Mindfulness in medical education: coming of age
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Perspect Med Educ https://doi.org/10.1007/s40037-020-00598-w
Mindfulness in medical education: coming of age Ronald M. Epstein
© The Author(s) 2020
The word ‘mindfulness,’ relatively unheard-of in medical education before 1998, has become a guiding principle of some thoughtful efforts to promote reflection, self-awareness and well-being in pre- and post-graduate and continuing medical education. Mindfulness refers equally to attentive focus and adapting to the unexpected in the operating room as it does to conducing a family meeting regarding a dying patient. While the emphasis on mindfulness is welcome for those entering and practicing an increasingly beleaguered profession, the term has also become popularized, conflated with particular techniques and practices, and associated with claims that range from the sensible to the sensational. There is also confusion about what ‘being mindful’ actually is, reflected in the divergent and heterogeneous educational programs claiming to cultivate it [1, 2]. Mindfulness, in my view, is not a ‘thing’ but rather a vector; it is dynamic and heading toward goals that are pragmatic and ethically robust. In fact, the origins of the word ‘mindfulness’ are within the context of a philosophical frame that emphasizes ‘right mindfulness’ as one of eight principles for living a righteous and transformative life. Mindfulness is not the same as reflection. While reflection often refers to activities undertaken after-the-fact (what the educator Donald Schön called ‘reflection on action [3]’), mindfulness is more akin to Schön’s ‘reflection in action’—it is a practice in the moment. Mindfulness in medicine includes the capacity for non-judgmental attention to self and other in the moment during every day work—and with the goal to act with clarity, resolve, compassion, practical wisdom and interpersonal efR. M. Epstein () Family Medicine, University of Rochester Medical Center, Rochester, NY, USA [email protected]
fectiveness [4]. Particularly important are the qualities of presence, curiosity and beginner’s mind—the capacity to see a familiar situation with new eyes and hold two or more contrasting perspectives at the same time without the need for premature resolution [5]. Leaving those skills for discussion in rounds the next day is helpful, but not enough. In these times of pandemic virus, gut-wrenching angst and epistemic uncertainty, the need for moment-to-moment clarity, tolerance of ambiguity, emotional intelligence and ethical awareness—framed by an ability to hold contradictions and inconstancies in information and guidance—is greater than ever. Moreover, our responsibility as medical educators is to make every effort to help our students and junior colleagues acquire those capabilities. The clarity of intent and methods in the Show and Tell in this issue by Tom Hutchinson and Stephen Liben about their novel curricular elements at McGill University are particularly welcome [6]. Their program addresses important issues such as the relationship between self-aware
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