings of this study are that if future doctors are routinely instructed in mindfulness as a clinical intervention they may be more likely to form a more positive attitude towards it, that is more consistent with that of nonmedical health professions such as psychologists, and that they therefore may be more likely to administer it or refer its use. The inclusion of mindfulness exposure in medical courses, and possibly also in psychology courses, may help mindfulness fulfill its clinical potential, and increasingly benefit patients who are suffering from a range of clinical conditions.

Managing multiple sclerosis in primary care: are we forgetting something?

Multiple sclerosis (MS) is the commonest debilitating, progressive neurological disorder in most Western countries. It is important for many reasons, including the personal costs, levels of disability produced, age group affected and the resultant economic burden placed on individuals, families and the community. Although it is thought to be an autoimmune condition, in general little is understood about the causation of MS and the factors that trigger or contribute to exacerbations and deterioration. This overview of the literature will consider some important studies examining the relationship between lifestyle and psychosocial factors and MS progression. These studies suggest that nutrition, sunlight, exercise, stress and social factors can all modulate the rate of progression of MS and the level of disability. Although appearing in respected journals, this information tends to be little known or discussed by clinician and patient alike. If lifestyle approaches do offer potential avenues for therapy, this raises important questions regarding the management of MS in primary care. More widely prescribed conventional medicines have been studied in more detail but are only modestly effective and may have significant side-effects. Are we presently neglecting the most effective approach of combining the non-drug or holistic approach with the best of conventional pharmaceutical therapies, and if so what are the implications of this omission?

Bringing holism into mainstream biomedical education.

Introducing holism and complementary medicine into mainstream medical education provides many scientific, philosophical, and personal challenges. The growth of new knowledge always necessitates venturing into areas, which are, by definition, unknown, hence arise potential clashes of ideology, knowledge, evidence, interpretation, language, and personality. This paper outlines some of the experience and progress made at Monash University Victoria, Australia, in teaching this material in undergraduate medical education. The Monash medical course has always been known for its commitment to an integrated curriculum, a holistic perspective, and the personal development of its students. Some of the points of integration in the core curriculum already achieved include health enhancement and mindfulness-based stress management programs right from first year, lectures and forums on complementary medicine, integration of this material into weekly case-based teaching, and health promotion and mind-body medicine. For very interested students, electives provide an opportunity to explore subjects in more depth. Experience has taught us that it is as important to learn how to deliver the message as it is to refine its content. This presents challenges that are as much personal as they are intellectual. Areas of particular importance are the academic environment, language, diplomacy, style, relevance, and evidence. In this process, building relationships, collegiality, patience, objectivity, impartiality, and humor are helpful.