Components of Mindful Practice Programs
Three components that make up the core experience of Mindful Practice are:
- Formal and Informal Mindfulness Meditation: Cultivation of an open, receptive, and non-judgmental orientation to one’s present experience, which helps promote physical, emotional and cognitive stability
- Narrative Medicine: Creation and sharing of reflective stories that explore the profound and meaningful experiences one has as a physician/clinician, which helps connect the clinician with sources of professionalism and satisfaction
- Appreciative Interviews: Based on Appreciative Inquiry, a strength-based approach to individual and organizational change that alters habitual patterns of thinking and behavior, designed to help participants discover capacities and resources within themselves for positive potential
The acquisition of medical knowledge, assimilation of clinical information, and continued honing of manual skills are vital to professional competence. Likewise, the continual honing of interpersonal skills, steady development of increased intrapersonal and interpersonal awareness, and capacity to attend to patients with presence are also central tasks toward the goal of practicing high quality, relationship-centered medical care. A desirable outcome of Mindful Practice is the integration of these skills into the practitioner’s clinical understanding and individual expression in much the same way that the understanding of organ systems and their physiology and pathology become integrated into an approach to solving problems in a clinical encounter.
Formal and Informal Mindfulness Meditation
The quality of mindfulness, which can be cultivated through a variety of meditation practices, functions as an ever-present lens through which personal stories are contemplated, written, shared, and discussed.
The following formal meditative practices are designed to enhance the participant's awareness of the steam of thoughts, flow of feelings, and presence of sensations that often go unnoticed, yet inform action and behavior from moment to moment:
- Body Scan: A guided exercise to promote awareness of each part of the body
- Mindful Movement: Also known as mindful yoga in which participants are guided through a series of gentle movements, postures, and stretching exercises
- Sitting Meditation: Quiet sitting attending to the breath, thoughts, feelings, and sensations.
- Walking Meditation: Slow or fast walking with awareness
Through the regular practice of these mindfulness exercises, it becomes possible to step out of the automatic pilot mode of being, and instead experience and act with greater awareness.
Mindful Practice programs encourage participants to foster the same quality of awareness established through mindfulness exercises during other activities both in the classroom (i.e., during discussion, while developing and sharing narratives, when engaged in appreciative inquiry exercises), and outside of the workshop (i.e., while engaged in life’s activities at work and at home). Because the cultivation of mindfulness is best supported by regular practice, we recommend participants engage in daily home practices that might include meditation, yoga, and other awareness-enhancing practices. Participants with backgrounds in other forms of contemplative practice are encouraged to use those approaches as well.
Narrative Medicine provides a way to understand both the personal connections between clinicians and patients, and the meaning of medical practice and experiences for individual physicians. Narratives reflect clinicians’ values and beliefs, how these become manifest in the clinician-patient relationship, and the influence of the social and cultural environment that surrounded their creation. Narrative medicine helps imbue the facts and objects of health and illness with their consequences and meanings to individual patients and physicians. The use of narratives in medicine provides insight into both patient and practitioner. Narrative medicine in the Mindful Practice program includes the sharing of stories that arise from the participants’ clinical experiences and experiences with colleagues. Our Narrative medicine exercises include reflection, dialogue, and discussion in large and small groups, specific writing exercises, and journaling.
Program participants share narratives from their own personal experiences with patient care that have affected them on cognitive and emotional levels. In addition to emphasizing confidentiality and creating a supportive atmosphere, participants are encouraged to consider narratives they feel comfortable sharing in dyads and small group settings.
Appreciative interviews strives to foster growth and change by focusing participants’ attention on successes rather than problems and challenges. Much of medical training focuses on what is wrong rather than what is right. Patients are described in terms of problem lists, but there are no defined places to describe their strengths and resources. Morbidity and mortality rounds focus on analyzing bad outcomes, but there are few opportunities to explore effective teamwork and joint decision-making.
The theory behind Appreciative Interviews is that reinforcement and analysis of positive experiences are more likely to affect behavior positively, in comparison to a problem-oriented approach that focuses on negative experiences or failures. Appreciative interviews involve the art of asking unconditionally positive questions that acknowledge, anticipate, and heighten positive potential. It is an inquiry tool that fosters imagination and innovation. Mindful Practice participants are guided in the application of Appreciative Interview techniques when engaged in dialogues, discussion, and reflection. With practice and support, this approach becomes second nature.
Appreciative Interviews are based on a broader approach known as Appreciative Inquiry, which relies on several assumptions:
- For every person, group, organization, or institution, no matter how dysfunctional, there is something that is working well
- Looking for what works well and doing more of it is more motivating than looking for what doesn‘t work well and doing less of it
- What we focus on becomes our reality, because individuals and groups move towards what they focus on
- The language we use to describe reality helps to create that reality
- People have more confidence to journey to the future if they carry forward parts of the past
- We should carry forward the best parts of the past
Traditionally, the steps of Appreciative Inquiry are : 1) definition-what we wish to see or grow in ourselves and our groups; 2) discovery-what gives life; 3) dream-what might be; 4) design-what should be; and 5) delivery-what will be. Appreciative Inquiry 's way of fostering change includes strengthening confidence and encouraging positive dialogue about the future, increasing feelings of connection and participation, and fostering an appreciative mindset and culture. In the Mindful Practice ® curricula, the first two steps-definition and discovery-are integrated into the structure of interpersonal dialogues and the sharing of participants' narratives.