Number of Citations: 0

Submitted: 14 October 2024
Accepted: 4 March 2025
Published online: 6 January, TAPS 2026, 11(1), 86-88
https://doi.org/10.29060/TAPS.2026-11-1/II3542

Craig Hassed

Department of Medical Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia

I. INTRODUCTION

In this article I will outline some of the personal and clinical challenges faced by medical and allied health professionals. Mindfulness will be proposed as a necessary skill to be taught in under and postgraduate training to address a number of these challenges. To provide some insights into how this can be done effectively, I will share our experience from Monash University where we have successfully integrated the mindfulness-based Health Enhancement Program (HEP) into medical and allied health professional training for over 20 years. The case will be made for why other medical schools around the world can benefit from adopting similar curriculum.

II. DISCUSSION

It is well documented that medical and allied health professionals face many challenges in their working life including high rates of burnout, stress, alcohol and substance use, and poor mental health. Furthermore, in the complex work environments that health professionals work in, they need to make many decisions throughout the day which have major implications for patients’ health. The complexity is further complicated by the fast-paced modern world where the misuse and overuse of technology is leading to high levels of distraction and clinical errors.

The job-ready health professional needs practical skills to help them navigate such challenges. Unfortunately, these skills are often seen as optional ‘soft’ and are rarely part of the core-curriculum, but without these skills being taught in a comprehensive way, history keeps repeating itself.

One generic skill which can help address many specific challenges outlined above is mindfulness. The most widely used definition by Jon Kabat-Zinn is, “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” In its broadest sense, mindfulness is a practice in training attention and attitude. It can be practiced formally as in mindfulness meditation, and informally by being present and engaged as one goes about daily life.

Before introducing such training into the medical and allied health curriculum one needs a rationale for doing it supported by a sound evidence-base. The exponential growth of research into mindfulness for health professionals has confirmed its efficacy in managing stress and anxiety, reducing relapse rates from depression, lowering burnout, and reducing addictive behaviours. Importantly, the modern doctor also needs to be equipped with non-pharmaceutical options or adjuncts for their patients in the management of stress and mental health problems, chronic pain, and coping with chronic illness.

Because of the enhanced attentional, situational awareness and self-monitoring capacities that mindfulness provides, there is evidence that it enhances clinical decision making, reduces the impact of cognitive biases and helps prevent clinical errors, in part because doctors can learn to be alert to the negative impact of practices like complex multitasking or the distracting effect of technology.

Also important is the evidence from Krasner and Epstein (Krasner et al., 2009) showing that mindfulness not only enhances physician wellbeing but also conscientiousness, emotional intelligence, communication and compassion leading to better clinical interactions with patients.

Mindfulness training has been a part of the core curriculum for medical students at Monash University since 1992. Initially it was on a small scale and then in 2002 the program grew into what we call the Health Enhancement Program. Monash was the first university in the world to integrate mindfulness as core-curriculum and soon after Rochester University introduced a mindfulness program into its curriculum (Dobkin & Hutchinson, 2013).

The HEP is a mindfulness-based healthy lifestyle program delivered in the first semester of the first year of Monash’s five-year undergraduate medical curriculum. It is underpinned by mindfulness training alongside content on lifestyle including the benefits of healthy diet, exercise, environment, connectedness and spirituality, as well as behaviour change strategies and goal setting.

A lecture series providing the evidence and clinical rationale for learning about mindfulness and other elements of the HEP followed by a series of five two-hour tutorials where the students learn to apply mindfulness and lifestyle-focused behaviour change skills in their own lives.

This experiential and deep learning model helps students to foster their own wellbeing, be better manage their stress, and to build an understanding of how these approaches can be used with patients in future medical practice. To assist in the reflective learning approach, students are very actively engaged in group discussions during tutorials. They also keep a weekly reflective journal sharing their reflections, insights, challenges and questions in applying mindfulness and healthy lifestyle change in their own lives. These journals are read by the tutor who provides personalised feedback and encouragement to the students.

The authenticity, credibility and motivation of the tutoring team is crucial for the effectiveness of the program. All tutors are working health professionals – nearly all doctors and psychologists – who personally and professionally use the mindfulness skills they are teaching.

The HEP is core-curriculum and, like any other part of core-curriculum, is assessable and students are required to attend tutorials and learn the content, but we are very clear in communicating to the students that what they practice or apply outside of the tutorial room in their personal life is very much their own personal choice. Students are invited to explore the techniques and apply them in ways that are meaningful for them, but mindfulness is not being imposed on them.

