Medical students in South Africa face numerous challenges during their years of tough study, often risking burnout from the strain. The practise of “mindfulness” – or purposefully focusing on the present moment – could be a significant help in hard times, according to two academics linked to Stellenbosch University (SU).

Professor Elize Archer, Associate Professor in the Department of Health Professions Education (DHPE) in the Faculty of Medicine and Health Sciences (FMHS), and Dr Nabeela Kajee, an alumna of the FMHS, believe that attending a formal course in mindfulness could be a potential gamechanger for the mental health for medical students and people working in the health professions.

Archer, who heads the Simulation and Clinical Skills Unit at the DHPE and Kajee, who is currently completing a DPhil in Psychiatry at the University of Oxford as a Rhodes Scholar, recently concluded the META Research Study on mindfulness at the FMHS. 

Mindfulness, according to Professor Jon Kabat-Zinn, the American professor who founded the Centre for Mindfulness in Medicine, Health Care and Society, is “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment”.

The study, a collaboration between Stellenbosch and Oxford universities, saw more than 100 FMHS students participating in a weekly mindfulness course. It found that practising mindfulness could have a positive impact on reducing burnout among students.

Explaining the background to their study, Archer said she had observed medical students at SU often display high levels of stress and burnout.

“We realised that medical students in South Africa’s healthcare system face many challenges, including that they are young when they start. In many overseas medical programmes, students have graduated before going into medicine, but most of our students start straight out of school.”

“Many of them are high achievers who are not trained to cope with failure and uncertainty. They become stressed out by the challenges. Many students don’t want to acknowledge their stress. There’s a culture that ‘you have to cope’”.

Kajee said the META research study was a mixed method study, involving quantitative and qualitative aspects. “We offered mindfulness training, on a voluntary basis, to medical students across year groups at SU. During the training, we collected data that helped us to understand the ways in which the medical students experienced the training, and how it impacted them in terms of burnout, clinical communication skills and empathy.”

Kajee said the training was based on the concept of Mindfulness-Based Stress Reduction (MBSR), a standardised form of evidence-based mindfulness training. “During the sessions, they received group training with a locally-qualified instructor on mindfulness skills, such as mindful awareness and breathing techniques. Typically, a session saw the students coming together in a safe space to practise these skills.”

“The training became increasingly complex and challenging as the weeks went on. The sessions included topics from the ‘beginner’s mind’, being able to re-experience things in a new way, to the numerous other attributes of mindfulness, such as mindful awareness (being present in the current moment without judgement).

“The students also learnt various exercises to help them regulate their breathing and to notice their bodies. They were also encouraged to keep a diary to record ‘depleting’ and ‘nourishing’ activities in their daily lives, and to keep notes on things which increase their levels of stress and distress.

“There was an activity which looked at the way in which they hold conversations with other people, and whether they allow them the space to express themselves.”

Archer said the study initially enrolled 102 students to participate in the pilot study, who were divided into smaller groups to do the course. There were four trainers, each of whom worked with about ten to twelve students over each course.

“The students were asked to fill in psychometric questionnaires during the training, to keep a logbook, and to do various homework exercises. Following training, we conducted interviews with them about their experience of the mindfulness training.”

“At the end of the course, students were invited to contribute a photo-voice essay which formed part of an exhibition which ran at the faculty to share the students’ experiences with others.”

The study found a moderate impact of mindfulness training on burnout in medical students. Further research is required to understand effects and the long-term effects of mindfulness training on burnout, empathy and communication. 

According to Kajee: “Students described the ability to experience wellbeing, being present and aware, and also having access and interest in using mindfulness training both in home spaces and in nature following the training.”

“These findings are significant as burnout is a huge challenge in the medical profession. It remains an unsolved problem in health professions education but also the health professions. Interventional research is paramount to explore and address this crucial concern.” 

Kajee said their research supports the potential impact of mindfulness on improving burnout. “It’s of course an early study and a larger randomised control trial is required to look at ‘effects,’ but our findings suggest that there is a positive signal for mindfulness training to be further explored in research for use in burnout.” 

Archer said that, in the qualitative data, involving interviews with students, they described how they were able to apply mindfulness to other parts of their lives. “For example, one student is a runner who could improve his running times by being mindful. We found the practise speaks to them as a whole person.”

Commenting on next steps, Archer said: “We believe there is a place for mindfulness training research in health professions education, and it should be explored further.”

Both Archer and Kajee hailed the collaboration between Global South and Global North universities in a pragmatic study aimed at addressing real concerns in the medical profession, adding that the concept of mindfulness, while used widely in medical education settings in the global North, remains relatively unexplored in the South African context.

They said their research project coincides with the 70th birthday celebrations of the FMHS. “Kajee completed her MBCHB degree at SU ten years ago and it is special that she chose to do part of her PhD data collection with me in the DHPE/Skills Unit at SU with her Rhodes Scholarship.