Our study utilized the Healer’s Art elective for medical students at the University of Michigan Medical School (UMMS) during the Spring semester (February-May 2022). This course consisted of 5 sessions, with each 2-hour session focused on a topic pertaining to medical training and providing patient care. Sessions were taught in the medical school library and led by faculty and senior students. For the 2022 Healer’s Art course, we integrated mindfulness practices into the third session. Again, please note that any changes to the Healer’s Art program must be first approved by the RISHI leadership team. Half of the students were randomized into a meditation session, while the other half was randomized into a yoga session. Investigators were not blinded to the study groups.

Prior to the first session of the course, students were given a pre-course survey (Appendix A) to assess baseline measures of mindfulness, burnout, and energy levels. Pre- and post-mindfulness session surveys (Appendices B, C) were administered to the students at the third session to evaluate immediate changes in mindfulness, burnout, and energy levels.

Surveys were administered to participants immediately before and after participation in the yoga or meditation sessions to assess the intervention’s short-term impact. Study authors collected all surveys. Study authors were not blinded to the groups as they participated in the sessions. Please see Appendices B and C for the full surveys.

Our feasibility endpoints were based on students’ reactions to the class and if they would recommend continuing a mindfulness practice in the Healer’s Art course. On the post-intervention survey, students were asked on a scale of 1 to 5 if they agree that the class should be continued. This survey also captured student reactions to the class.

To explore intervention effectiveness, we analyzed our pre- and post-intervention outcome data from surveys in Appendices B and C. Baseline survey data (Appendix A) was collected but was not analyzed, consistent with our a priori statistical analysis plan. We analyzed each intervention (yoga and meditation) separately. We report the percentage change from pre-intervention to post-intervention for each outcome; 95% confidence intervals were constructed. Paired two-sample t tests were used to assess significance of the effect of each intervention on each of our outcomes. Additionally, we performed a comparative analysis exploring whether either intervention had a significantly greater effect than the other on any of our outcomes. For this, we utilized a two-sample t test comparing the mean pre- and post-test differences for the yoga and mindfulness groups for all outcomes. Two-sided testing and an alpha level of 0.05 were used for all analyses. Additionally, mean ratings for course recommendations were reported as descriptive statistics for each intervention. Listwise deletion was used to address missing data. All analyses were performed using R software version 4.1.2.²²

Twenty-three students participated in the study (100% response rate). Nineteen students were from the graduating class of 2025, 2 students from the class of 2023, and 1 student each from the classes of 2024 and 2022. Twenty students used she/her pronouns, and 3 students used he/him pronouns (Table 1). Twelve and 11 students were randomized to the yoga and meditation interventions, respectively. All participating students filled out pre- and post-intervention surveys. There was one missing response on a single baseline survey.

The yoga intervention resulted in increase in energy (26%, p=0.01) and increase in breath (13%, p=0.03) outcomes as well as a decreased level of burnout (14%, p=0.03; see Table 2, Figure 1). Simultaneously, the meditation intervention resulted in an increase in mindfulness (22%, p=0.01) as well as a decreased level of burnout (10%, p=0.02). When comparing the two modalities of mindfulness, both of our interventions were found to be statistically significant to decrease burnout among participants. The effects on our outcomes were not statistically significantly different for the yoga and mindfulness interventions.

The mean recommendation score (out of 5) was 4.8 for the yoga group and 4.1 for the meditation group.

Burnout among medical providers, especially medical students, is statistically greater than among age-matched controls, with nearly 1 in every 2 students experiencing detrimental clinical burnout.^4,25 Our feasibility study aimed to integrate mindfulness practices into a pre-existing course for medical students, the Healer’s Art, to examine immediate effects on students and the course’s potential use as a space to offer mindfulness practice for medical students across the nation, with the ultimate goal of reducing burnout.

Our study results demonstrate a short-term decrease in burnout measures, an increase in energy and breath awareness, and an increase of mindfulness measures after a one-hour session of mind-body practices. Of note, between the two groups, there was no significant difference in the degree of decrease in burnout. This suggests that in order to achieve decreased burnout, perhaps the type of mindfulness activity performed, whether it involves physical movement, does not matter as much as simply incorporating the practice of mindfulness.

Our feasibility measure was included in the post-intervention survey: we asked participants to respond to the statement “Yoga or meditation should be incorporated into future Healer’s Art courses.” We found that 22 of the 23 students agreed or strongly agreed with this statement, indicating the Healer’s Art course is a potentially acceptable space for mindfulness practices. Thus, we found our intervention to be feasible and acceptable.

In addition, on the post-intervention survey, we elicited feedback from students on the session. Although a full qualitative analysis was not performed, anecdotally some of the students reported, “I really enjoyed this (yoga session)” and “Loved this (yoga session)!” One student wrote, “I would have loved to do one hour of meditation and one hour of yoga, rather than just one.” Another student said, “I think yoga is awesome for med students but idk if it should be in Healer’s Art.” This comment implies that further qualitative exploration is necessary in understanding students’ reactions to this session.

Our findings build on prior studies that have shown the benefits of implementing mindfulness practices into pre-existing programming for medical trainees and physicians. Thompson et al’s²⁶ 2022 study evaluated the effects of offering restorative yoga to third-year medical students during their core pediatrics rotation. They found that students reported feeling more relaxed and better about themselves following this 6-week intervention.²⁶ A study by Chung et al²⁷ found that integrating mindfulness into a pre-existing emergency medicine clerkship for third- and fourth-year medical students improved students’ ability to meditate, and students reported these practices became important to their well-being. Krasner et al²⁸ evaluated the effects of a mindfulness-based training as part of continuing medical education credits for primary care physicians. They found this intervention decreased levels of burnout among the physician group and improved attitudes associated with patient-centered care, both in the immediate aftermath and 3 months post-intervention.²⁸ In addition, Hassed et al²⁹ studied the impact of a mindfulness program at Monash University and found improved student well-being on all markers and decreased depression among students in the pre-exam period.

Interestingly, Dobkin and Hutchinson’s³⁰ 2013 study found that most mindfulness classes offered in medical schools are electives as opposed to being a mandatory component of the curriculum. This suggests the students are already motivated to engage in these practices and thus experience more benefit. This is an important finding because students choosing elective courses such as the Healer’s Art might experience more self-motivation to engage in all aspects of the course’s programming as opposed to an enforced curriculum. However, Rabow et al’s³¹ 2016 study specifically evaluated medical students taking the Healer’s Art and found no difference in outcomes between those who elected to take the course and those who were mandated to do so. Thus, further research is needed to understand if differences in outcomes exist between elective wellness and mandatory wellness.

We recommend a future mixed methods randomized control trial to evaluate the effectiveness of mindfulness practices for the reduction of burnout in medical school students. Mindfulness practice might be offered to students in addition to the Healer’s Art 5-session curriculum. We acknowledge the importance of the third session centering on grief and loss and thus recommend mindfulness practices to be incorporated after at least an hour discussion centering on grief and loss. More comprehensive surveys — such as the Five Facet Mindfulness Questionnaire²⁴ and Maslach Burnout Inventory²³ in their entirety — could be used with longer duration of follow-up, such as 6 months or longer following the intervention. Qualitative interviews would be helpful in further understanding students’ reactions to the intervention. Additionally, further research can investigate the difference between one longer mindfulness session versus shorter, more consistent sessions throughout a semester.

Further studies could examine the impact of incorporating mindfulness into the Healer’s Art courses in other health professional schools more broadly, with the appropriate approval by RISHI leadership. The Healer’s Art course has now expanded to curricula for physician assistant (PA), nursing, and veterinary students, for whom burnout is also unfortunately increasing and only accelerated during the COVID-19 pandemic.^32–35 Thus, there is great potential in offering mindfulness classes across the Healer’s Art courses in these adjacent healthcare fields, and this could be an important area of future study.

Our study needs to be interpreted within the context of the following limitations. First, the study has a small sample size and was implemented within a self-selecting group of medical students at one institution for a single session. Future studies would need to explore the impact on a larger group of students in geographically diverse settings and perhaps among other types of medical trainees (eg, PA and nursing students). Second, our results were obtained immediately after students completed the intervention and thus cannot be used to demonstrate sustained outcomes. It would be useful to obtain follow-up data 6 months or longer after the intervention. Third, student participants self-selected to participate in this course, which limits generalizability to students who did not elect to participate in this course. Finally, there was a discrepancy between the yoga instructors teaching in-person and the meditation instructor teaching remotely via Zoom due to the unforeseen COVID-19 pandemic.