‘Dear Doctor’: a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists

Brazier, Alix; Larson, Erika R.; Xu, Yixin; Judah, Gaby; Egan, Mark; Burd, Hannah; Darzi, Ara

doi:10.1111/anae.15643

Cited by 9 publications

(16 citation statements)

References 31 publications

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“…The group and online delivery of the intervention supported greater scalability, accessibility, and lower cost compared with individual coaching. Furthermore, the magnitudes of improvement in scores described here were generally higher than other coaching and wellness interventions and higher than that of our single-site pilot RCT . Our findings show effectiveness in a broader population and match national data for trainees that self-report as underrepresented in medicine .…”

Section: Discussionsupporting

confidence: 65%

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Online Well-Being Group Coaching Program for Women Physician Trainees

Mann,

Shah,

Thibodeau

et al. 2023

JAMA Netw Open

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ImportancePhysician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking.ObjectiveTo assess the generalizability of a coaching program (Better Together Physician Coaching) in a national sample of women physician trainees.Design, Setting, and ParticipantsA randomized clinical trial involving trainees in 26 graduate medical education institutions in 19 states was conducted between September 1, 2022, and December 31, 2022. Eligible participants included physician trainees at included sites who self-identified as a woman (ie, self-reported their gender identity as woman, including those who reported woman if multiple genders were reported).InterventionA 4-month, web-based, group coaching program.Main Outcomes and MeasuresThe primary outcomes were change in burnout (measured using subscales for emotional exhaustion, depersonalization, and personal achievement from the Maslach Burnout Inventory). Secondary outcomes included changes in impostor syndrome, moral injury, self-compassion, and flourishing, which were assessed using standardized measures. A linear mixed model analysis was performed on an intent-to-treat basis. A sensitivity analysis was performed to account for the missing outcomes.ResultsAmong the 1017 women trainees in the study (mean [SD] age, 30.8 [4.0] years; 540 White participants [53.1%]; 186 surgical trainees [18.6%]), 502 were randomized to the intervention group and 515 were randomized to the control group. Emotional exhaustion decreased by an estimated mean (SE) −3.81 (0.73) points in the intervention group compared with a mean (SE) increase of 0.32 (0.57) points in the control group (absolute difference [SE], −4.13 [0.92] points; 95% CI, −5.94 to −2.32 points; P &lt; .001). Depersonalization decreased by a mean (SE) of −1.66 (0.42) points in the intervention group compared with a mean (SE) increase of 0.20 (0.32) points in the control group (absolute difference [SE], −1.87 [0.53] points; 95%CI, −2.91 to −0.82 points; P &lt; .001). Impostor syndrome decreased by a mean (SE) of −1.43 (0.14) points in the intervention group compared with −0.15 (0.11) points in the control group (absolute difference [SE], −1.28 (0.18) points; 95% CI −1.63 to −0.93 points; P &lt; .001). Moral injury decreased by a mean (SE) of −5.60 (0.92) points in the intervention group compared with −0.92 (0.71) points in the control group (absolute difference [SE], −4.68 [1.16] points; 95% CI, −6.95 to −2.41 points; P &lt; .001). Self-compassion increased by a mean (SE) of 5.27 (0.47) points in the intervention group and by 1.36 (0.36) points in the control group (absolute difference [SE], 3.91 [0.60] points; 95% CI, 2.73 to 5.08 points; P &lt; .001). Flourishing improved by a mean (SE) of 0.48 (0.09) points in the intervention group vs 0.09 (0.07) points in the control group (absolute difference [SE], 0.38 [0.11] points; 95% CI, 0.17 to 0.60 points; P &lt; .001). The sensitivity analysis found similar findings.Conclusions and RelevanceThe findings of this randomized clinical trial suggest that web-based professional group-coaching can improve outcomes of well-being and mitigate symptoms of burnout for women physician trainees.Trial RegistrationClinicalTrials.gov Identifier: NCT05222685

