From Rush to Ritual: Restoring the Sacred in Daily Care.

University of Wisconsin Medical School.

BACKGROUND & OBJECTIVE: Mindfulness practices are recognized as effective strategies for coping with stress in medical education. This study aims to determine the correlation between mindfulness engagement and self-reported academic performance in medical students METHODOLOGY: An analytical cross-sectional study was conducted from October 2023 to March 2024, involving 90 undergraduate medical students. Data were collected online using Google Forms and analyzed in Google Sheets. Students' self-reported academic achievement was then correlated with mindfulness practices. A p-value of less than 0.05 was considered significant. RESULTS: The mean age of participants was 22 ± 1.1 years, with the majority (66.1%) aged 22-24. The gender distribution was 55.8% male and 44.2% female. A significant majority (93%) were aware of mindfulness activities, and 60% reported participating in them. There was a significant difference in mindfulness awareness and practice, as indicated by p-values. Additionally, 81% of students believed that mindfulness practices positively influenced their academic performance. A statistically significant relationship was identified between mindfulness practices and self-reported academic achievements (p-value=0.002). Common barriers to practice included lack of time (61.8%), lack of interest (14.7%), and skepticism about its effectiveness (10.3%). CONCLUSION: The study's findings suggest a positive correlation between mindfulness practices and self-reported academic achievement among undergraduate medical students. Most participants reported improvements in educational performance and mental health, highlighting the potential benefits of incorporating mindfulness practices into medical education.

Event Abstract Back to Event The Effect of Mindfulness Meditation on Lowering Stress Level in Medical Students Dian Wulandari1*, Darmawati A. Indraswari2, Yosef Purwoko2 and Ainun R. Gumay2 1 Faculty of Medicine, Diponegoro University, Indonesia 2 Faculty of Medicine, Diponegoro University, Department of Physiology, Indonesia Background: Many studies have reported that the prevalence of psychological stress among medical students during education was high. However, there has not been an effective and efficient method to help medical students coping with stress in that particular situation. Mindfulness meditation has been practiced worldwide in any level of society on lowering stress. This study aims to determine the effect of mindfulness meditation on lowering stress level in medical students. Methods: This is an experimental study with pre- and post-test control group design. Thirty medical students of first year were included in the study were divided into two groups and filled the cognitive test anxiety scale (CTAS) and Hamilton anxiety rating scale (HARS) as the pretest. The intervention group of fifteen students did a mindfulness meditation program in fourteen days using meditation application in android/ios. While the control group of fifteen students did not do a mindfulness meditation program in fourteen days or any similar activities. Post-test for both groups were applied after the intervention with CTAS and HARS. The stress level were calculated using the T test and Wilcoxon test. Result: There was a significant decrease in both CTAS and HARS after doing mindfulness meditation in intervention group compared to before doing mindfulness meditation. Meanwhile there was not a significant decrease in both CTAS and HARS in control group. Conclusions: Mindfulness meditation helps lowering the stress level in medical students. Keywords: stress, mindfulness meditation, medical students, CTAS, HARS.

The persistence of blood imagery throughout Philip Roth's Indignation is undeniable, yet surprisingly few critics have offered a sustained interpretation of its meaning. I suggest here that what has been overlooked in recent criticism of the novel is that these images of blood are inseparable from the novel's representation of and commentary on ritual. Drawing from Catherine Bell's theories of ritual and ritualization, I propose that Roth uses blood imagery to emphasize those moments where occasions of ritualization profane the sacred ritual from which they arise. Specifically, I argue that the novel's subversions of both religious and secular ritual point to the consequences of an overextension of ritual, as the blood-marked scenes highlight instances in which ritualization serves to imbue actions and events with an exaggerated cultural meaning that is often constructed on a false sense of tradition or authority.

