Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message–Based Assessment Tool: Longitudinal Pilot Study

Abstract

Background Physician burnout is a multibillion-dollar issue in the United States. Despite its prevalence, burnout is difficult to accurately measure. Institutions generally rely on periodic surveys that are subject to recall bias. SMS text message–based surveys or assessments have been used in health care and have the advantage of easy accessibility and high response rates. Objective In this pilot project, we evaluated the utility of and participant engagement with a simple, longitudinal, and SMS text message–based mental health assessment system for physician-trainees at the study institution. The goal of the SMS text message–based assessment system was to track stress, burnout, empathy, engagement, and work satisfaction levels faced by users in their normal working conditions. Methods Three SMS text message-based questions per week for 5 weeks were sent to each participant. All data received were deidentified. Additionally, each participant had a deidentified personal web page to follow their scores as well as the aggregated scores of all participants over time. A 13-question optional survey was sent at the conclusion of the study to evaluate the usability of the platform. Descriptive statistics were performed. Results In all, 81 participants were recruited and answered at least six (mean 14; median 14; range 6-16) questions for a total of 1113 responses. Overall, 10 (17%) out of 59 participants responded “Yes” to having experienced a traumatic experience during the study period. Only 3 participants ever answered being “Not at all satisfied” with their job. The highest number of responses indicating that participants were stressed or burnt out came on day 25 in the 34-day study period. There were mixed levels of concern for the privacy of responses. No substantial correlations were noted between responses and having experienced a traumatic experience during the study period. Furthermore, 12 participants responded to the optional feedback survey, and all either agreed or strongly agreed that the SMS text message–based assessment system was easy to use and the number of texts received was reasonable. None of the 12 respondents indicated that using the SMS text message–based assessment system caused stress. Conclusions Responses demonstrated that SMS text message–based mental health assessments are potentially useful for recording physician-trainee mental health levels in real time with minimal burden, but further study of SMS text message–based mental health assessments should address limitations such as improving response rates and clarifying participants’ sense of privacy when using the SMS text message–based assessment system. The findings of this pilot study can inform the development of institution-wide tools for assessing physician burnout and protecting physicians from occupational stress.