A Pilot Study: Exploring The Role Of an Artificial Intelligence Powered Mental Health Support Tool For Mental Health Wellness For Physicians In Training
Phase: NA
Conditions: Wellness, Psychological, Mental Health Wellness 1
Sponsor: Cedars-Sinai Medical Center

 
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Title: A Pilot Study: Exploring The Role Of an Artificial Intelligence 
Powered Mental Health Support Tool For Mental Health Wellness 
For Physicians In Training 
 
 
ID: STUDY00003196 
 
NCT ID: Pending 
 
Date: 6/6/2025 
 
 
 
 
 

 
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Table of Contents  
 
1.0 Protocol Summary ................................................................................................................ 3 
2.0 Background, Rationale ......................................................................................................... 3 
3.0 Study Purpose and Objectives ............................................................................................. 4 
4.0 Study Population .................................................................................................................. 5 
4.1 Inclusion Criteria ........................................................................................................ 5 
4.2 Exclusion Criteria ....................................................................................................... 5 
4.3 Subject Identification, Recruitment, and Consent ..................................................... 5 
4.3.1 Consent Description .......................................................................................5 
5.0 Study Design and Procedures ............................................................................................. 6 
5.1 Schedule of Events .................................................................................................... 6 
5.2 Study Design and Duration ........................................................................................ 7 
5.3 Description of Study Procedures ............................................................................... 8 
6.0 Data Collection and Management...................................................................................... 10 
6.1 Data Procurement .................................................................................................... 10 
6.2 Time Period of Data under Review .......................................................................... 11 
6.3 Data Elements .......................................................................................................... 11 
6.4 Confidentiality and Security of Data ........................................................................ 12 
7.0 Data and Safety Monitoring ............................................................................................... 12 
7.1 Data and Safety Monitoring Plan ............................................................................. 12 
7.2 Quality Control and Quality Assurance .................................................................... 12 
8.0 Sample Size and Statistical Considerations ...................................................................... 12 
8.1 Sample Size ............................................................................................................. 12 
8.2 Statistical Sample Size Justification ........................................................................ 12 
8.3 Statistical Analysis Methodologies........................................................................... 13 
9.0 References ......................................................................................................................... 13 
 
 
 
 

 
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1.0 Protocol Summary  
Study Purpose 
The purpose of this pilot study is to evaluate the acceptability 
of an artificial intelligence powered mental health support 
tool  for mental health wellness amongst physicians in 
training.   
Research Procedures 
 
The primary research procedures are: 
• The primary research procedure will be the utilization 
of artificial intelligence powered mental health support 
session through a web browser for physicians in 
training to address symptoms related to depression 
and anxiety. A pre and post intervention survey, 
evaluating depression symptoms with the 
standardized PHQ-9 questionnaire and anxiety 
symptoms with the standardized GAD-7 questionnaire 
will be conducted to assess changes in mental health 
wellness. 
Subject Population 
The study will enroll physicians in training, including 
Internal Medicine residents and Gastroenterology fellows.  
Duration of Subject’s 
Participation 
• The study includes at least 4 sessions.  
• The total study duration for each subject is 3 months.  
 
2.0 Background, Rationale  
Mental health is an important aspect of trainee’s wellbeing, training and success. Mental health 
concerns may arise as changes in behavior and emotions and include symptoms related to 
stress, anxiety and depression (Nobleza, 2021). Physicians are an at-risk profession for suicide, 
and a recent systemic review and meta-analysis found that physicians in the USA are at higher 
risk for suicide as compared to other countries [Dutheil, 2019].  Depression is a known risk for 
suicide, with an estimated 20-43% of trainee physicians experiencing depression and 
symptoms of depression [Mata, 2015]. Psychosocial works factors thought to contribute to 
depression include lack of a cohesive teamwork, social support, delivering bad news, frequent 
contact with illness and death [Dutheil, 2019]. In addition, female physicians in training 
appear to be at a higher rate for depression which may be related to imbalances in work and 
household obligations [Guille,2017]. Numerous studies have demonstrated a higher prevalence 
of depression or emotional distress including anxiety, irritability, loneliness and stress among 
trainees and physicians. These conditions have been associated with adverse outcomes, 
including patient care errors, medical leaves, career shifts, and even suicide [Collier 2002,Craig 
1968, Fahrenkopf 2008, Reuben 1985, West 2006, West 2009, Pospos 2019].  Emotional 