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Section: Discussionsupporting

confidence: 65%

“…Intervention participants experienced a significant decrease in impostor syndrome with an absolute difference (SE) of −1.28 (0.18) points (95% CI, −1.63 to −0.93 points; P < .001); the mean (SE) change in score for the intervention group was −1. 43…”

Section: Impostor Syndromementioning

confidence: 99%

Online Well-Being Group Coaching Program for Women Physician Trainees

Mann,

Shah,

Thibodeau

et al. 2023

JAMA Netw Open

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“…The following interventions did not enhance well-being among healthcare workers: mindful colouring of mandalas for 10 days [ 44 ]; a 40-week football or Zumba training course for an hour per session, 2–3 times per week [ 45 ]; an intervention of 22 text messages about factors associated with burnout in a period of 10 months [ 46 ]; a small-group intervention based on theory of successful ageing for mental health promotion [ 37 ]; an 8-week relaxation meditation course [ 47 ]; in-person mindfulness resilience training or smartphone-delivered resilience training [ 48 ]; an 8- to 12-week online multi-component positive psychology intervention of psychoeducation and positive psychology exercises [ 49 ]; and a 3-h community resiliency training course (psychoeducation and sensory awareness skills) [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…A 10-week peer-support intervention had no effect on burnout among health and social service workers [ 54 ]. Moreover, none of the following interventions reduced job burnout among healthcare workers: a psycho-oncology training on supportive communication and a crisis intervention to address psychological problems for cancer patients [ 93 ], 22 text messages about factors associated with burnout over 10 months [ 46 ], mindful colouring of mandalas for 10 days [ 44 ], an 8-week spiritually based passage meditation [ 94 ], a 9-month facilitated group discussion [ 95 ], a one-page discussion guide for self-facilitated discussion [ 96 ], a 7-week coping training on cognitive and problem-solving coping strategies [ 97 ], a 7-week social support intervention [ 97 ], a 12-month psychological intervention based on problem-based learning and personnel empowerment [ 98 ], a 12-week authentic connections groups program to enhance resilience [ 99 ], a 3-h community resiliency training on psychoeducation and sensory awareness skills [ 50 ], an educational program to manage challenging behaviour [ 100 ], a 13-week training program in dementia care to improve caregivers’ knowledge and competencies [ 101 ], a 13-week relaxation training such as muscle relaxation, breathing relaxation or guided imaginary journeys [ 101 ], a compassion fatigue resiliency program [ 102 ], management change on psychosocial factors involving education and problem-solving discussions [ 103 ], and a 6-week self-guided internet intervention on self-efficacy or perceived social support [ 104 ].…”

Section: Resultsmentioning

confidence: 99%

“…We also found that the following interventions did not reduce the number of sickness absence days among healthcare workers: Online mindfulness programs without guidance [ 42 ]; a personalized mindfulness-based program [ 64 ]; a multidisciplinary program that included exercise, nutrition, ergonomics and psychology [ 55 ], text messages about burnout prevention [ 46 ]; tailored aerobic fitness and strength exercises for 10 weeks [ 31 ]; a multi-faceted intervention that included physical training, participatory ergonomics, and cognitive behavioural training [ 33 ]; a program that included diet, strengthening and fitness exercises, and cognitive behavioural training [ 38 ]; a 6-month light aerobic, strengthening and stretching exercises for an hour per week [ 134 ], a 5-week physical and behavioural preventive intervention [ 135 ]; a multifaceted intervention that included participatory ergonomics, healthy lifestyle promotion and a tailored case management [ 136 ]; an 8-week educational and individualized program to manage sleep and the consequences of shift work [ 137 ]; a 9-month integrated health program that consisted of exercise, stress management, health information and an examination of workplace to cope with the job [ 56 ]; education of patient transfer technique [ 138 ]; patient transfer technique education combined with supervised aerobic fitness and strength training [ 138 ]; and integration of health promotion and health protection into continuous improvement system (Kaizen) [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

2023

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Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.

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