Ethics Review: Suffering is optional
Applying “beginner’s mind” to the REB process
To complete my degree I will be conducting a research study exploring the application of mindfulness to address physician wellbeing - specifically through the teachings of Thich Nhat Hanh. Before implementing the study, the entire protocol (every minute step, from who is included in the study, how they will be recruited, what the sample size will be, how consent will be given, how data will be stored and analyzed etc.) needs to be rigorously designed and then submitted to the hospital’s review ethics board (REB).
As I neared the end of my course work and started gearing up to design the protocol, I felt quite excited. This was the practical part of my degree I was most passionate about! However, like many others processes that are part of completing a PhD, I once again found myself surrounded by a string of negative narratives. Whenever I would tell someone I was preparing to submit my protocol to the REB process, I would hear about how painful the process would be, how slow and annoying it was, and how time consuming and difficult it might be. The way these comments were shared had a tone of an eye-roll mixed with a sense of solidarity, recognizing a kind of painful right of passage that all researchers must go through.
“Whenever I would tell someone I was preparing to submit my protocol to the REB process, I would hear about how painful the process would be”
Spoiler: I am at the other end of the process and this was not at all what I experienced. My take away from the REB process was this: other human beings, who are experts in reviewing research studies, took the time to comb through my protocol and make sure that from start to finish it was clear, rigorous, and well designed. This is an incredible service to receive, as once you are close enough to some materials, or have edited a consent form several times, it becomes really difficult to catch errors or inconsistencies. I felt really supported by the process and people involved.
“Why once again was I having a fun joyful time, while my peers were suffering deeply? ”
This led me to wonder why my experience was so different than others. Why once again was I having a fun joyful time, while my peers were suffering deeply? I took some time to reflect on this question and came up with a two part hypothesis 1) if you have not been trained to receive feedback, the REB process could feel like a critical attack on you and your work 2) if you want the process to be something it is not (quick and without feedback) then the process will likely be annoying and frustrating.
“Take the feedback as support to make your study better and not hear it as saying there is something wrong with you or your study.”
Let’s unpack these a little further…
1) If you have not been trained to receive feedback, the REB process could feel like a critical attack on you and your work:
They provide incredibly detailed notes and suggestions on how to edit your study and all the accompanying paperwork. Without approaching this as helpful feedback to make your study better, one could easily feel attacked or judged. This brings me back once again to the notion that as researchers, it is incredibly important to recognize that our research is tied into our identity - no matter how “unbiased” or “subjective” one might be, we are pouring an incredible amount of time, energy and likely passion into a project. Hearing what is “wrong” with it, what needs changing, without a positive and open framing, could easily turn a process like an ethics review into a combative difficult situation. The solution? Take the feedback as support to make your study better and not hear it as saying there is something wrong with you or your study.
2) If you want the process to be something it is not (quick and without feedback) then the process will likely be annoying and frustrating:
In addition to reframing notes and suggestions as positive guides to making one’s study better, the other component I propose causes extra suffering along the process is simply wanting it to go faster or be less detail oriented. In other words, wanting the process to be something it is not, then being frustrated each time it is what it is. The truth is that the ethics review process is incredibly detail oriented and therefore takes time. If you begin the process accepting this, then you will definitely have a much better time when you receive six pages of notes and spend a few days with track changes making updates. There is a formula often used in Mindfulness Based Interventions (MBIs) that this insight reminded me of: suffering = pain x resistance. When you go through the REB process there will be a little pain that you cannot avoid - a ton of minute details you need to update across a lot of documents and some inevitable hiccups with the online submission system. This is already enough to deal with. But from speaking with my peers it seems that most people are increasing their suffering by resisting the process, which is to go back and forth with your REB rep, receive feedback and make updates.
Summary of how to navigate the REB process with ease and less suffering:
Our framing of the event before it starts impacts our entire experience of it. Try starting the REB process with the idea that experts are about to help level up your study by cross checking all your work and finding any inconsistencies that you have missed.
The inferences we make based on the sensory input we receive from the world are simply that: inferences. Our brain is doing its best guess work to determine what things mean, but meaning is subjective. Thich Nhat Hanh says “when you are sure check again”. As you receive feedback from the REB notice what it feels like to interpret it as supportive feedback rather than criticism or annoying homework.
Accepting the REB for what it is. As with many things in life, if we accept a task or person for who they are, spending time with them can be a lot easier. Throughout the REB process, see what it feels like to accept the general pacing and timeline of the process for what it is and not what you want it to be. This might apply to the time it takes, or the amount of feedback you receive, or the number of changes you need to make.
I am not saying that all of the thoughts above are easy to implement, or that you should never be frustrated during an REB process (suffering is, after all the first noble truth). But this reflection is an invitation to consider how you might reduce your suffering. After all, if you are doing a research study, you have to go through the process either way - why not set an intention to have a good time? Or at least, suffer as little possible?
“After all, if you are doing research study, you have to go through the process either way - why not set an intention to have a good time? Or at least, suffer as little possible?”
The concept of “beginner’s mind” comes from Zen buddhist theory and is the invitation to apply a kind of fresh, open, curious mind to what you encounter in life. If we are feeling stuck, frustrated or anxious with a task or situation the practice of beginner’s mind can help us to reframe and reconnect with the situation in a new way.
Suggested Reflection Practice: Beginner’s Mind Meditation
Step 1: find a comfortable sitting/standing/lying down position where you will not be disturbed for a few moments. Once you are settled close your eyes. Begin by anchoring yourself in your in-breath and out breath.
Step 2: imagine you are walking with a small child towards the ocean. This child has never seen the ocean before. Imagine as you arrive at the ocean, where the sun is dancing off the water and huge waves are rolling towards the beach, what the reaction of the young child is seeing all this for the first time. Take a moment to notice their excitement and curiosity.
Step 3: can you remember a time when you felt this kind of excitement and curiosity? This could be from a long time ago, for something big or small. Can you remember encountering something new for the first time and how that felt? This is our beginner’s mind.
Step 4: Now, imagine applying this kind of “beginner’s mind” to a project, task or situation that you are currently experiencing in your life. What would it be like to look at it with the eyes of excitement and curiosity? To let go of being sure and to really check again to see what is there, to see what is needed?
Step 5: Before ending this practice take a moment to return once again to the anchor of your breathing. Give yourself the gift of stopping for a few moments before returning to your day.
My nephew Avi “helping” fold a sail for the first time with his Grandfather