 
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distress not only poses health risk to the individual but has also been linked to poor-quality 
patient care and increased medical errors [Mata 2015, West 2009].  
Studies have also shown that only a minority of physicians utilize mental health services 
[Nobleza, 2021]. Preventative strategies need to include recognition and management of stress 
and depression symptoms. Physicians in training have limited free time and unpredictable 
schedules limit ability to schedule appointments with mental health care providers. Artificial 
intelligence (AI) has been shown to comprehend language and respond with conversational 
and knowledgeable answers [OpenAI]. The effectiveness of the use of an AI therapist has not 
been evaluated in the management of mental wellness in regards to symptoms of depression 
and anxiety in physicians in training. 
Artificial intelligence powered mental health support could provide an opportunity for mental 
health support that is easier to implement within the constrained work schedules of trainees. 
We propose a self-guided AI powered  mental health support tool for physicians in training as 
an additional resource to address mental health management such as symptoms of depression 
and anxiety to promote mental health wellness  in physicians in training.  
 
3.0 Study Purpose and Objectives  
 
The purpose of this pilot study is to evaluate the acceptablity of an Artificial Intelligence (AI) 
mental health support system as an additional resource to address mental health wellness 
amongst  physicians in training at Cedars Sinai.  The AI program is not meant to be an 
intervention or to replace mental health resources for the treatment of depression and anxiety 
diagnosis.   
 
The primary objective is to determine if the trainees find the AI sessions through a web 
browser to be an acceptable and feasible wellness resource for promoting mental health 
wellness   A pre and post intervention survey evaluating depression symptoms with the 
standardized PHQ-9 questionnaire and anxiety symptoms with the standardized GAD-7 
questionnaire will be conducted as a measure of mental health wellness.  
 
The secondary objectives of this study are to: 
• Evaluate the prevalence of depression and anxiety in training physicians  
• Determine what work-related and home-related factors physicians in training believe 
impact their mental health. 
• To describe the acceptance and feasibility of AI powered mental health support sessions 
for physicians in training. If our study shows these sessions to be efficacious and 
feasible in this pilot cohort, we plan to recruit other training physicians in a larger study 
here at Cedars Sinai. 
•  

 
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4.0 Study Population  
 
Physicians in training at Cedars Sinai. 
4.1 Inclusion Criteria 
• Individuals 18 years old or older are included. 
• Training physicians in Internal Medicine residency and Gastroenterology fellowship at 
Cedars Sinai. 
• Study is limited to Cedars-Sinai employees who are known to speak English.  
• HRP-514.2 academic HR compliance addendum review is attached (Appendix A)  
4.2 Exclusion Criteria  
• Pregnancy 
• Active treatment of severe and uncontrolled anxiety or depression with a health care 
professional 
• Unwilling and or unable to participate 
• Non-English speakers. 
4.3 Subject Identification, Recruitment, and Consent 
Subjects will be initially identified in the following ways: 
• The study population will be identified from the internal medicine residency and 
gastroenterology fellowship roster at Cedars Sinai. All subject’s will be invited to 
participate in this study. Subjects will be recruited through an e-mail sent to the group 
roster and through didactic announcements.  
4.3.1 Consent Description 
Informed consent will take place via e-consent through REDCap. Participants will be invited 
via e-mail to participate in the study. The email will be sent to the group email for Internal 
medicine residents and the group email for Gastroenterology fellows for inclusion and limiting 
perceived coercion as no one person will be emailed directly. If trainees have questions or 
concerns, they will be directed to contact a team members who is not involved in trainee 
education or employment.  
 
Potential Risks 
 
Artificial Intelligence mental health support: The AI  system developed here at Cedars trained system 
here trained the test system to behave with beneficence and act according to professional standards 
for a psychotherapist, there is potential that the artificially intelligent therapist response to the 
participant’s communications in a manner perceived to be offensive, incorrect, or potentially 
traumatic. These adverse responses may cause the participant emotional or psychological harm. 
 
Questionnaire risks: The questionnaires could make participants feel uncomfortable or embarrassed.  
 

 
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Potential Benefits 
We expected little to no immediate benefit to be incurred by exposure of participants to one 20-
minute session of AI powered mental health support. However, those who complete the 4 sessions 
over the course of the 4 weeks may experience mental health benefits. The long-term potential benefit 
of this investigation is evaluating the safety and feasibility of AI-powered mental health support tool 
over the course of 4 weeks. In doing so, the overall benefits and limitations of this approach will be 
better understood for future investigations and potential implementation. Furthermore, the 
information yielded from this investigation will inform further research and development of AI 
powered mental health support, which, if proven efficacious and safe, has the potential to greatly 
increase accessibility to high-quality mental health support to physicians in training with limited free 
time.  
 
ASSESSMENT OF POTENTIAL RISKS AND BENEFITS 
The risk of the artificially intelligent therapist generating adverse responses/advice during the session 
is rationalized by the nature of the investigation being a feasibility study of the implementation of an 
AI-powered mental health support tool. We anticipate that the built-in safeguards which minimize the 
ability of the model to generate derogatory, unprofessional, or dangerous responses will greatly 
minimize the chances of this occurring. In internal pilot testing within our lab, which has included over 
100 mock conversations to date, we have not yet experienced any perceived adversarial, derogatory, 
unprofessional, or harmful response or advice. Nonetheless, an important purpose of this feasibility 
study is to confirm safety and appropriateness of the system. Furthermore, the risk of emotional or 
psychological adverse events as a result of the interaction with the AI model will also be minimized by 
providing participants with access to a hot line (Appendix E) to licensed mental health workers who are 
available at all times free at charge to trainees at Cedars Sinai. At the beginning of each session, 
participants will be provided instruction on how to access the licensed mental health works should an 
adverse event occur. If participants feel they need immediate assistance or report concerning suicidal 
thoughts or ideation, XAIA can send an immediate text and email to our social worker who is not 
involved in trainee education and employment. Our social worker can then contact the trainee for 
immediate intervention and provide immediate psychiatric resources available to trainees. In addition, 
a psychiatrist who is not involved in the proposed participants training, will be available for any urgent 
psychiatric attention. 
 
5.0 Study Design and Procedures 
5.1 Schedule of Events 
 
Legend  
• 
R = Research item/procedure done only for research purposes and their costs are 
covered by the study. You are not responsible for the costs of these procedures. 

 
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Procedures  
Screening  
Visit 
Visit 
#1 
Visit 
#2 
Visit 
#3 
Visit  
#4 
3-month 
follow-up 
Informed 
Consent 
R 
 
 
 
 
 
Questionnaires 
R 
 
 
 
R 
R 
VR sessions 
 
R 
R 
R 
R 
 
 
5.2 Study Design and Duration 
 
This is a prospective pilot study with internal medicine residents and gastroenterology fellows 
to evaluate the role of AI mental health support tool as a wellness resource.   
 
Participants will be invited via e-mail to participate in the study. ]The invitation e-mail will 
describe the study and ask that those who meet exclusion criteria do not participate in this 
pilot study. The e-mail will also include a file with information of the study for participants to 
review including how study members are blinded and the de-coding process required for 
participants to be contacted by our social worker should they score >15 on PHQ-9 and or >10 
on GAD-7. Those who choose to participate will be asked email our team member who is not 
involved in trainee education who will send the participants a REDCap link to the consent, 
survey and a code to be used in the survey. 
 