This article examines Hui Ermaili as a form of “living Islam”—a ritual practice that integrates theological intentionality, communal devotion, and embodied transmission of Islamic knowledge within China’s minority Hui Muslim context. Ermaili, derived from the Arabic term ʿamal (righteous deed), encompasses Qur’anic recitation, prophetic eulogy chanting, supplication, charity, sermons, and communal meals. Far from being a syncretic or folkloric tradition, Ermaili is framed here as daʿwah bi’l-ḥāl: a performative invitation to Islam through lived example rather than verbal preaching. Drawing on Talal Asad's concept of discursive tradition and Catherine Bell's theory of ritualisation, the study interprets Ermaili because of religious agency through which Islamic knowledge and values are transmitted across generations, Islamic faith is strengthened, and communal solidarity is reinforced. Methodologically, the research combines insider ethnography with textual analysis and comparative ritual studies. The author approaches the topic as both researcher and participant-observer, drawing on experience as a Hui Muslim raised within the Ermaili tradition. The article challenges reductionist readings that treat Ermaili as cultural adaptation, arguing instead for its theological authenticity through examination of Sufi genealogies and scriptural foundations. Despite reformist critiques from movements like Yihewani that view certain Ermaili practices as bidʿah (innovation), the study demonstrates Ermaili's persistence as authentic Islamic devotion. By foregrounding Ermaili’s pedagogical, ethical, and spiritual dimensions, the study contributes to broader discussions in the anthropology of Islam, minority daʿwah, and ritual theory. It affirms Ermaili as a vital expression of living Islam – where belief is enacted, theology embodied, and religious agency cultivated in everyday life.

At first glance, the emergency department might seem like the least opportune environment for mindfulness practice. The paradox in modern medicine, and particularly in the emergency room (ER), is that to be effective one must be simultaneously thorough and fast-paced, patient centered, and clinically efficient. The ability to establish quick rapport in order to develop a therapeutic relationship is essential. With no chance for in-depth histories and no expectation of an ongoing therapeutic relationship, the ER encounter unfolds entirely in the present. Mindful practice has a sustainable and central relevance in emergency medicine—it allows consistent calm presence and focused attention in the midst of constant pressure to multitask in a busy, high stakes, and life and death environment. Mindfulness in clinical settings improves intuition, reduces medical errors, bolsters teamwork, combats cynicism, and informs professional and personal growth. At its most powerful, it provides a sense of meaning and connection that fosters healing long after the clinical encounter has ended. Mindful practice is a chance to provide kindness, attention, and a gentle touch given unconditionally to whoever is placed into our care. Mindful medical practice as well as mindfulness in daily life can be an antidote to stress and burnout. It can foster what we all need and want in our lives—attention, understanding, care, dignity, to be heard to feel sacred, and to be remembered.

Title: The Impact of Integrating Mindfulness into the Healer’s Art course at University of Michigan Medical School: a Feasibility Study. Background Nearly half of medical students in the United States suffer from burnout – a triad of emotional exhaustion, depersonalization, and decreased personal accomplishment. These higher rates are associated with increased likelihood of leaving medical school, suicidal ideation, and lower patient satisfaction. Mindfulness practice such as yoga and meditation is a potential intervention found to reduce stress levels and burnout among healthcare workers . Integrating mindfulness practices during pre-existing courses within medical education is a potential intervention to prevent burnout. Methods We evaluated the impact of introducing mindfulness practices (meditation and yoga) into the 2022 Healer’s Art elective course at University of Michigan Medical School. Half of the medical students were randomized into a meditation class (n=11) while the other half were randomized to a yoga class (n=12) for the third session. Students were given a pre-course survey to assess baseline measures of mindfulness, burnout, and energy levels, adapted from Maslauch’s Burnout Inventory and the Five Facet Mindfulness survey. Pre- and post-mindfulness session surveys were administered to the students, with a 100% participation completion rate. Results The yoga intervention resulted in a statistically significant increase in energy (26% increase) and breath awareness (13% increase) outcomes. Simultaneously, the meditation intervention resulted in a significant increase in mindfulness (22% increase). Both of our interventions were found to be statistically significant to decrease burnout among participants (14% and 10%, respectively). 95% of students expressed that mindfulness practices should be incorporated into future Healer’s Art courses. Conclusion Our feasibility study evaluated the impact of offering a mindfulness course for medical students enrolled in the Healer’s Art elective. In summation, students in both the meditation and yoga groups had reported decreased levels of burnout, although there was no significant difference between the two groups. Thus, perhaps the type of mindfulness practice did not matter as much as the act of doing a mindful practice. In addition, the vast majority of students recommended mindfulness practices continued to be offered into future Healer’s Art courses. Based on our results, medical students’ mental health would likely benefit from integrating mind-body practices into the Healer’s Art course.

