Teaching Experiential Practices in Medicine

“Knowing” Through Direct Experience

What exactly is an “experiential” practice, and how is teaching such practices different from other forms of teaching in clinical medicine? A simple way to understand experiential practices is that they involve learning through direct experience, rather than by reading, listening or watching.  In other words, you cannot learn these practices by reading a book; you can only learn them by doing them. 

What “knowing” means is to have had direct experience of a state of body and mind, rather than holding a collection of facts.  Some examples of experiential practices include meditation, yoga, and breathing techniques. Some examples of non-experiential knowledge include the names and uses of medications, the pathophysiology of diseases, and the ability to accurately recognize and categorize different diagnoses.

To be effective for your goals, and the goals of your patients, it is essential to experience these practices with guidance from a teacher, who has also been a student.  That is, the teacher must have experienced these practices with guidance from their own teachers themselves.  As you can see, this is quite different from typical clinical teaching, which usually involves educating patients by sharing data, rather than guiding them through an experience. 

To Teach, you Must also Practice

I have been so pleased to see the progress the fields of psychiatry and psychology have made in recognizing the benefits of mindfulness-based practices in clinical work.  When I was a medical and graduate student (2003-2011), I did not hear the word “meditation” at all during my education.  Fast-forward to 2018, when I returned to clinical work after a hiatus, and there were dozens of psychiatry residencies proudly advertising mindfulness-based stress reduction (MBSR), and similar distillations of meditative practices, as a part of clinical training. 

However…what I found was that trainees were typically given written scripts, which they would read to their patients in order to teach them meditation.  Meditation was not necessarily experienced or practiced by the trainees, instead it was recited, similar to other types of medical education.  I wonder…did those patients benefit from the teaching, and did they continue to practice?  The teachers who have guided me in my own experiential practices have advised that if the teaching is mechanical, the practice is likely to become mechanical.  Although you may benefit from such a mechanical practice in the beginning, you will likely reach a barrier, and without guidance from someone with experience, you may not continue to progress.

A few studies have looked into the factors that influence whether or not people benefit from meditation, and if they continue to practice.  These studies have found that those who have had a retreat experience or have spoken with a meditation teacher are more likely to continue to practice, whereas those who had their first experience using a technology are less likely to continue to practice.  This does not mean that learning from apps or scripts is “bad”; they reduce barriers to entry, and get many people started with meditation who cannot access a teacher.  However, to move beyond the mechanics of experiential practices, and towards your goals, it is important to find a teacher, and importantly, find a teacher who also practices what they are teaching.

The Mindful Pause: A How-to Guide

Mindfulness Supports a Calm and Attentive Mind

Mindfulness-Based Stress Reduction (MBSR) is a program based on the principles of mindfulness meditation practices, which has been simplified and repurposed for Western lifestyles.  The goal of MBSR is to cultivate life-skills that are useful for reducing the stress response, and the mental health and physical health consequences that result from chronic stress.

The mindful pause is one of the mindfulness-based practices considered integral to MBSR, and is exactly what it sounds like -- a pause, in which you stop whatever you are doing, and take 3-5 min to engage in a mindfulness exercise.  This is one of my go-to introductory meditation practices, due to its simplicity, and because it is feasible for most people to make time for this brief practice in their daily lives.

In my experience, the most difficult part of this practice is remembering to use it on a regular basis.  To help with this, my recommendation is to pair this practice with something you are already doing on a regular basis.  For example, you can practice this every time you open the door to enter or leave your home, or when you enter or leave your place of work.  For physicians, maybe you use this practice every time you transition between patients.  Pick something that feels practical and feasible for you.

An easy way to remember the steps in the mindful pause, is by remembering the “STOPP” acronym:

Stop

Take several deep breaths

Observe your breathing

Purpose

Prepare

The Mindful Pause Step-by-Step Guide:

Step 1: Pause whatever you are doing.

Step 2: Take several intentionally deep breaths.

Step 3: Observe the quality of your breathing:

Is your breathing fast, or slow? How does it feel to breathe?  Does your breath feel open, easy and comfortable, or does it feel restricted, shallow or difficult? 

Just observe the quality of your breathing.  As you observe the quality of your breathing, try not to judge your breathing as good or bad, just observe the quality of your breathing

Step 4: Take a moment to reflect on what your purpose is right now:

What are you meant to be doing? For example, are you about to go to a meeting? Are you about to start driving?  Are you about to start writing?  Are you about to call a friend?  What exactly is your purpose, right now?

Once you have decided on your purpose, prepare; step by step, what exactly do you need to do in order to fulfil your purpose. For example, if you are about to call a friend, you would first pick up your phone, then you would unlock your phone, then you would search for your friends name, then you would hit the green dial button, then you would hear the phone ring, then your friend would answer the phone, and then you would say something like “Hi Anne”. 

Step by step, what exactly do you need to do, in order to fulfil your purpose, right now?

Step 5: Open your eyes.

Now you are ready to fulfil your purpose.

Audio recording: