This study followed first-year clinical clerkship students at one university medical center in Nijmegen, the Netherlands. Of 232 eligible students, 167 (72%) took part. They were 23 years old on average, and most were female. Whole clerkship groups were randomly assigned to an added mindfulness course or to clerkships as usual. The course, Mindfulness-Based Stress Reduction (MBSR), met for two hours a week for eight weeks, with home practice.
Over 20 months, the course group reported less psychological distress than the comparison group. The difference was small and unlikely to be down to chance. They also reported better positive mental health, higher life satisfaction, more mindfulness skills and fewer unhelpful thoughts. Self-reported empathy toward patients did not differ. The authors call the overall improvement small to moderate, and the drop in distress stayed within the normal range, not at a clinical level.
Only 3 course students (4%) went to fewer than four sessions. By 20 months, 81% of the course group remained. In the comparison group, 69% remained.
There was no active comparison condition, so the gains cannot be credited to mindfulness rather than peer support or attention. The study used a single Dutch school. The authors suggest that MBSR built into the clerkship curriculum could be a valuable part of medical education for clerkship students, and they call for repeat studies with active comparison groups.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- van Dijk, 2017: lower psychological distress (the main outcome) over 20 months, P = .03, Cohen's d = 0.20.
- van Dijk, 2017: higher positive mental health over 20 months, P = .002, Cohen's d = 0.44.
- van Dijk, 2017: higher life satisfaction over 20 months, P = .01, Cohen's d = 0.51.
- van Dijk, 2017: more mindfulness skills over 20 months, P = .05, Cohen's d = 0.35.
- van Dijk, 2017: fewer unhelpful (dysfunctional) thoughts over 20 months, P = .05, Cohen's d = 0.18.
- van Dijk, 2017: self-reported empathy toward patients over 20 months, no difference, P = .18, Cohen's d = 0.27. What the terms mean:
- P is the chance of seeing a difference this big if the course truly made no difference; smaller values mean the result is less likely to be down to chance.
- Cohen's d shows how big the difference between groups was. Roughly, 0.2 is small, 0.5 is moderate and 0.8 is large. A minus sign shows the direction of the change, not its size.
Source: van Dijk I, Lucassen P, Akkermans R, et al.. Effects of Mindfulness-Based Stress Reduction on the Mental Health of Clinical Clerkship Students: A Cluster-Randomized Controlled Trial. Academic Medicine (2017). doi:10.1097/ACM.0000000000001546