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Components of Mindful Practice Programs

Three components that make up the core experience of Mindful Practice are:

  • Mindfulness Meditation: Cultivation of an open, receptive, and non-judgmental orientation to one’s present experience
  • Narrative Medicine: Creation and sharing of reflective stories that explore the profound and meaningful experiences one has as a clinician
  • Appreciative Inquiry: A strength-based approach to individual and organizational change that alters habitual patterns of thinking and behavior

The acquisition of medical knowledge, the assimilation of clinical information, and the continued honing of manual skills are vital to professional competence. Likewise, the continual honing of interpersonal skills, the steady development of increased intrapersonal and interpersonal awareness, and the 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 for these skills to become integrated into the practitioner’s clinical understanding and individual expression in much the same way as the understanding of organ systems and their physiology and pathology become integrated into an approach to problem-solving in the clinical encounter.

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. Formal meditation practices aim to enhance:

  • The capacity for lowering one’s reactivity
  • The ability to notice and observe sensations, thoughts and feelings even though they might be unpleasant
  • Acting with awareness and intention
  • Focusing on experience, not the labels and judgments we apply to them

All of these formal meditative practices are designed to enhance the participant’s awareness of the stream of thoughts, the flow of feelings, and the presence of sensations that are very often not noticed, 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 living, and instead experience and act with greater awareness.

In order to assist the participant in applying these lessons to their daily lives, we help participants discover how they can bring the same quality of awareness to their other activities — in the classroom (during discussion, while developing and sharing narratives, when engaged in appreciative inquiry exercises), and outside of the classroom (while engaged in life’s activities at work and at home). Because the cultivation of mindfulness is best supported by regular practice, we encourage participants to 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

Narrative Medicine provides a way of understanding the personal connections between clinicians and patients, and the meaning of medical practice and experiences for individual clinicians. Narratives reflect clinicians’ values and beliefs, how these become manifest in the clinician-patient relationship, and the influence of the social and cultural environment. Narrative medicine helps imbue the facts and objects of health and illness with their consequences and meanings for individual patients and clinicians. The use of narratives in medicine gives us insights into the patient and the clinician. Narrative medicine in the Mindful Practice program includes the sharing of stories that arise from the participants’ clinical experiences and experiences with colleagues. We use reflection, dialogue, and discussion in large and small groups, specific writing exercises, and journaling.

Appreciative Inquiry

Appreciative inquiry (AI) strives to foster growth and change by focusing participants’ attention on their successes rather than an exclusive focus on 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 AI is that reinforcement and analysis of positive experiences are more likely to affect behavior positively, rather than taking a problem-oriented approach focusing on negative experiences or failures. Appreciative inquiry involves the art of asking unconditionally positive questions that acknowledge, anticipate, and heighten positive potential. It is an inquiry tool that fosters imagination and innovation. Participants are guided in using AI techniques when engaged in dialogues, discussion, and reflection. With practice and support, this approach becomes second nature.

The AI approach makes several assumptions:

  • For every person, group, organization, or institution, no matter how dysfunctional, there is something that is working.
  • 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; 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.