Kathi J. Kemper

What Factors Promote Resilience and Protect Against Burnout in First-Year Pediatric and Medicine-Pediatric Residents?

Burnout has high costs for pediatricians and their patients. There is increasing interest in educational interventions to promote resilience and minimize burnout among pediatric trainees. This study tested a conceptual model of factors that might promote resilience and protect against burnout, and which could serve as targets for addressing burnout in pediatric residents. Questionnaires were administered in a cross-sectional survey of (n = 45) first-year pediatric and medicine-pediatric residents. A minority (40%) of residents met one or more criteria for burnout. Physician empathy and emotional intelligence were not significantly correlated with burnout or resilience. Self-compassion and mindfulness were positively associated with resilience and inversely associated with burnout. Thus many residents in this sample endorsed burnout; mindfulness and self-compassion were associated with resilience and may promote resilience and protect against burnout in these trainees. Future studies should explore the impact of training in mindfulness and self-compassion in pediatric trainees.

Acute Effects of Online Mind-Body Skills Training on Resilience, Mindfulness, and Empathy

Background. Some studies have begun to show benefits of brief in-person mind–body skills training. We evaluated the effects of 1-hour online elective mind–body skills training for health professionals on mindfulness, resilience, and empathy. Methods. Between May and November, 2014, we described enrollees for the most popular 1-hour modules in a new online mind–body skills training program; compared enrollees’ baseline stress and burnout to normative samples; and assessed acute changes in mindfulness, resilience, and empathy. Results. The 513 enrollees included dietitians, nurses, physicians, social workers, clinical trainees, and health researchers; about 1/4 were trainees. The most popular modules were the following: Introduction to Stress, Resilience, and the Relaxation Response (n = 261); Autogenic Training (n = 250); Guided Imagery and Hypnosis for Pain, Insomnia, and Changing Habits (n = 112); Introduction to Mindfulness (n = 112); and Mindfulness in Daily Life (n = 102). Initially, most enrollees met threshold criteria for burnout and reported moderate to high stress levels. Completing 1-hour modules was associated with significant acute improvements in stress (P < .001), mindfulness (P < .001), empathy (P = .01), and resilience (P < .01). Conclusion. Online mind–body skills training reaches diverse, stressed health professionals and is associated with acute improvements in stress, mindfulness, empathy, and resilience. Additional research is warranted to compare the long-term cost-effectiveness of different doses of online and in-person mind–body skills training for health professionals.

Complementary and conventional medicine use among youth with recurrent headaches

OBJECTIVE: To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care. METHODS: Variables were constructed for youth aged 10 to 17 by using linked data from the 2007 National Health Interview Survey and the 2008 Medical Expenditures Panel Survey. Bivariate, logistic, and 2-part regression analyses were used. RESULTS: Of the 10.6% of youth experiencing HA, 29.6% used CAM, rising to 41% for the many HA sufferers who also experienced difficulties with emotions, concentration, behavior, school attendance, or daily activities. Biologically based products (16.2%) and mind-body therapies (13.3%) were most commonly used, especially by the 86.4% of youth with HA experiencing at least 1 other chronic condition. Compared with non-CAM users, youth with HA who used CAM also had higher expenditures for and use of most types of conventional care. CONCLUSIONS: CAM use is most common among youth with HA experiencing multiple chronic conditions and difficulties in daily functioning. Associations among CAM use, multiple chronic conditions, and higher use of conventional care highlight the need for medical providers to routinely ask about CAM use to meet the complex health needs of their patients and facilitate the optimal integration of care. Research is needed to identify models for coordinating complementary and conventional care within a medical home and to understand the health benefits or risks associated with CAM use in conjunction with conventional treatments for patients with HA.

What Is the Impact of Online Training in Mind–Body Skills?

