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Cited by 131Mindfulness and Compassion InterventionsHealthcare professionals’ stress and burnoutSurgical Simulation and Training

Efficacy of Mindfulness-Based Cognitive Training in Surgery: Additional Analysis of the Mindful Surgeon Pilot Randomized Clinical Trial

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Lebares, Carter C., Guvva, Ekaterina V., Olaru, Maria, Sugrue, Leo P., Staffaroni, Adam M., Delucchi, Kevin L., Kramer, Joel H., Ascher, Nancy L. +1 more·2019·JAMA Network Open
DOI 10.1001/jamanetworkopen.2019.4108PMC PMC6632137
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Abstract

Importance: Mindfulness meditation training has been shown to be feasible in surgical trainees, but affective, cognitive, and performance benefits seen in other high-stress populations have yet to be evaluated. Objective: To explore potential benefits to stress, cognition, and performance in postgraduate year 1 (PGY-1) surgery residents receiving modified mindfulness-based stress reduction (modMBSR). Design, Setting, and Participants: This follow-up study is an analysis of the Mindful Surgeon pilot randomized clinical trial of modMBSR (n = 12) vs an active control (n = 9), evaluated at baseline (T1), postintervention (T2), and 1 year (T3), took place at an academic medical center residency training program among PGY-1 surgery residents. Data were collected between June 2016 and June 2017 and analyzed from June 2017 to December 2017. Interventions: Weekly 2-hour modMBSR classes and 20 minutes of daily home practice during an 8-week period vs an active control (different content, same structure). Main Outcomes and Measures: Preliminary evidence of efficacy was explored, primarily focusing on perceived stress and executive function and secondarily on burnout, depression, motor skill performance, and changes in blood oxygen level-dependent functional neuroimaging during an emotion regulation task. Group mean scores were calculated at T1, T2, and T3 and in linear mixed-effects multivariate analysis. Effect size for analysis of covariance is presented as partial η2 with the following cutoff points: small, less than 0.06; medium, 0.06 to 0.14; large, greater than 0.14. Results: Postgraduate year 1 surgery residents (N = 21; 8 [38%] women) were randomized to a modMBSR arm (n = 12) or an active control arm (n = 9). Linear mixed-effects modeling revealed differences at T2 and T3 in perceived stress (mean [SD] difference at T2: modMBSR, 1.42 [5.74]; control, 3.44 [6.71]; η2 = 0.07; mean [SD] difference at T3: modMBSR, 1.00 [4.18]; control, 1.33 [4.69]; η2 = 0.09) and in mindfulness (mean [SD] difference at T2: modMBSR, 3.08 [3.63]; control, 1.56 [4.28]; η2 = 0.13; mean [SD] difference at T3: modMBSR, 2.17 [3.66]; control, -0.11 [6.19]; η2 = 0.15). Burnout at T2 (mean [SD] difference: modMBSR, 4.50 [9.08]; control, 3.44 [6.71]; η2 = 0.01) and T3 (mean [SD] difference: modMBSR, 5.50 [9.96]; control, 5.56 [9.69]; η2 = 0.01) showed similar increase in both groups. Working memory increased more at T2 in the modMBSR arm (mean [SD] difference, 0.35 [0.60]) than in the control arm (mean [SD] difference, 0.21 [0.74]; η2 = 0.02) and at T3 (modMBSR, 0.68 [0.69]; control, 0.26 [0.58]; η2 = 0.20). Cognitive control decreased more in the control arm at T2 (mean [SD] difference at T2: modMBSR, 0.15 [0.40]; control, -0.07 [0.32]; η2 = 0.13) and at T3 (mean [SD] difference: modMBSR, 0.07 [0.59]; control, -0.26 [0.53]; η2 = 0.16). Mean (SD) circle-cutting time improved more at T2 in the modMBSR arm (-24.08 [63.00] seconds) than in the control arm (-4.22 [112.94] seconds; η2 = 0.23) and at T3 in the modMBSR arm (-4.83 [77.94] seconds) than in the control arm (11.67 [145.17] seconds; η2 = 0.13). Blood oxygen level-dependent functional neuroimaging during an emotional regulation task showed unique postintervention activity in the modMBSR arm in areas associated with executive function control (dorsolateral prefrontal cortex) and self-awareness (precuneus). Conclusions and Relevance: In this pilot randomized clinical trial, modMBSR in PGY-1 surgery residents showed potential benefits to well-being and executive function, suggesting a powerful role for mindfulness-based cognitive training to support resident well-being and performance, as mandated by the Accreditation Council for Graduate Medical Education. Trial Registration: ClinicalTrials.gov identifier: NCT03141190.

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  • These barriers are consistent with reports from medical students and trainees facing similar pressures.

    “These barriers are consistent with reports from medical students and trainees facing similar pressures [20, 30, 33].”

    From Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation (2025) · cites this paper as [30]

    The Methods (Trial Overview; page unavailable) report that two surgery residents were withdrawn because study sessions conflicted with required teaching, and the Introduction describes overwhelming stress among physicians. The paper therefore supports pressures and a scheduling barrier for trainees, but it does not establish that medical students faced the same barriers. (LLM, conf=0.78)

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  • Our findings provide the first evidence of the effectiveness of ESRT in graduate-entry medical students, complimenting findings reported in US- and UK-based surgical trainees.

    “Our findings provide the first evidence of the effectiveness of ESRT in graduate-entry medical students, complimenting findings reported in US- and UK-based surgical trainees [23, 30–32].”

    From Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation (2025) · cites this paper as [30]

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1 of the 76 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [9]Bohman B, Dyrbye L, Sinsky C, Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. https://catalyst.nejm.org/physician-well-being-efficiency-wellness-resilience. Accessed March 11, 2019.

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Authors
Lebares, C. C., Guvva, E. V., Olaru, M., Sugrue, L. P., Staffaroni, A. M., Delucchi, K. L., Kramer, J. H., Ascher, N. L., & Harris, H. W.
Affiliations
University of California, San Francisco (US)
Corresponding author
Lebares, Carter C.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2019-05-24
Volume
2
Issue
5
Pages
e194108
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2019.4108
PMC
PMC6632137
OpenAlex
W2945828971
Cited by
131
References
76
Citations by year
2026: 7 · 2025: 26 · 2024: 17 · 2023: 10 · 2022: 27 · 2021: 26 · 2020: 14 · 2019: 4
FWCI
20.73
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Health Sciences › Medicine › Surgery › Surgical Simulation and Training
Keywords
mindfulness-based stress reduction, surgical residents, perceived stress, executive function, burnout, depression, motor skill performance, emotion regulation, functional neuroimaging, mindfulness meditation, surgical training
MeSH terms
Adult, Attitude of Health Personnel, Cognition, Curriculum, Education, Medical, Graduate, Female, Humans, Internship and Residency, Male, Pilot Projects, Stress, Psychological, Young Adult, Mindfulness, Surgeons

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