Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians

Context: Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce. Objective: To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients. Design, Setting, and Participants: Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo). Main Outcome Measures: Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months. Results: Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Δ], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Δ=-6.8; 95% CI, -4.8 to -8.8; depersonalization, 8.4 to 5.9; Δ=-2.5; 95% CI, -1.4 to -3.6; and personal accomplishment, 40.2 to 42.6; Δ=2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Δ=4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Δ=-4.1; 95% CI, -1.8 to -6.4); total mood disturbance (33.2 to 16.1; Δ=-17.1; 95% CI, -11 to -23.2), and personality (conscientiousness, 6.5 to 6.8; Δ=0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Δ=0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r=-0.39, P<.001), perspective taking subscale of physician empathy (r=0.31, P<.001), burnout (emotional exhaustion and personal accomplishment subscales, r=-0.32 and 0.33, respectively; P<.001), and personality factors (conscientiousness and emotional stability, r=0.29 and 0.25, respectively; P<.001). Conclusions: Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.