Background. Mind–body skills (MBS) training is popular, but in-person training can be inconvenient and costly. We assessed the impact of online MBS training on clinicians’ and trainees’ stress, mindfulness, and confidence in providing calm, compassionate care. Methods. This was a prospective cohort trial. Trainees entering medical school; graduate programs in nursing, social work, and dietetics; and residencies in family medicine and pediatrics at a large Midwestern academic health center were invited to complete online surveys before and 12 weeks after enrolling in online elective integrative health courses on MBS training or not. The elective offered no course credit and had no mandated deadlines for completion. Results. At baseline, the 60 who engaged in MBS training were similar to the 43 who did not in terms of profession, gender, perceived stress levels, mindfulness, resilience, and compassion. MBS participants engaged in a median of 3 of 12 available modules with a bimodal distribution peaking at 1 to 2 and 12 modules. Twelve weeks later, those who participated in MBS showed significantly greater improvements in measures of stress, mindfulness, and confidence in providing calm, compassionate care than those who did not. Conclusions. Online elective training offers a feasible strategy to improve mindfulness, stress, and confidence in providing calm, compassionate care. Additional studies are needed to determine the impact of required versus elective courses, the optimal dosage and content of training, and the costs and benefits of online versus in-person training.

Group Online Mindfulness Training Proof of Concept

Mindfulness-based stress reduction training is attractive, but training with an expert teacher is often inconvenient and costly. This proof-of-concept project assessed the feasibility of providing a hybrid of free online mindfulness-based stress reduction training with small group peer facilitation. Six medical students asked a family medicine resident with 5 years of meditation experience but no formal training as a teacher to facilitate 8 weekly group sessions using a free online mindfulness-based stress reduction course. They completed pre- and posttraining questionnaires online. Six of the 7 trainees completed at least half the sessions. Completers and noncompleters had similar age (29 years), gender (about half male), and health status. Changes in the expected direction were observed for perceived stress, mindfulness, resilience, and confidence in providing calm, compassionate care. The hybrid of online mindfulness-based stress reduction training with peer support is feasible. Additional research is warranted to formally evaluate the impact of this approach.

Factors Associated With Well-being and Confidence in Providing Compassionate Care:

We explored the relationships between potentially modifiable factors (mindfulness and self-compassion), intermediate factors (resilience and stress), and outcomes of interest in a cross-sectional study of medical trainees (compassionate care and clinician well-being). Among the 12 participants, the average age was 27.6 years. Mindfulness and self-compassion were positively associated with confidence in providing calm, compassionate care (r = 0.91 and 0.81, respectively; P < .01); they were also positively correlated with clinician resilience (P < .01), which was correlated with clinician mental health (r = 0.83; P < .01). Perceived stress was strongly and significantly negatively correlated with all measures (rs ranging from –0.62 for flourishing to –0.92 for confidence in delivering calm, compassionate care; P < .05 for all correlations). Given the positive correlations between mindfulness and self-compassion with both clinician well-being and confidence in providing calm, compassionate care, interventional studies are warranted to determine what kind of training most efficiently and effectively improves trainee mindfulness and self-compassion.

Brief Online Mindfulness Training: Immediate Impact

Background. Online training is feasible, but the impact of brief mindfulness training on health professionals needs to be better understood. Methods. We analyzed data from health professionals and trainees who completed self-reflection exercises embedded in online mindfulness training between May 2014 and September, 2015; their changes in mindfulness were measured using standardized scales. Results. Participants included nurses (34%), physicians (24%), social workers and psychologists (10%), dietitians (8%), and others (25%); 85% were women, and 20% were trainees. The most popular module was Introduction to Mindfulness (n = 161), followed by Mindfulness in Daily Life (n = 146), and Mindful Breathing and Walking (n = 129); most (68%) participants who took 1 module took all 3 modules. There were no differences in participation in any module by gender, trainee status, or profession. Completing modules was associated with small but significant improvements on the Cognitive and Affective Mindfulness Scale–Revised, the Mindful Attention Awareness Scale, and the Five Facet Mindfulness Questionnaire (P < 0.001 for all). Conclusion. Online training reaches diverse health professionals and is associated with immediate improvements in mindfulness. Additional research is warranted to compare the long-term cost-effectiveness of different doses of online and in-person mindfulness training on clinician burnout and quality of care.

