Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Environmental Medicine and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
BMC Med Educ. 2024 Oct 30;24(1):1234. doi: 10.1186/s12909-024-06195-3.
Burnout among resident physicians during training has been prevalent, prompting training centers to introduce interventions at the individual or organizational level. However, empirical evidence is crucial before implementing such programs in practice.
A systematic review and meta-analysis was carried out to evaluate the effectiveness of individual and organizational interventions in reducing burnout among resident physicians. Searching was done across five databases-PubMed, Scopus, ScienceDirect, Embase, and Cochrane Library from 1 December 2023 to 26 August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for our reporting of study selection process. Eligibility criteria were randomized or non-randomized designs, with prospective intervention, with a comparator group focused on individual or organizational interventions reducing burnout, in any language and publication date. The Maslach Burnout Inventory scores for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were the three outcome measures. Two investigators independently extracted the data. The risk of bias was evaluated using Cochrane risk-of-bias tool for randomized trials (RoB2) and non-randomized studies of interventions (ROBINS-I). Cohen's d and heterogeneity was estimated using a random-effects DerSimonian-Laird model and visualized by forest plots. Sensitivity analyses were carried out by leave-one-out meta-analysis.
We identified 33 eligible studies (n = 2536), comprising 25 (75.8%) individual intervention studies and 8 (24.2%) organizational intervention studies. Cohen's d for individual intervention versus control were as follows: EE -0.25 (95% CI -0.40 to -0.11, p < 0.01, I = 49.3%), and DP -0.17 (95% CI -0.32 to -0.03, p = 0.02, I = 50.0%). The organizational intervention showed no significant association with any domain. Sensitivity analyses were robust in all outcomes, with differences in intervention description and design identified as potential contributors to heterogeneity.
Various interventions, including individual coaching, meditation, and organization interventions, have been implemented to improve resident burnout. The effectiveness of intervention demonstrated none to small practical significance in improving burnout. Data inconsistency and high risk of bias across studies limited the validity of the pooled results. Further studies should focus on a combined approach.
The study was registered on PROSPERO, under PROSPERO registration number CRD42022349698.
培训期间住院医师的倦怠现象普遍存在，促使培训中心在个人或组织层面引入干预措施。然而，在实践中实施此类方案之前，实证证据至关重要。
我们进行了系统评价和荟萃分析，以评估针对住院医师倦怠的个体和组织干预措施的有效性。从 2023 年 12 月 1 日至 2024 年 8 月 26 日，我们在五个数据库（PubMed、Scopus、ScienceDirect、Embase 和 Cochrane Library）中进行了搜索。我们使用系统评价和荟萃分析的首选报告项目（PRISMA）声明报告研究选择过程。纳入标准为随机或非随机设计，前瞻性干预，有对照组，侧重于个体或组织干预措施可降低倦怠，语言和出版日期不限。三个结局指标是情绪耗竭（EE）、去人格化（DP）和个人成就感（PA）的 Maslach 倦怠量表评分。两名调查员独立提取数据。使用 Cochrane 随机试验偏倚风险工具（RoB2）和干预非随机研究偏倚风险工具（ROBINS-I）评估偏倚风险。使用随机效应 DerSimonian-Laird 模型估计 Cohen's d 和异质性，并通过森林图可视化。通过逐个剔除元分析进行敏感性分析。
我们确定了 33 项符合条件的研究（n=2536），其中 25 项（75.8%）为个体干预研究，8 项（24.2%）为组织干预研究。个体干预与对照组相比的 Cohen's d 如下：EE-0.25（95%CI-0.40 至-0.11，p<0.01，I=49.3%），DP-0.17（95%CI-0.32 至-0.03，p=0.02，I=50.0%）。组织干预与任何领域均无显著关联。所有结局的敏感性分析均稳健，干预描述和设计的差异被认为是异质性的潜在来源。
已实施各种干预措施，包括个体辅导、冥想和组织干预，以改善住院医师倦怠。干预的效果在改善倦怠方面显示出无到小的实际意义。研究之间的数据不一致和高度偏倚限制了汇总结果的有效性。进一步的研究应侧重于联合方法。
该研究在 PROSPERO 上进行了注册，注册号为 PROSPERO 注册号 CRD42022349698。
