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Barriers to Mindfulness in Med School

The life of a medical student is a rapid succession of lectures, small group sessions, exams, clinical experiences, workshops, meetings, eat, sleep, rinse and repeat. As such, there has never been a more perfect time to stop and smell the roses. Seriously.

As described in the blossoming literature, mindfulness techniques quite literally offer the opportunity to stop, breath, and take in the present moment -– roses, exams and all. Mindfulness is the nonjudgmental observation and active acceptance of reality as it is, not as you would like it to be. The application of such acceptance slows down the tortuous undercurrent of med to a pace at which students can truly focus in lectures, engage in small groups, hone skills in workshops, and take pleasure in exams. Seriously.

How come I haven’t heard of this before?

Despite its clear benefit, there are only a handful of med schools across the United States and Canada that offer more than a lecture here and a role-play there regarding this important topic. Fortunately, organizations that support research and education of med school mindfulness are growing and, as part of their mandates, are providing their audience with mindfulness-based tools to navigate the white waters of med school (

So, why isn’t mindfulness more popular in med school?

Expansion of the mindfulness niche into mainstream medicine is opposed by an array of barriers at the level of the institution and the level of the individual.

First and foremost, the profession of medicine is an establishment, an institution, a tradition, with its own unique culture and resultant behavioral norms. And like any culture, its evolution is a molasses-paced process. Consequently, resistance to mindfulness seems to be quite high among more traditional physicians, who categorize meditation, yoga, and the like under the “New-Age Fluff” tab of their paper-based, leather-bound, briefcase filing systems. Tweed-jacketed stereotypes aside, perhaps this dismissive view of mindfulness is the result of the association with alternative medicines and the ever-heated controversy about pseudo-scientific methods. Regardless, the admission that I meditate has thrust me onto the jagged edge of many a disparaging scoff since starting med school.

That sounds painful.

It’s a 7/10 and radiates to my left shoulder. However, if truth be told, I can empathize with the lack of understanding that drives each scoff. Mindfulness is a complex concept to intellectualize and an even harder model to practice.

Here’s the disclaimer: mindfulness is no small feat. It requires the commitment to face all of the dirty, dark, deep-rooted emotions, reactions, and thoughts that bubble up from the dusty, neglected depths of the mind, body, and soul nearly hundreds of times a minute, every minute. The practice of mindfulness asks the practitioner to simply observe all these emotions without judgment and without reaction. Observe the stress of exams. The fear of failure. The expectation to never make a mistake. The pressure to always have an answer. The generalized feelings of inferiority. The self-doubt. The doubt of colleagues. The disappointment in the health care system. The helpless exacerbation with the politics. The frustration of tied hands. The lack of time in everyday. The fatigue that only comes from exchanging an entire night’s sleep for hard work.

THAT sounds painful.

9/10. No small feat, indeed. Mindfulness takes a whole lot of hard work.

And that which requires hard work — as we all know so well — requires hard time. Never mind attempting to find half an hour every morning to practice mindfulness meditation. How are we expected to find mere seconds throughout the day to stop, breath, and feel?

Consider the next time you are called on to answer a question in front of a group of colleagues. Even before uncovering whether the correct answer is squatting somewhere in your mind’s real estate, stop. Take a breath. Observe your reaction. Are you feeling anxious? Apprehensive? Excited? Empowered? Frustrated? Exhausted?

Doesn’t matter. You should’ve answer the question by now, but instead you stood, blankly staring, and now you’ve disappointed a senior colleague who has never heard of mindfulness and does not have time to play emotional games while patients are dying!

Patients are dying?!

Of course, once again, this is a delightfully exaggerated scenario, but not an unlikely one. Mindfulness, in my experience, requires the practitioner to take a tiny step back out of the turbulent waters of medicine and move at an ever-so-slightly slower pace. A slower pace is not the reality of med. Reality involves endless hard work, high expectations, difficult decisions, emotionally charged situations, and scarcity of time. And tomorrow’s reality may be a completely different scenario — good, bad, ugly, or all of the above.

While it is not difficult to accept a reality full of the “good,” a reality of turmoil and torture should be welcomed as an opportunity to hone skills in mindfulness. Thus, med is the ultimate training grounds upon which to cultivate objective awareness and acceptance. No matter what comprises the reality of each moment in med, nonjudgmental, nonreactive acceptance is possible. Acceptance makes any situation tolerable, perhaps enjoyable, and often quite amusing. Suddenly, the turbulence is less daunting, the expectations aren’t so high, and time doesn’t seem so scarce.

Time doesn’t seem so scarce…

While it may be easy to point fingers and identify the problem as some external variable, is it possible that the solution to any external variable lies within?

Like I said, isn’t it the perfect time to stop and smell the roses?

Nicole Perkes Nicole Perkes (3 Posts)

Contributing Writer Emeritus

University of British Columbia Faculty of Medicine

Nicole is a Class of 2015 medical student at the University of British Columbia, Canada, who enjoys the unique perspective her bachelor's of tourism management provides her in medicine.