Ditton Elizabeth, Knott Brendon, Hodyl Nicolette, Horton Graeme, Oldmeadow Christopher, Walker Frederick Rohan, Nilsson Michael
Centre for Rehab Innovations, University of Newcastle, Callaghan, Australia.
Hunter Medical Research Institute, New Lambton Heights, Australia.
JMIR Ment Health. 2023 Feb 6;10:e42566. doi: 10.2196/42566.
Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority.
This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version.
This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs.
The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed.
This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods.
Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/32992.
医生职业倦怠是一个常见问题，常在本科教育阶段出现。对医学生进行心理灵活性技能培训的早期干预策略有助于促进其幸福感，并降低与不可改变的职业压力源相关的倦怠风险。需要通过随机对照试验来评估其有效性。由于心理灵活性因情境和个体而异，量身定制干预措施可能会改善结果。智能手机应用程序可以促进个性化和可及性，对这种方法的评估是一个已确定的研究重点。
本研究旨在评估一款独立的、通过应用程序提供的接受与承诺疗法干预措施对改善医学生自我报告的倦怠、幸福感、心理灵活性和心理困扰结果的有效性。我们旨在探讨个性化应用程序是否比非个性化版本更具优势。
本平行随机对照试验以2所澳大利亚大学的医学生为样本（N = 143）。参与者以1:1:1的分配比例随机分配到3个干预组之一（个性化组、非个性化组和等待名单组）。个性化组和非个性化组的参与者对分组情况不知情。为期5周的干预包括一个介绍模块（第1阶段）和按需访问的简短技能培训活动（第2阶段），学生可按照自己的节奏进行学习。第2阶段要么是非个性化的，要么是根据学生确定的心理灵活性培训需求进行个性化设置的。
干预组与等待名单组相比，从基线开始的倦怠结果变化的平均差异无统计学意义：疲惫（主要指标；个性化组：-0.52，95%置信区间-3.70至2.65，P = 0.75；非个性化组：1.60，95%置信区间-1.84至5.03，P = 0.37）、玩世不恭（个性化组：-1.26，95%置信区间-4.46至1.94，P = 0.44；非个性化组：1.00，95%置信区间-2.45至4.46，P = 0.57）和学业效能感（个性化组：0.94，95%置信区间-0.90至2.79，P = 0.32；非个性化组：2.02，95%置信区间0.02 - 4.03，P = 0.05）。干预后，与等待名单组的参与者相比，个性化组的心理灵活性有所提高（0.50，95%置信区间0.12 - 0.89；P = 0.01），僵化程度降低（0.48，95%置信区间-0.92至-0.04；P = 0.04），压力减轻（-6.89，95%置信区间-12.01至5.99；P = 0.01），非个性化组的幸福感有所提高（6.46，95%置信区间0.49 - 12.42；P = 0.04），压力减轻（-6.36，95%置信区间-11.90至-0.83；P = 0.03）。个性化组和非个性化组之间的组间差异无统计学意义。观察到高失访率（75/143，52.4%）。
本试验为接受与承诺疗法对医学生幸福感和心理结果的潜在益处提供了早期支持，并表明可以使用智能手机应用程序来训练心理灵活性和僵化程度。尽管干预后的倦怠结果无统计学意义，但次要结果的改善可能表明早期风险得到了缓解。需要进行更大样本量和长期随访的重复研究，未来的研究应侧重于改进实施框架，以提高参与度并优化个性化方法。
澳大利亚新西兰临床试验注册中心12621000911897；https://tinyurl.com/2p92cwrw。
国际注册报告识别码（IRRID）：RR2 - 10.2196/32992。
