Dyrbye Liselotte N, Shanafelt Tait D, Gill Priscilla R, Satele Daniel V, West Colin P
Department of Medicine, Program on Physician Well-Being, Mayo Clinic, Rochester, Minnesota.
Department of Medicine, WellMD Center, Stanford School of Medicine, Stanford University, Palo Alto, California.
JAMA Intern Med. 2019 Oct 1;179(10):1406-1414. doi: 10.1001/jamainternmed.2019.2425.
Burnout symptoms among physicians are common and have potentially serious ramifications for physicians and their patients. Randomized studies testing interventions to address burnout have been uncommon.
To explore the effect of individualized coaching on the well-being of physicians.
DESIGN, SETTING, AND PARTICIPANTS: A pilot randomized clinical trial involving 88 practicing physicians in the departments of medicine, family medicine, and pediatrics who volunteered for coaching was conducted between October 9, 2017, and March 27, 2018, at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin. Statistical analysis was conducted from August 24, 2018, to March 25, 2019.
A total of 6 coaching sessions facilitated by a professional coach.
Burnout, quality of life, resilience, job satisfaction, engagement, and meaning at work using established metrics. Analysis was performed on an intent-to-treat basis.
Among the 88 physicians in the study (48 women and 40 men), after 6 months of professional coaching, emotional exhaustion decreased by a mean (SD) of 5.2 (8.7) points in the intervention group compared with an increase of 1.5 (7.7) points in the control group by the end of the study (P < .001). Absolute rates of high emotional exhaustion at 5 months decreased by 19.5% in the intervention group and increased by 9.8% in the control group (-29.3% [95% CI, -34.0% to -24.6%]) (P < .001). Absolute rates of overall burnout at 5 months also decreased by 17.1% in the intervention group and increased by 4.9% in the control group (-22.0% [95% CI, -25.2% to -18.7%]) (P < .001). Quality of life improved by a mean (SD) of 1.2 (2.5) points in the intervention group compared with 0.1 (1.7) points in the control group (1.1 points [95% CI, 0.04-2.1 points]) (P = .005), and resilience scores improved by a mean (SD) of 1.3 (5.2) points in the intervention group compared with 0.6 (4.0) points in the control group (0.7 points [95% CI, 0.0-3.0 points]) (P = .04). No statistically significant differences in depersonalization, job satisfaction, engagement, or meaning in work were observed.
Professional coaching may be an effective way to reduce emotional exhaustion and overall burnout as well as improve quality of life and resilience for some physicians.
ClinicalTrials.gov identifier: NCT03207581.
医生职业倦怠症状普遍存在，对医生及其患者可能产生严重影响。针对职业倦怠进行干预的随机研究并不常见。
探讨个性化辅导对医生幸福感的影响。
设计、背景和参与者：2017年10月9日至2018年3月27日，在亚利桑那州、佛罗里达州、明尼苏达州和威斯康星州的梅奥诊所，对88名来自内科、家庭医学科和儿科的执业医生进行了一项试点随机临床试验，这些医生自愿接受辅导。2018年8月24日至2019年3月25日进行了统计分析。
由专业教练提供总共6次辅导课程。
使用既定指标评估职业倦怠、生活质量、心理韧性、工作满意度、工作投入度和工作意义。基于意向性分析进行分析。
在该研究的88名医生中（48名女性和40名男性），经过6个月的专业辅导，干预组的情感耗竭程度平均（标准差）下降了5.2（8.7）分，而对照组在研究结束时平均增加了1.5（7.7）分（P＜0.001）。干预组5个月时高情感耗竭的绝对发生率下降了19.5%，对照组增加了9.8%（差值为-29.3%[95%CI，-34.0%至-24.6%]）（P＜0.001）。干预组5个月时总体职业倦怠的绝对发生率也下降了17.1%，对照组增加了4.9%（差值为-22.0%[95%CI，-25.2%至-18.7%]）（P＜0.001）。干预组的生活质量平均（标准差）提高了1.2（2.5）分，对照组提高了0.1（1.7）分（差值为1.1分[95%CI，0.04-2.1分]）（P = 0.005），干预组的心理韧性得分平均（标准差）提高了1.3（5.2）分，对照组提高了0.6（4.0）分（差值为0.7分[95%CI，0.0-3.0分]）（P = 0.04）。在去人格化、工作满意度、工作投入度或工作意义方面未观察到统计学上的显著差异。
专业辅导可能是减少部分医生情感耗竭和总体职业倦怠、提高生活质量和心理韧性的有效方法。
ClinicalTrials.gov标识符：NCT03207581。
