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A randomised controlled trial of the effects of mindfulness practice on medical student stress levels


Dr Emma Warnecke, School of Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania 7001, Australia. Tel: 00 61 3 6226 4757; Fax: 00 61 3 6226 4894; E-mail:


Medical Education 2011: 45: 381–388

Objective  This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students.

Methods  We carried out a multicentre, single-blinded, randomised controlled trial with intention-to-treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block-randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self-report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow-up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS).

Results  Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age-matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (− 3.44, 95% confidence interval [CI] − 6.20 to − 0.68; p < 0.05) and the anxiety component of the DASS (− 2.82, 95% CI − 4.99 to − 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (− 3.69, 95% CI − 7.38 to 0.01; p = 0.05). Follow-up at 8 weeks post-trial revealed that the effect was maintained.

Conclusions  Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self-administered, evidence-based intervention now exists to manage stress in this at-risk population and should be widely utilised.