It is commonly understood that students undergoing medical training need to cope with high levels of stress from various stressors. Some examples of stressors faced by medical students include issues related to their studies, personal psychosocial problems, as well as existential crises. At extreme circumstances, these stressors may push medical students to suffer from various psychological disorders, damage their sense of identity, ethics, and relationships with people surrounding them. According to prior research, the practice of mindfulness has shown to be effective in reducing stress, not only for medical students, but also the general public. Mindfulness refers to the action of deliberately being aware of the situation that is currently occurring without any judgement towards it. Mindfulness-based stress reduction (MBSR) is an intervention that involves different formal and informal mindfulness practices.
Rosenzweig, Reibel, Greeson, Brainard, & Hojat (2003) conducted a study between autumn 1996 to autumn 2000, which aimed to investigate the efficacy of administering MBSR intervention to the psychological states of second-year medical students. This five-year study involved 302 second-year students at Jefferson Medical College in a prospective, non-randomised, cohort-controlled study. As it is a prospective study, a repeated measure design is used to observe the impact of MBSR intervention on the mood disturbances of the medical students. Therefore, all 302 participants completed the Profile of Mood States (POMS) prior and after the study. The medical students were divided without randomisation into two groups; MBSR (experimental) and control, according to which elective seminar they chose to be in. The MBSR group which consisted of 140 participants attended seminars which taught different MBSR techniques including breathing awareness, mindful stretching, and various types of meditation. On the other hand, 162 medical students in the control group attended seminars on complementary and alternative medicine, which involved didactic sessions, demonstrations, presentations, and group discussions. Seminars for both groups were conducted for 90 minutes in 10 weekly sessions.
The independent variable of this study was the implementation of the MBSR intervention. In addition to the content difference in the seminar of both groups, the MBSR and control groups differ in terms of how the participants practised the knowledge they gained throughout the seminars. The MBSR group received a daily meditation audiocassette, and a home assignment, which was to practice formal meditation for 20 minutes daily, six days a week. In contrast, the control group participants were only exposed to basic mind-body techniques but were not trained formally. Analysis was done to detect changes in total mood disturbance (TMD) before and after the seminars for both MBSR and control groups. Based on the results of this study, it can be concluded that there is significant evidence of MBSR being an effective stress coping mechanism for medical students.
Participants in the MBSR group showed significantly improved mood states and decreased TMD scores as compared to their counterparts in the control group. In addition, students in the MBSR course reported that the practice was very helpful for them to be more mindful in daily life and cope with stressors better. This study used a repeated measures design by testing the psychological well being of the participants before and after the seminar sessions.
This is an advantageous design as it controls for confounding variables that may arise due to individual differences. One of the strengths of this study lies within the instrument used to measure the impact of MBSR on the participants. The measure used in this study was the POMS, a 56-item self-report inventory with rating scales for six distinguishable mood states, which are Tension-Anxiety, Depression-Dejection, Anger-Hostility, Fatigue-Inertia, Vigor-Activity, and Confusion-Bewilderment (McNair, Lorr, & Doppelman, 1984).
The use of the POMS is justified and valid, as it measures the dependent variable, which is the effect of the intervention on the psychological states of the medical students. The validity and reliability of this instrument has also been demonstrated by various studies which involved different samples from different populations. Examples of the aforementioned studies are the study by Gibson (1997), which measured the mood states of older adults, as well as the study by Yokoyama, Araki, Kawakami, and Tkakeshita (1990), which tested the Japanese edition of the POMS on 354 healthy males. The overall findings of this study support the idea of MBSR being an effective intervention for medical students to cope with stress. The authors provided detailed explanations of the results, which include the difference between pre-test and post-test scores for each of the six subscales and the TMD in the POMS for both groups of participants, whether or not the impact of the intervention was significant, and the effect size, which was calculated to test if the differences observed had any clinical significance. According to Coe (2002), using the effect size as a way to gauge the differences between two groups is a much more advantageous way as compared to relying solely on statistical tests, such as the multivariate analysis of variance (MANOVA) and the analysis of variance (ANOVA) that were used in the study by Rosenzweig et al. (2003).
This is because the effect size describes the strength of the relationship between the two variables involved in the study and eliminates the effect of a big sample size, which is an aspect that may cause statistical tests to produce significant results. Another limitation that can be analysed is that POMS is a self-report questionnaire, where participants need to rate their distinct feelings at the current moment. A suggestion for an appropriate physiological test to compare pre-test and post-stress mood disturbances is by drawing blood samples to measure natural killer (NK) cells activity. It was found in a study by Kiecolt-Glaser et al. (1984) that lower count of NK cells in a blood sample correlates to higher stress levels. A way to improve this is to administer more than one test to measure the psychological distress of the participants.
Using more than one test can result in an increase in the reliability of the result. Each measure or test may have several weaknesses, such as the absence of aspects that are prominent to determine the actual severity of the psychological distress experienced by the medical students. Although reliability of test is shown in numerous studies, there are various tests to measure psychological distress.
As suggested above, physiological tests can be administered to measure psychological distress.Rosenzweig et al (2003) suggested future research to investigate the correlation between the reduction of stress level with the academic achievement and clinical performance of medical students.