Quantitative results
Fifty GP trainers, 18 from VUmc and 32 from Radboudumc, participated and received the first online questionnaire. The majority of participants were male (n = 33, 66%) and their mean age was 54.9 years (SD 5.7). Most worked in a duo or group practice (n = 45, 90%) and five (10%) worked in private practice. The mean duration of practice was 24.4 years (SD 6.3, range 14–39 years). Based on participants’ preference, 30 GPs were allocated to the MBSR group and 20 to the waiting list (control) group. Due to the online system mistakenly operating on anonymous ratings, seven pre-test sets of questionnaires from the intervention group could not be attributed to an individual participant; therefore, these data had to be considered as missing. There were no significant differences in sociodemographic characteristics between the missing and non-missing questionnaires.
Between-group differences at baseline
There were no baseline differences between the groups in age, sex, practice setting, and years in practice. However, the MBSR group did report significantly more depersonalisation, less work engagement, and fewer mindfulness skills than the waiting list group (Table 1). They also reported more emotional exhaustion (trend) and less work engagement (trend).
Table 1. Baseline characteristics of the intervention and control groups
Between-group differences at the end of treatment
Controlled for baseline scores, the MBSR group reported a greater decrease in depersonalisation than the control group (−1.42, 95% confidence interval [CI] = −2.72 to −0.21, P = 0.03). This did not apply to the other two subscales of burnout. Dedication increased more significantly in the MBSR group than in the control group (adjusted difference, 2.17, 95% CI = 0.51 to 3.83, P = 0.01). No significant differences were found in the other work engagement subscales. Furthermore, mindfulness skills increased significantly in the MBSR group compared with the control group (adjusted difference 6.90, 95% CI = 1.42 to 12.37, P = 0.01). These were all moderate effects (Table 2).
Table 2. Burnout, work engagement, mindfulness, and empathy at pre- and post-treatment of mindfulness-based stress reduction (MBSR), and control condition
Qualitative results
Thirty-one GPs divided into two groups, 18 in the first and 13 in the second, attended the last MBSR sessions, which were audiotaped at Radboudumc. In total, 91 minutes of audiotaped reflections were collected. At VUmc, 17 GPs filled in the evaluation form.
Six themes emerged from the data; each theme is described below. Although most GPs stated that they learned and benefited from the training, it is important to note that two GPs did not; they stated that mindfulness did not really suit them.
Theme 1: awareness
One theme that emerged from the data was increased awareness. Participants mentioned that the training helped them to become aware of their bodily sensations, thoughts, and emotions. Some participants also became more aware of their beliefs and values. Often the GPs mentioned the recognition of mindlessness and autopilot mode they usually engaged in:
‘I have become very aware of the breathing, which suits me well. The breathing comes and goes in a harmonious manner and it is the foundation you are always carrying with you. It also gives me safety, it can bring me back to myself, and I even discovered it can be an indicator of how I feel at a particular moment.’
(GP, female)
‘Because of the training I’m often able to turn the switch during the day. For example, when having dinner or brushing my teeth; turning on the switch of awareness.’
(GP, male)
Theme 2: recognising patterns
The second theme was the ability to recognise patterns. Participants gained an insight into their own automatic patterns and were able to recognise and observe their own behavioural patterns. They were also able to notice their routines, when they were behaving as they always did.
‘I learned that I am a perfectionist and I have the tendency to prepare very well and anticipate, keeping up schedules of everything and everyone, which takes a lot of energy.’
(GP, female)
Theme 3: change in patterns
The next theme was about changing behavioural patterns. Participants could let go of old patterns. Some participants indicated that, by the acceptance of thoughts and emotions, they could put things in perspective and let things be. They were making more deliberate choices, taking rest occasionally, and setting limits; additionally, they were taking better care of themselves:
‘Sometimes at work I get upset, then with the use of this symbol (the cap of a kettle), I’ll try to remember the mindfulness training and say to myself: “It’s all right, try to reset, stay calm, it is not so bad.” And I’ll use it during the day at work, taking a cup of tea and letting it go, so I can communicate more calmly, openly, honestly, and more balanced with my patient.’
(GP, male)
Theme 4: wellbeing
Another theme was physical and mental wellbeing. Participants indicated that mindfulness helped them to balance and harmonise with increased energy and joy in life. In addition, they were able to relax more:
‘The “now” is beautiful and full of richness, as a human being and as a trainer.’
(GP, male)
‘Now, I occasionally don’t do anything, just being instead of doing, which gives me energy.’
(GP, female)
Theme 5: attitude towards oneself
The fifth theme was about attitude towards oneself. Participants mentioned attitudinal changes towards themselves, aspects of self-acceptance and compassion. Some participants indicated that their own beliefs and values had changed; they became less judgemental, more open, more accepting, and were less striving. They were also able to be open to unpleasant experiences, acknowledging them instead of avoiding them:
‘I think mindfulness deals with — and these are serious words — a sort of unconditional right of existence, that all people have. And the consequence of that, for me, is that I don’t have to prove myself, that I can simply be the way I am. And that it is OK like that. And whatever I do or strive for is fine, but even without that, it is already fine.’
(GP, male)
Theme 6: attitude towards others
The final theme was about one’s attitude towards others. Some participants indicated that mindfulness training taught them to accept others, including their patients, and to have compassion for them. This contributed to communication with patients:
‘One beautiful meditation I have been doing the last weeks and still like to do is the metta meditation, where you evoke a feeling of love towards your loved ones, and afterwards for yourself, the rest of the world, and people with whom you have difficulties. And I notice it gives me space.’
(GP, male)
‘This stone lies on the desk in my office. I use it when I’m stuck with my patient. I will have a look at the stone, breathe, and try to feel some love for the patient. It gives me some space and I can continue without being annoyed with my patient’
(GP, male)
