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.
