“Breaking Burnout: A Personal Reflection on Mindfulness Exercises for Physicians”

Burnout is frequently a problem for medical students, residents, and attending staff throughout all levels of training. Burnout reduction strategies are of particular focus given a severe shortage of physicians. This mini review article is a reflection of a previously skeptical resident who found that mindfulness activities were refreshingly effective in stress reduction and improving personal performance in patient care.


Introduction
Physician burnout is an increasingly prevalent cause of clinical underperformance which inevitably negatively impacts patient care [1]. Interventions to alleviate physician burnout have included workshops for improving verbal communication, teamwork, and leadership skills [2][3][4]. Mindfulness activities such as reflection, sensory awareness activities, and Yoga for staff, residents, and medical students also reduce burnout at all levels of training [2][3][4]. The benefits of mindfulness and Yoga on stress management have also been demonstrated to extend broadly to nurses, teachers, police officers, and military personnel [5][6][7][8][9][10]. Unsurprisingly, mindfulness is an effective nonpharmacologic therapy for psychogenic disorders, dysthymia, and stress reduction in the general population [11][12][13]. This article is a reflection on the writer's personal experience with mindfulness, sensory awareness activities, and Yoga as part of the standard curriculum for pediatrics graduate medical education at Indiana University. Reduction of internalized anxiety and negative talk in the workplace was found to concomitantly promote resilience and restoration of effective clinical performance.

Discussion
My first experience with participation in mindfulness activities at work was initially met with cynicism. "What would using the next 20-30 minutes for nothing achieve on my long check list?", I remember internalizing. At least the afternoon consisted of mindfulness activities, so the check list was not multiplying by the second as it would on the inpatient service or in clinic.
Our first activity was to be mindful of our thoughts as we were guided by our mentor with eyes closed in a quiet place. We were instructed to recall a conflict, emotional case, or other tumultuous circumstance and to analyze our thoughts. We first reflected on our anger, frustration, or worries at the thought of revisiting such times, though we were given tools to address and release these negative thoughts. We were instructed to acknowledge the emotions, to be curious about them for a time, and to let them go when we understood them well. We again practiced this with other negative emotions and even happily restless situations. With each round of this simple 3 step exercise, I saw the power of mindfulness for reflection, even if it was only a personalized internal debrief. I would recall an emotionally charged situation, analyze the emotion in a nonjudgmental fashion by identifying its existence and questioning its origin, and dismiss it to a seemingly distant and unnamed place where it no longer held its pungence.
The second exercise was to be mindful of our senses. We were each given wrapped Lifesavers. As the wrappers were opened, we were instructed to listen closely to the sounds that were made by the wrapping as we held and exposed the Lifesaver. We were reminded to be aware and grateful for our sense of hearing. How rarely did I notice such a small stimulus as the noise made by wrapping paper in a positive way? How many times in a conference had I tried to suppress the sounds of my wrapped bag of chips or crackers as I opened my food? I found it comical to be enjoying the sounds of the wrapper on my hands as I opened the Lifesaver yet focusing my thoughts on this everyday task was refreshing. We

Journal of Yoga and Physiotherapy
then removed the Lifesaver and took a moment to appreciate the beauty of its features. The perfectly rounded edges, the crafted letters, and the vibrant color were all to be inspected. We were instructed to be grateful for our sense of sight and to witness detail where we previously would have been neglectful for lack of time or habit. Then we placed the Lifesaver in our mouths with noses pinched and were mindful of the taste and sensation of the candy against the tongue and palate. How many times had I eaten in such a hurry without noticing delicious textures of food or tastes that were pleasant? We were reminded to be grateful for the senses of touch and of taste prior to the final portion of this activity. We unpinched our noses and through glorious retronasal olfaction experienced the full flavor of the candy. Isolating our senses of taste and smell which synergistically interweave their afferent inputs into flavor gave the simple task of eating the possibility of more complete mindfulness.
An introduction to Yoga was the final mindfulness task. We started with sitting comfortably with deep breathing in through our noses followed by brief hold and then out through our mouths. The custom of being mindful of breath at rest was also observed. We then would assume a pose such as arms extended, and feet spread to a comfortable distance with the same deep breathing exercises. Laying down with deep breathing, tripod, and on all four extremities while focusing on breathing were all performed in sequence. This focus on each breath centered my thoughts and distracted me fully from the many additional responsibilities and deadlines which previously were at the forefront of my focus.
While the simple act of breathing was often relinquished to chemoreceptors and acidity through circulating carbon dioxide, volitional breathing through supratentorial focus seemed to break the never-ending pursuit of the next goal. The many bullets on my long checklist seemed far away, and I felt relief that I could always return to them at the end of the mindfulness activities. It is important for trainees to realize that there is always time to plan ahead and achieve. Time to utilize mindfulness and relieve burnout from continuous breakneck pace is only possible through volitional choice.
Though I entered the mindfulness session desiring to use that half hour to send emails, write notes, and read articles, I left the activities with renewed vigor and was prepared to do my work with twice the efficiency and half the stress.

Conclusion
Despite numerous responsibilities, tremendous pressure, and prolonged training, medical students, residents, and staff would find benefits from brief mindfulness techniques that are practiced periodically. Though it is initially hard to partition the time required for such activities, the efficiency boost from breaking burnout more than accounts for the time utilized for these activities for the writer. Spending 20-30 minutes initially can soon be pruned down to 3-5 minute sessions more frequently throughout the day with ease and without sacrificing efficacy. I am hopeful that this reflection resonates with others who feel the effects of burnout and helps them to experiment with mindfulness, awareness, or Yoga with deep breathing.