Contextualisation of mindfulness to fit with students’ studies, lives and future work is vital otherwise it won’t be seen as being relevant in the medical curriculum. If this is done well then students receive mindfulness very positively and they apply it in meaningful ways. We have found that over 90% of students report personally applying the formal and informal mindfulness practices in their own lives outside of tutorials (Hassed et al., 2009). If it’s done poorly then the opposite will happen. Contextualisation is further reinforced with mindfulness-based experiments like exploring the effects of complex multitasking, mindful communication, dealing with distractors, and a mindful eating and exercise.

Students need to understand that mindfulness is a transferable skill relevant to their work and life generally, and it is not just seen as a superfluous addition to the ‘serious’ medical curriculum. It is therefore important that mindfulness is horizontally and vertically integrated with other relevant curriculum such as being more present in communication skills training, better focus when learning medical procedures like venepuncture, learning how to manage exam anxiety and, in later years, being more self-aware in clinical decision-making. One method of increasing integration and giving the content a clinical focus is through weekly role-plays similar to the kinds of cases students might meet in OSCE exams.

For the students to take any part of the curriculum seriously and to engage with it, it needs to be assessable. If the mindfulness content is not assessable students will not think it’s important because, in their perception, if it was important, it would be assessed. The journal is marked by the tutors based on the insights students glean and the authenticity and quality of their self-reflection. The knowledgebase and science covered in the HEP lectures is assessed in written exams. Students’ understanding of how to communicate the principles of what mindfulness is about, and what kinds of clinical applications would be appropriate for its use is assessed in OSCE exams. We do not expect the students to reach a point where they could teach mindfulness skills to patients. Further training would be required to reach this objective.

The HEP has become an integral and distinctive part of the Monash medical curriculum. As core-curriculum we have never had the option of performing a randomised control trial on the program outcomes, but we have performed a series of pre-post studies. Our findings that students report improvements in mental health, perceived stress, study engagement, and mindfulness from pre- to post-intervention, even though pre-intervention measures were taken in a low stress period of semester and the post-intervention measures were taken in the period immediately prior to mid-year exams, is very encouraging and counter to evidence showing medical student wellbeing inevitably declines as the semester progresses and students approach assessment (Hassed et al., 2009; Kakoschke et al., 2021).

III. CONCLUSION

Deficiencies in medical education in providing job-ready health professional do not generally lie with a lack of biomedical knowledge and clinical teaching in undergraduate years. The main deficit in training relates to necessary personal skills like attentional control, emotional regulation, stress management, resilience, self-awareness and self-care. One generic skill that has the potential to meet these diverse needs is mindfulness. There is much to be gained by giving all medical and allied health professional students contextualised, relevant, and evidence-based training in mindfulness to help them meet the personal and professional demands that come with increasingly complex and demanding careers in healthcare. A more extensive discussion of the why and how of doing that successfully can be found in a discussion paper in the journal, Mindfulness (Hassed, 2021).

Notes on Contributors

Craig Hassed was the sole author, responsible for the conceptual development and writing of this article.

Funding

There was no funding source for this paper.

Declaration of Interest

The author declares to have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

Dobkin, P. L., & Hutchinson, T. A. (2013). Teaching mindfulness in medical school: Where are we now and where are we going? Medical education, 47(8), 768–779. https://doi.org/10.1111/medu.12200

Hassed, C., de Lisle, S., Sullivan, G., & Pier, C. (2009). Enhancing the health of medical students: Outcomes of an integrated mindfulness and lifestyle program. Advances in Health Sciences Education, 14(3), 387–398. https://doi.org/10.1007/s10459-008-9125-3

Hassed, C. (2021). The art of introducing mindfulness into medical and allied health curricula. Mindfulness, 12, 1909–1919. https://doi.org/10.1007/s12671-021-01647-z

Kakoschke, N., Hassed, C., Chambers, R., & Lee, K. (2021). The importance of formal versus informal mindfulness practice for enhancing psychological wellbeing and study engagement in a medical student cohort with a 5-week mindfulness-based lifestyle program. PloS one, 16(10), e0258999. https://doi.org/10.1371/journal.pone.0258999

Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., & Quill, T. E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284–1293. https://doi.org/10.1001/jama.2009.1384

*Craig Hassed
Faculty of Medicine, Nursing and Health Sciences
Monash University
Wellington Road, Clayton,
Victoria, Australia
Email: craig.hassed@monash.edu