Summary One in four doctors in training in the UK reports feeling ‘burnt out’ due to their work and similar figures are reported in other countries. This two‐group non‐blinded randomised controlled trial aimed to determine if a novel text message intervention could reduce burnout and increase well‐being in UK trainee anaesthetists. A total of 279 trainee anaesthetists (Core Training Year 2, Specialty Training Years 3 or 4) were included. All participants received one initial message sharing support resources. The intervention group (139 trainees) received 22 fortnightly text messages over approximately 10 months. Messages drew on 11 evidence‐based themes including: gratitude; social support; self‐efficacy; and self‐compassion. Primary outcomes were burnout (Copenhagen Burnout Inventory) and well‐being (Short Warwick‐Edinburgh Mental Well‐being Scale). Secondary outcomes were as follows: meaning in work; professional value; sickness absence; and consideration of career break. Outcomes were measured via online surveys. Measures of factors that may have affected well‐being were included post‐hoc, including the impact of COVID‐19 (the first UK wave of which coincided with the second half of the trial). The final survey was completed by 153 trainees (74 in the intervention and 79 in the control groups). There were no significant group differences in: burnout (β = ‐1.82, 95%CI ‐6.54–2.91, p = 0.45); well‐being (‐0.52, ‐1.73–0.69, p = 0.40); meaning (‐0.09, ‐0.67–0.50, p = 0.77); value (‐0.01, ‐0.67–0.66, p = 0.99); sick days (0.88, ‐2.08–3.83, p = 0.56); or consideration of career break (OR = 0.44, ‐0.30–1.18, p = 0.24). Exploratory post‐hoc analysis found the intervention was associated with reduced burnout in participants reporting personal or work‐related difficulties during the trial period (‐9.56, ‐17.35 to ‐1.77, p = 0.02) and in participants reporting that the COVID‐19 pandemic had a big negative impact on their well‐being (‐10.38, ‐20.57 to ‐0.19, p = 0.05). Overall, this trial found the intervention had no impact. However, given this intervention is low cost and requires minimal time commitment from recipients, it may warrant adaptation and further evaluation.

Antimicrobial resistance could cause 10 million deaths per year by 2050 if no action is taken. While we depend on researchers to find new antimicrobials, reducing the demand for existing ones requires human behaviour change. This article by The Behavioural Insights Team discusses some of the areas with the greatest potential for behavioural interventions to reduce the development of antimicrobial resistance. Three areas are discussed: (i) ‘nudging’ antimicrobial stewardship (e.g. highlighting comparative over-prescribing was seen to reduce GP antibiotics prescriptions by 3.3%); (ii) promoting good hygiene practices (e.g. placement and salience of hand sanitizer increased hospital visitor compliance from 0.4% to 19.7%); and (iii) leveraging market forces (e.g. front-of-package labelling could increase demand for meat produced with minimal antibiotics, encouraging food production behaviour change).

Background Over one in five UK doctors reports feeling burnt out because of their work. This study aimed to determine if a novel text message intervention could reduce burnout in UK trainee anaesthetists. Methods In this two-arm, non-blinded, randomised controlled trial, we recruited 2nd to 4th year trainees registered with the Royal College of Anaesthetists, UK. Eligible trainees were given information about the trial and asked to provide their mobile phone numbers to indicate consent to participate. Participation was optional. Participants who signed up to the trial were randomly assigned (using a random number generator in the statistical programme Stata) to receive either fortnightly text messages over 10 months (treatment group) or no intervention messages (control group). Randomisation was stratified by training year and region. A literature review and qualitative study informed the intervention design and content: our intervention was low cost to deliver and minimally time-intensive for participants (contrasting many previous interventions), and it aimed to address factors identified as contributing to burnout. The message content also drew on 11 themes from the behavioural science and wellbeing literature (eg, gratitude, social support, self-compassion) to improve burnout and wellbeing. The co-primary outcomes were burnout (measured by the work-related subscale of the Copenhagen Burnout Inventory) and wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale). Secondary outcomes were meaning in work, professional value, sickness absence, and consideration of career break. Exploratory outcomes were factors potentially affecting wellbeing, including COVID-19. Outcomes were measured via an online survey. Intervention impact for those who completed the endline survey was evaluated using regression adjusting for gender, training year, training region, and baseline measurement. We conducted exploratory analyses of intervention impact in subgroups of participants using the same regression model. The Imperial College Research Ethics Committee approved the study on Aug 14, 2019 (reference number 19IC5205). The Imperial Joint Research Compliance Office approved the additional exploratory outcomes in an amendment on July 21, 2020. This trial is registered with the ISRCTN registry, ISRCTN11418903. Findings In September-October 2019, 279 trainees were randomised, of whom 153 (80 female; 73 male) completed the endline survey (74 in the treatment group; 79 in the control group). There were no significant group differences in burnout (β=-1•82, 95% CI -6•54 to 2•91, p=0•45), wellbeing (-0•52, -1•73 to 0•69, p=0•40), or secondary outcomes (all p values ≥0•24). However, 49 (66%) of 74 participants in the treatment group recommended the messages be sent to future trainees. Exploratory analyses found the intervention was associated with reduced burnout in participants who reported personal or work-related difficulties (β=-9•56, -17•35 to -1•77), and those for whom COVID-19 had a large negative wellbeing impact (β=-10•38, -20•...

Background Burnout in doctors is reported in many countries. Following a randomised controlled trial of a novel 10-month fortnightly text message intervention to reduce burnout in trainee anaesthetists, an interview study was conducted. The intervention's format and content were developed based on findings from a preceding literature review and interview study with trainee anaesthetists, and messages incorporated 11 evidenced themes including gratitude and self-efficacy from the wellbeing and behavioural science literatures. Objectives of the interviews were to explore experiences of the intervention, understand perceived mechanisms of impact (or lack thereof), and identify improvements. MethodsIn the trial's endline survey (ISRCTN11418903), all 74 participants in the treatment group (those who received the text messages) were invited to interview and sampled purposively. Semi-structured interviews (audiorecorded and transcribed) were conducted following verbal consent (the participant information sheet and consent questions were sent by email before the interview). Data were managed using the Framework Approach and analysed thematically. The Imperial Joint Research Compliance Office approved this study on July 13, 2020 in an amendment to an original application to the Imperial College Research Ethics Committee (reference number 19IC5205, approval Aug 14, 2019).Findings The pool of 23 potential participants (who registered interest) was resampled five times (eg, when the research team did not receive a response to the initial recruitment or subsequent reminder emails) until no volunteers remained. Nine interviews (three women, six men) were conducted, with diversity captured across training location, year, and change in burnout over the trial. Reported engagement (reading or acting on messages) varied. Factors affecting engagement were work pressures, mood, and COVID-19 (due to wearing personal protective equipment and wellbeing information overload). Interviewees described the content as useful, varied and interesting, among other positive descriptors. Critique referenced the intervention's impersonal nature, and that some content was generic or basic. Interviewees enjoyed the low-intensity, passive nature of the intervention. Text message was viewed as a novel, unsaturated (not heavily used) delivery mechanism (better than email). Messages provoking meaningfulness, professional value, and community were highlighted as higher impact, along with those fostering perceptions of shared experience and encouraging communication between colleagues. Suggestions for no perceived impact included personal factors (eg, high existing resilience and support) and the intervention's impersonal nature. Interviewees suggested content to add and remove, and ways of personalising format and content.Interpretation Interviewees generally found the intervention acceptable and recommended it. Although the trial only observed an effect in a subsample, the intervention may benefit from re-evaluation following adaptation based on intervie...