Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
Lowry Internal Medicine, Denver, Colorado.
JAMA Netw Open. 2022 May 2;5(5):e2210752. doi: 10.1001/jamanetworkopen.2022.10752.
Female resident physicians are disproportionately affected by burnout, which can have serious consequences for their well-being and career trajectory. Growing evidence supports the use of professional coaching to reduce burnout in resident physicians, yet individual coaching is resource intensive and infeasible for many training programs.
To assess whether a structured professional group-coaching program for female resident physicians would lead to decreased burnout.
DESIGN, SETTING, AND PARTICIPANTS: This pilot randomized clinical trial was conducted from January 1 to June 30, 2021, among 101 female resident physicians in graduate medical education at the University of Colorado who voluntarily enrolled in the trial after a recruitment period. Surveys were administered to participants before and after the intervention.
With the use of a computer-generated 1:1 algorithm, 50 participants were randomly assigned to the intervention group and 51 participants were randomly assigned to the control group. The intervention group was offered a 6-month, web-based group-coaching program, Better Together Physician Coaching, developed and facilitated by trained life coaches and physicians. The control group received residency training as usual, with no coaching during the study. The control group was offered the 6-month coaching program after study completion.
The primary outcome of burnout was measured using the Maslach Burnout Inventory, defined by 3 Likert-type 7-point subscales: emotional exhaustion, depersonalization, and professional accomplishment. Higher scores on the emotional exhaustion and depersonalization subscales and lower scores on the professional accomplishment subscale indicate higher burnout. Secondary outcomes of impostor syndrome, self-compassion, and moral injury were assessed using the Young Impostor Syndrome Scale, Neff's Self-Compassion Scale-Short Form, and the Moral Injury Symptom Scale-Healthcare Professionals, respectively. An intention-to-treat analysis was performed.
Among the 101 female residents in the study, the mean (SD) age was 29.4 (2.3) years, 96 (95.0%) identified as heterosexual, and 81 (80.2%) identified as White. There were 19 residents (18.8%) from surgical subspecialties, with a range of training levels represented. After 6 months of professional coaching, emotional exhaustion decreased in the intervention group by a mean (SE) of 3.26 (1.25) points compared with a mean (SE) increase of 1.07 (1.12) points in the control group by the end of the study (P = .01). The intervention group experienced a significant reduction in presence of impostor syndrome compared with controls (mean [SE], -1.16 [0.31] vs 0.11 [0.27] points; P = .003). Self-compassion scores increased in the intervention group by a mean (SE) of 5.55 (0.89) points compared with a mean (SE) reduction of 1.32 (0.80) points in the control group (P < .001). No statistically significant differences in depersonalization, professional accomplishment, or moral injury scores were observed. Owing to the differential follow-up response rates in the treatment groups (88.2% in the control group [45 of 51]; 68.0% in the intervention group [34 of 50]), a sensitivity analysis was performed to account for the missing outcomes, with similar findings.
In this randomized clinical trial, professional coaching reduced emotional exhaustion and impostor syndrome scores and increased self-compassion scores among female resident physicians.
ClinicalTrials.gov Identifier: NCT05280964.
重要性:女性住院医师受到倦怠的不成比例的影响,这对他们的幸福和职业轨迹可能产生严重后果。越来越多的证据支持使用专业辅导来减少住院医师的倦怠,但个体辅导资源密集且对许多培训计划不可行。
目的:评估针对女性住院医师的结构化专业小组辅导计划是否会减少倦怠。
设计、地点和参与者:这项试验性随机临床试验于 2021 年 1 月 1 日至 6 月 30 日在科罗拉多大学的研究生医学教育中的 101 名女性住院医师中进行,他们在招募期后自愿参加了该试验。在干预前后向参与者进行了调查。
干预:使用计算机生成的 1:1 算法,随机将 50 名参与者分配到干预组,随机将 51 名参与者分配到对照组。干预组提供了一个为期 6 个月的基于网络的小组辅导计划,名为“更好地一起医生辅导”,由经过培训的生活教练和医生开发和主持。对照组接受住院医师培训,研究期间没有辅导。对照组在研究结束后提供 6 个月的辅导计划。
主要结果和措施:使用 Maslach 倦怠量表衡量倦怠的主要结果,该量表由 3 个李克特 7 点分量表定义:情感衰竭、去人格化和职业成就。情绪衰竭和去人格化分量表的得分越高,职业成就分量表的得分越低,表明倦怠程度越高。使用青年冒名顶替者量表、Neff 的自我同情量表-简短版和道德伤害症状量表-医疗保健专业人员分别评估冒名顶替者综合征、自我同情和道德伤害的次要结果。进行了意向治疗分析。
结果:在研究中的 101 名女性住院医师中,平均(SD)年龄为 29.4(2.3)岁,96 名(95.0%)为异性恋,81 名(80.2%)为白人。有 19 名(18.8%)来自外科专业,代表了不同的培训水平。经过 6 个月的专业辅导,干预组的情绪衰竭平均(SE)下降了 3.26(1.25)分,而对照组在研究结束时平均(SE)增加了 1.07(1.12)分(P = .01)。与对照组相比,干预组的冒名顶替者综合征明显减少(平均[SE],-1.16 [0.31] vs 0.11 [0.27] 分;P = .003)。与对照组相比,干预组的自我同情评分平均(SE)增加了 5.55(0.89)分(P < .001)。在去人格化、职业成就或道德伤害评分方面未观察到统计学上显著差异。由于治疗组的随访应答率存在差异(对照组为 88.2%[51 人中有 45 人];干预组为 68.0%[50 人中有 34 人]),进行了敏感性分析以考虑缺失的结果,得出了类似的发现。
结论和相关性:在这项随机临床试验中,专业辅导减少了女性住院医师的情绪衰竭和冒名顶替者综合征评分,并提高了自我同情评分。
试验注册:ClinicalTrials.gov 标识符:NCT05280964。