The Impact of Mindfulness on Stress and Resilience During Military Medical Field Exercises

Military medical students train in austere, high-stress environments that simulate prolonged casualty care and the cognitive and emotional demands of combat medicine. These scenarios can heighten stress and cognitive load, yet few curricula explicitly equip learners with structured strategies for psychological self-regulation. Mindfulness training has shown promise in clinical and operational contexts, but its educational role in military medical training is underexplored.

We developed the Mental Strength and Resilience Training (MSRT), a brief, theory-informed mindfulness curriculum incorporating three 1-hour sessions and asynchronous video materials. Mental Strength and Resilience Training emphasized 5 mindfulness strategies-breathing, mantra, movement, stretching, and body scan-framed for transfer to prehospital operational environments. Ninety-seven third- and fourth-year medical students at the Uniformed Services University participated across 2 high-fidelity military medical field exercises: Operation Gunpowder (36 hours) and Operation Bushmaster (5 days). Outcomes were assessed with the Mindful Attention Awareness Scale (MAAS), Brief Resilience Scale (BRS), and Perceived Stress Scale (PSS) at 4 time points. These 4 time point measures were then analyzed using a repeated measures Analysis of Variance (ANOVA) model, and the relationships between each scale score were analyzed using correlations. Faculty observers also evaluated clinical performance at Operations Gunpowder and Bushmaster for all students. Performance comparisons between students involved in the study and students not involved were compared via independent samples t-testing. The relationships between study participants' performance and their mindfulness, resilience, and stress were analyzed via correlations, with any significant correlations being entered into a regression model for further examination. This study was approved and deemed exempt by the Uniformed Services University Institutional Review Board (IRB) committee.

Learners demonstrated significant increases in mindfulness (η2p = 0.32, P < .001) and resilience (η2p = 0.06, P = .002), alongside reductions in perceived stress (η2p = 0.28, P < .001). Correlation analyses showed stress was consistently negatively associated with mindfulness and resilience. Faculty-rated performance scores did not differ significantly between the students involved in the study and non-participating students regularly enrolled at Operations Gunpowder and Bushmaster. However, pre-Bushmaster resilience predicted performance outcomes (P = .02) in the participating student sample.

Brief, theory-informed mindfulness training enhanced learners' self-regulation and reduced stress during high-fidelity military medical exercises. Although performance gains were not statistically significant, the findings suggest mindfulness is a feasible and scalable approach to strengthen psychological readiness in military medical education, with potential applications across military and civilian health professions training.