BackgroundHealth professionals in training may be overwhelmed by the emotional dimensions of their work. Balint groups have been proposed as an intervention to support students to process emotional aspects their encounters with patients. The aim of this study was to explore medical students’ emotional experiences of a Balint group during their psychiatry attachment.MethodsMedical students completing a six week clinical attachment in psychiatry took part in weekly Balint group sessions. Five sessions were audio-recorded, transcribed and coded by members of the research team and an independent researcher co-coded all transcripts. Themes were discussed and refined over three rounds of coding.ResultsFour themes were identified: the Balint process as a container to enable vulnerability; becoming attuned to clinical and professional encounters; an evolving sense of identity within the medical hierarchy; and, the need for self-preservation to retain empathy for others.ConclusionThe Balint structure provides medical students with a secure and emotionally resonant experience. Medical students’ engagement with the Balint process, even over a relatively short time period, teaches them how to reflect on difficult emotions associated with clinical encounters. Early exposure during a psychiatry placement may benefit students in terms of understanding relationship dynamics and the need for self-integration and lifelong reflection over the course of their medical career.

Effective patient-centred communication requires physicians to respond 'in the moment' to comments and questions. It is a valuable skill to be able to react to unexpected patient utterances with empathy and support, and these surprises may be most common in general practice where patients are encouraged to speak to their doctor about anything. We developed an elective for medical students to learn and practise improvisational skills that would optimise their communications with patients during medical encounters. Nineteen second-year medical students during two consecutive years (n =38) participated in a four-session elective that introduced and allowed them to practise the principles and skills of improvisation, and reflect on the role of those skills in their communication with patients. Specific skills that were practised and emphasised included listening, affirmation, vocal tone modulation, nonverbal communication, agreement, collaboration, acceptance and validation. In addition to previously developed 'Improv' exercises, students created their own improvisation exercises targeted at specific communication skills. Twenty-seven (71%) of all participating students completed the post-curriculum assessment survey. Twenty-two (81%) rated their enjoyment as 'tremendous'. The desire to experience something new and different from the standard medical curriculum served as the motivation for many of the students (67%) to sign up for the course. Most students (23/27; 85%) thought that the concepts that were addressed were either 'very much' or 'tremendously' relevant to the care of patients. We have found that an improvisational workshop geared towards enhancing medical student communication skills has the potential to impart valuable skills that are essential to providing empathic, supportive patient-centred care. Communication skills training programmes have become a cornerstone in medical student and postgraduate medical education over the past 20 years. Both national accreditation and expert panel consensus guidelines have stressed the importance and framed the structure for best communication practices. Exemplary curricula for teaching medical trainees in core communication strategies to use with patients have been published; many emphasise patient-centred and/or relationshipcentred strategies. Simulated patient technologies with video review can allow learners to practise their skills through both self-assessment and feedback from others. However, despite these newer learning resources, frameworks and behavioural checklists, learners naïve to clinical patient encounters must still learn how to function and adapt within the interpersonal communicative space that is created by the learner and patient. At its core, this is an iterative, spontaneous process created by the dyad and yielding, from moment to moment, to unique and unanticipated outcomes. Thus, repetitive practice will improve confidence but may miss the mark in learning the essential skills of intuitive and improvised interpersonal responsiveness. One could argue that existing approaches in teaching medical learners communication skills may promote rigid and stereotyped responses. Haidet proposes that there are significant parallels between the patient-physician dialogue (when a physician attempts to learn details about a patient and their illness) and improvisational jazz. 11 He contends that effective clinicians who are committed to relationship-centred practice depart from overarching principles of biomedical inquiry when necessary to respond spontaneously and without script to the particular circumstances of each encounter. It is believed that successful doctor-patient relationships are founded upon trusting and open communication, as well as genuine respect that can be shown by a willingness to listen or respond to the issues raised by patients. 12 The nature of the comprehensive care in family medicine makes it likely that GPs will regularly be surprised by concerns raised by patients such that they must be adept at improvising. Because of the gap that currently exists in interview skills training programmes, we hypothesised that the field of improvisational theatre would effectively supplement the traditional curriculum. Improvisation relies on listening, confidence and responding instinctively and spontaneously. 13,14 In this paper, we describe our efforts to develop a brief curriculum for medical students providing training in the art of theatre improvisation, with the goal of enhancing students' confidence and performance in clinical encounters. We hoped that this innovative curricular experience would establish a venue where secondyear medical students could learn and practise improvisational skills that might prove helpful in their communications with patients during medical encounters.

Background: Chronic pain affects over 25% of U.S. adults and is a leading cause of disability. Mindfulness meditation (MM) is a nonpharmacologic approach to manage pain and improve well-being. Despite mounting evidence supporting its efficacy, MM remains underutilized in medical practice. Understanding physicians' engagement with MM and the barriers they face can inform strategies for integration into clinical care. This study assessed physicians' attitudes toward MM, including barriers to practice and their likelihood of recommending it to patients. Methods: A cross-sectional survey of U.S. physicians was conducted from April to July 2024. Participants provided information on demographics, health struggles, and meditation practices and completed the Determinants of Meditation Practice Inventory-Revised to evaluate barriers. Results: Of 171 respondents, 37.4% meditated weekly, primarily for stress relief. Regular meditators were significantly more likely to recommend MM to patients (90.6%) compared to past (75%) or non-meditators (46.8%; P < .0001). Common barriers included time constraints (50.9%) and prioritizing other tasks (51.5%). Non- and past meditators reported low perceived benefits and inadequate knowledge (P ≤ .0001). Conclusion: Physicians' engagement with MM influences their likelihood of recommending it. Addressing barriers through education, training, and promoting brief practices could enhance MM adoption and integration into clinical care.

Routine Assessment of Quality of Life: The Next Step in Helping Children With Chronic Medical Conditions Thrive

9032 Background: The rising incidence of common cancers, an aging oncology workforce, and workforce shortages underscore the importance of medical education in oncology. However, U.S. medical students report that cancer education is underemphasized in their curriculum, and non-surgical oncology clerkships are infrequently required. Providing medical students with exposure to cancer care and research is crucial for encouraging them to pursue careers in oncology. This study evaluates the current landscape of medical student education and training initiatives at National Cancer Institute-designated cancer centers (NCIDCCs). Methods: In January 2025, we conducted a qualitative evaluation of the education and training webpages of NCIDCCs. Each webpage was reviewed to identify programs and training opportunities available to medical students. Programs specifically designed for medical students, as well as those for which medical students are eligible, were included. Data were summarized using descriptive statistics. Results: Of the 72 NCIDCCs, 71 had evaluable education and training webpages. The majority (n = 63, 89%) listed at least one education, training, or professional development initiative for medical students. Five institutions offered more than five programs for medical students. Most NCIDCC medical student initiatives focused on research training, with the most common opportunities being summer research fellowships, Medical Scientist Training Programs (MSTP), and travel awards. Only a few NCIDCCs listed clinical electives or internships among their offerings. Additionally, only 14 (20%) NCIDCCs advertised medical student programs focused on students from diverse backgrounds. Conclusions: Expanding cancer education and training in medical school is essential to addressing the growing need for an oncology workforce. While multiple research training opportunities exist at NCIDCCs, few cancer centers offer clinical electives or internships that provide medical students with direct exposure to clinical cancer care. Our analysis is limited to publicly available webpage listings; as a next step, we will conduct a survey of NCIDCC offices of education and training to further evaluate medical student initiatives. Given their multidisciplinary focus and integration of research with clinical care, NCIDCCs are uniquely positioned to develop and train the next generation of oncologists and clinical researchers through enhanced oncology education and training programs for medical students.

