Plenary2-02: KEY LOGISTICAL FACTORS FOR MINDFULNESS-BASED BURNOUT INTERVENTIONS IN SURGERY
Aditi Desai, Ekaterina Guvva, BS, Carter Lebares, MD; UCSF Surgery

Introduction: Burnout and distress in physician trainees are potent and increasingly prevalent issues. The few effective interventions to date may reflect our poor understanding of key logistical elements underlying feasibility and acceptability. Formal mindfulness training (MT) among surgical interns has been shown to be feasible and acceptable when institutional, systemic and individual factors are clarified and addressed. Early evidence of benefits regarding well-being, executive function and performance suggests that defining these critical elements is worthwhile. However, in other groups of trainees, feasibility and acceptability of MT depends on factors that are partly unique. Here we explore the logistical and structural factors critical for successful implementation of MT among diverse groups of physician trainees at our institution.

Method: Using mixed methods, the key elements underlying feasibility and acceptability of MT were explored in three different studies: a longitudinal pilot randomized controlled trial of surgery interns (n=40), a cohort study of mixed level urology residents (n=20), and a registered clinical trial of surgical and non-surgical interns (n=41). Group means were compared for attendance, attrition and daily home practice, with differences evaluated in the context of concepts and themes derived from grounded theory analysis of focus group feedback, field notes, satisfaction surveys and key informant interviews. Structural and logistical factors for MT feasibility and acceptability were identified across groups.

Results: Scheduling, protected time and a clear statement of value from leadership were found to be critical factors for MT success.  Training during the work week was essential. Utilizing established educational days and natural lulls in the academic year helped minimize conflicts with service obligations and didactic learning. Protection from service obligations was also essential, with decreased participation and perceived benefit when absent.  Attribution of value by leadership set the cultural attitude surrounding MT, affecting perceived credibility and colleagues’ willingness to provide coverage without hostility or retribution.

Conclusion: Our results suggest that scheduling, protected time and leadership support are inter-related and critical factors for the feasibility and acceptability of MT. Addressing such elements early may ease the work of implementing this promising intervention within surgical training.