Purpose
Mental health struggles are common for undergraduate medical students, but curricular interventions are rarely used to address these issues. We implemented a 5-minute mindfulness intervention at the beginning of class sessions to support first-year medical students in learning about mindfulness and centering them for the class.

Methods
Using a mixed methods approach, we administered a pre- and post-course survey to measure student knowledge and attitudes regarding mindfulness, academic self-efficacy, and test anxiety. At the beginning of each class session, team-based learning activity, and exam during one course (14 weeks), students completed a 5-minute guided mindfulness activity and learned a brief background on the benefits of the activity. At the end of the course, students were invited to participate in an interview about their experiences. We used constant comparative analysis for qualitative analysis. Attitudes about mindfulness were measured on a 5-point Likert scale from 1 = completely disagree to 5 = completely agree, and compared between pre-and post-course surveys with Wilcoxon signed ranks tests.

Results
For 33 students who completed pre- and post-course surveys, familiarity with mindfulness increased from a mean ±SD of 3.5±1.2 to 4.5±0.6 (P<0.001). Students’ perceptions of whether practicing mindfulness is beneficial increased from 4.0±0.9 to 4.4±0.7 (P=0.017), and whether it impacts their lives increased from 3.5±1.2 to 4.0±1.0 (P=0.044). Emergent themes from interviews (n=11) indicate that students appreciated the activities, and some students experienced a mindset shift as a result.

Conclusion
We found that an integrated curricular mindfulness intervention supported student attitudes, self-efficacy, and test anxiety, suggesting that small interventions at the curricular level could improve medical student mental health.