Systemic racism perpetuates health disparities and negatively impacts health care delivery and patient outcomes. Racism and bias can affect every aspect of clinical care, including history-taking, physical examination, laboratory interpretation, note-writing, oral presentation, and decision-making. Medical students must learn racism- and bias-mitigation skills early in their professional development to provide high-quality, equitable care. In November 2021, senior medical students and faculty with expertise in promoting health equity and justice in medicine designed and cotaught a Zoom-based, 75-minute, interactive session for second-year medical students. Participants prepared by reading assigned articles. Breakout rooms were used to facilitate small-group discussions. Session topics included use of a structural vulnerability assessment tool, examples of how bias can impact the physical exam, demonstration of how language can transmit bias, and skill practice using neutral instead of stigmatizing language. Forty second-year medical students participated in the session. Thirty-one students (78%) completed Likert-type surveys evaluating reaction and learning. Results showed improvements in students' perceptions of their abilities to assess for structural factors that influence health, recognize ways bias can impact clinical encounters, and apply skills to minimize bias in clinical care and decision-making. Providing opportunities for health care learners to think critically about how bias impacts patients and communities and equipping them with tools to begin dismantling exclusionary, racist practices in medicine are achievable and crucial to actualizing a just and equitable health system. This educational session can be adapted for training across health care professions and the educational continuum.

An important goal of medical education is to teach students to use an electronic health record (EHR) safely and effectively. The purpose of this study is to examine medical student accounts of EHR use during their core inpatient clinical clerkships using a national sample. Paper health records (PHRs) are similarly examined. An online survey about health record use within the inpatient component of six core clerkships was administered to medical students after they completed Step 2 Clinical Knowledge of the United States Medical Licensing Examination. The sample included 17,202 U.S. medical students graduating between 2012 and 2016. Mean percentages of clerkships in which students engaged in various health record activities were computed, and analysis of variance was used to examine differences. The mean percentages of clerkships in which a student accessed or entered information into an EHR increased from 78% to 93% and 59% to 72%, respectively. For students who used an EHR, the mean percentage of clerkships in which they entered information remained constant at 76%. Students entered notes during the majority of their clerkships, with increases over time. However, students entered orders in less than a quarter of their clerkships, with decreases over time. The percentage of clerkships in which students used PHRs was lower and declining. Although students used an EHR in the majority of their inpatient core clerkships, they received limited educational experiences related to order and note writing, which could translate into a lack of preparedness for future training and practice.

The Indiana University School of Medicine (IUSM) Office of Medical Education & Student Services directed the IUSM Educational Technology Unit to develop a Clinical Encounters Tracking system in response to the Liaison Committee on Medical Education's (LCME) updated accreditation standards. A personal digital assistant (PDA) and centralized database server solution was implemented. Third-year medical students are required to carry a PDA on which they record clinical encounter experiences during all clerkship clinical rotations. Clinical encounters data collected on the PDAs are routinely uploaded to the central server via the PDA HotSyncing process. Real-time clinical encounter summary reports are accessed in the school's online curriculum management system: ANGEL. The resulting IUSM Clinical Encounters Tracking program addresses the LCME accreditation standard which mandates the tracking of medical students’ required clinical curriculum experiences.