Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston.
Department of Occupational Medicine, Naval Medical Readiness and Training Command New England, US Navy, Portsmouth, New Hampshire.
JAMA Netw Open. 2024 Apr 1;7(4):e245645. doi: 10.1001/jamanetworkopen.2024.5645.
Physician burnout is problematic despite existing interventions. More evidence-based approaches are needed.
To explore the effect of individualized coaching by professionally trained peers on burnout and well-being in physicians.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial involved Mass General Physician Organization physicians who volunteered for coaching from August 5 through December 1, 2021. The data analysis was performed from February through October 2022.
Participants were randomized to 6 coaching sessions facilitated by a peer coach over 3 months or a control condition using standard institutional resources for burnout and wellness.
The primary outcome was burnout as measured by the Stanford Professional Fulfillment Index. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement, and self-valuation. Analysis was performed on a modified intention-to-treat basis.
Of 138 physicians enrolled, 67 were randomly allocated to the coaching intervention and 71 to the control group. Most participants were aged 31 to 60 years (128 [93.0%]), women (109 [79.0%]), married (108 [78.3%]), and in their early to mid career (mean [SD], 12.0 [9.7] years in practice); 39 (28.3%) were Asian, 3 (<0.1%) were Black, 9 (<0.1%) were Hispanic, 93 were (67.4%) White, and 6 (<0.1%) were of other race or ethnicity. In the intervention group, 52 participants underwent coaching and were included in the analysis. Statistically significant improvements in burnout, interpersonal disengagement, professional fulfillment, and work engagement were observed after 3 months of coaching compared with no intervention. Mean scores for interpersonal disengagement decreased by 30.1% in the intervention group and increased by 4.1% in the control group (absolute difference, -0.94 poimys [95% CI, -1.48 to -0.41 points; P = .001), while mean scores for overall burnout decreased by 21.6% in the intervention group and increased by 2.5% in the control group (absolute difference, -0.79 points; 95% CI, -1.27 to -0.32 points; P = .001). Professional fulfillment increased by 10.7% in the intervention group compared with no change in the control group (absolute difference, 0.59 points; 95% CI, 0.01-1.16 points; P = .046). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65 points; P = .04). Self-valuation increased in both groups, but not significantly.
The findings of this hospital-sponsored program show that individualized coaching by professionally trained peers is an effective strategy for reducing physician burnout and interpersonal disengagement while improving their professional fulfillment and work engagement.
ClinicalTrials.gov Identifier: NCT05036993.
尽管已经有了干预措施，但医生的职业倦怠仍然是一个问题。需要更多基于证据的方法。
探索由专业培训的同行进行个性化辅导对医生职业倦怠和幸福感的影响。
设计、地点和参与者：这是一项随机临床试验，涉及自愿接受辅导的马萨诸塞州综合医院医师组织的医生，辅导时间从 2021 年 8 月 5 日至 12 月 1 日。数据分析于 2022 年 2 月至 10 月进行。
参与者被随机分配到 6 个由同行教练在 3 个月内进行的辅导课程，或使用标准机构资源进行倦怠和健康的对照组。
主要结果是斯坦福职业满意度指数衡量的职业倦怠。次要结果包括专业满意度、工作对人际关系的影响、生活质量、工作投入和自我评估。分析基于改良的意向治疗进行。
在 138 名入组的医生中，67 名被随机分配到辅导干预组，71 名分配到对照组。大多数参与者年龄在 31 至 60 岁之间（128 [93.0%]），女性（109 [79.0%]），已婚（108 [78.3%]），处于职业生涯的早期到中期（平均[标准差]，12.0 [9.7]年实践经验）；39 名（28.3%）是亚洲人，3 名（<0.1%）是黑人，9 名（<0.1%）是西班牙裔，93 名（67.4%）是白人，6 名（<0.1%）是其他种族或族裔。在干预组中，有 52 名参与者接受了辅导，并纳入了分析。与没有干预相比，在接受 3 个月的辅导后，倦怠、人际脱节、职业满意度和工作投入方面的情况有了显著改善。干预组的人际脱节平均得分下降了 30.1%，而对照组则上升了 4.1%（绝对差异，-0.94 点[95%置信区间，-1.48 至-0.41 点；P = .001]），而整体倦怠的平均得分在干预组下降了 21.6%，对照组则上升了 2.5%（绝对差异，-0.79 点；95%置信区间，-1.27 至-0.32 点；P = .001）。与对照组相比，干预组的职业满意度提高了 10.7%（绝对差异，0.59 点；95%置信区间，0.01-1.16 点；P = .046）。干预组的工作投入增加了 6.3%，对照组则减少了 2.2%（绝对差异，0.33 点；95%置信区间，0.02-0.65 点；P = .04）。两组的自我评估都有所增加，但不显著。
该医院赞助项目的研究结果表明，由专业培训的同行进行个性化辅导是减少医生职业倦怠和人际脱节、提高职业满意度和工作投入的有效策略。
ClinicalTrials.gov 标识符：NCT05036993。