Online Training in Specific Meditation Practices Improves Gratitude, Well-Being, Self-Compassion, and Confidence in Providing Compassionate Care Among Health Professionals:

Mind-body practices that intentionally generate positive emotion could improve health professionals’ well-being and compassion. However, the feasibility and impact of clinician training in these practices is unknown. Data were analyzed from 3 online modules offered to health professionals: (a) Gratitude, (b) Positive Word, and (c) Loving-kindness/Compassion meditation. Paired t tests were used to assess pre- to posttraining changes in gratitude (Gratitude Questionnaire), well-being (World Health Organization Well-Being Index), self-compassion (Neff’s Self-Compassion Scale), and confidence in providing compassionate care (Confidence in Providing Calm, Compassionate Care Scale). The 177 enrollees included diverse practitioners (nurses, physicians, social workers, and others). Training was associated with statistically significant improvements in gratitude (38.3 ± 4.6 to 39.5 ± 3.3), well-being (16.4 ± 4.0 to 17.9 ± 4.2), self-compassion (39.5 ± 8.1 to 43.1 ± 7.6), and confidence in providing compassionate care (73.3 ± 16.4 to 80.9 ± 13.8; P < .001 for all comparisons). Brief, online training appeals to diverse health professionals and improves their gratitude, well-being, self-compassion, and confidence in providing compassionate care.

Preaching to the choir: comparing health professionals who enroll in mind-body skills versus herbs and dietary supplements training?

Background. Observational studies evaluating elective training programs may be biased if learners who enroll differ from nonenrollees. To assess self-selection bias, we compared participants who enrolled in 2 different online courses in complementary and alternative medical therapies. Methods. Participants were recruited from entering classes in medicine, nursing, social work, and dietetics, and residencies in family medicine and pediatrics. The 2 electives were (a) herbs and dietary supplements and (b) mind–body skills training. Participants completed standardized questionnaires before training. Results. The 218 participants had an average age of 28 years; 76% were trainees. There were no significant differences between enrollees in mind–body skills and herbs and dietary supplements with regard to age, gender, stress levels, mind–body training or practice, mindfulness, empathy, compassion, or resilience. Conclusions. Those who enroll in mind–body skills are not measurably different than those who enroll in herbs and dietary supplements. There is no evidence of self-selection bias or “preaching to the choir.”

Loving-Kindness Meditation’s Effects on Nitric Oxide and Perceived Well-being: A Pilot Study in Experienced and Inexperienced Meditators

BACKGROUND Meditation is associated with lower blood pressure, but little is known about how loving-kindness meditation affects nitric oxide (NO) metabolism, a key mediator of cardiovascular physiology associated with vasodilation. METHODS We studied seven inexperienced and five experienced healthy meditators at one study visit, after they refrained from eating nitrate-rich foods for at least 12h. Participants completed questionnaires on demographics and meditation practices. We measured nitrite and nitrate and self-reported stress at baseline, after a neutral reading period (prior to meditation), immediately after, and 10 min following a standardized 20-min loving-kindness meditation. RESULTS The 12 subjects had a mean age of 51 years, and two were male. Stress was significantly lower at baseline in the experienced group (15 vs. 49 on 100 point scale, P < .05) as was heart rate (HR) [68.1 ± 0.5 beats per minute (bpm) vs. 73.4 ± 0.7 bpm, P < .05]. Stress levels fell significantly with meditation (52 vs. 11, P < .05), while relaxation increased (55 vs. 89, P < .05) in the inexperienced group. Plasma nitrite levels were not significantly higher, but nitrate levels were more than twice as high (P < .05) for experienced vs. inexperienced meditators before and after loving-kindness meditation. CONCLUSION Loving-kindness meditation is associated with stress reduction in inexperienced meditators. Experienced meditators had higher nitrate levels, trended toward having higher nitrite levels, and had significantly lower stress levels than inexperienced meditators. Nitric oxide metabolism may be involved in the cardiovascular effects of persistent meditation practice. Larger longitudinal studies would be fruitful to better understand the mechanisms involved.