Participants will be asked to complete a set of questionnaires (Appendix B, C and D) to 
evaluate their mental health and factors that contribute to mental health as well as four AI 
powered mental health support sessions over a four-week period. This will conclude the active 
phase of their participations. Participants will then be sent a questionnaire at 3 months from 
study initiation to complete a questionnaire evaluating their mental health and if they would be 
interested in additional AI powered mental health support sessions. 
 
The questionnaires will be administered before the AI sessions and at the end of the study 
period to evaluate for changes in mental health scores. The questionnaires will include the 
validated PHQ-9 for a standardized depression score and the GAD-7 for a standardized anxiety 
score to evaluate symptoms related to depression and anxiety. In addition, a set of questions 
will focus on demographics, work and home environment to evaluate factors that may 
contribute to mental health prior to the AI sessions and a set of questions related to the AI 
sessions at the end of the study period. The questionnaire will be administered via REDCap. 
 
To maintain subject safety and confidentiality the following work-flow will be followed. 
1. Participants who choose to participate in the study will be given a redcap link for the 
consent form, survey and a code via e-mail. In order to complete the consent and survey, 
participants will have to enter the code provided to them. 
2. Our social worker will be the only study members with a list of the subject’s email and 
code.  
3. Our social worker will review the survey responses on redcap. 
4. If a participant survey has as a score on the PHQ9 >15 and or GAD>10, our social 
worker will contact the participant for evaluation and provide additional resources as 
needed. 

 
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5. During the sessions, XAIA will be programed to send a text message to our social worker 
from participants who report actionable comments such as suicidal thoughts and 
concerns. Our social worker will be available to receive the messages from XAIA and 
contact the trainee for immediate intervention and connect the trainee to additional 
resources as needed. In addition, a psychiatrist physician will be available for any urgent 
psychiatric attention. 
 
 
The AI powered sessions will be administered via a web browser such as a computer, laptop, 
tablets or cellphone. Participants can complete the session in the privacy of their home or in a 
private location at work such as a call-room. Participants will be asked to complete one 20-
minute session per week during the 4-week study period for a total of four sessions.  
 
The AI program used will be the XAIA software program. XAIA was developed at Cedars Sinai. 
Participants will be sent an email with the link to use the XAIA software. This includes a 
tutorial on how to use XAIA. Typical interactions with XAIA involve a process of XAIA initially 
probing for topics with general inquiries "So [name], how can I help?", then asking more in-
depth questions about a particular topic identified by the participant, and then offering  
support and/or coping methods about the identified problem or topic. Once XAIA is done 
speaking, the participant will answer the questions and press the “done speaking” button. 
XAIA then processes the messages and then replies. This process repeats until the participant 
informs XAIA that they wish to end the session and can click the “end session” button.  
 
Conversations are processed through a HIPAA-compliant server: audio is recorded, 
transcribed by speech-to-text AI, and responded to by LLM (GPT-4). The LLM output is sent 
through an “Appropriateness Classifier”—a stand-alone AI to detect potentially dangerous or 
unhelpful responses. If triggered, the LLM is again queried, and its response is again analyzed. 
Otherwise, the output is released to a text-to-speech AI, which finally, together with sentiment 
analysis meta-data controlling XAIAs expressions, plays to the user. The system’s development 
involved iterative testing with therapists role-playing clinical scenarios, leading to continuous 
refinement of its psychotherapeutic communication. The program compiles and records data 
through audio responses. The responses from the user are recorded in-app, encrypted, and 
sent to a speech-to-text AI model. the resulting text transcript is sent to the LLM, which replies 
with text that is then converted to speech and played back to the user. Both text from the user 
and the LLM are stored on HIPAA-compliant servers. All audio data is not stored. Investigators 
have no access to the encrypted data. 
 
The duration of the study session is 4 weeks and total duration of the study is three months. 
 
The study will be conducted at one site only, Cedars-Sinai or participants may conduct the 
sessions at the privacy of their own home. 
 
5.3 Description of Study Procedures 
 
The study involves the completion of questionnaires to be done at the start and at the end of 
the study period and the completion of four sessions over the course of four consecutive weeks. 

 
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The overall study will last four weeks but we may contact participants up to 3 months after for 
follow up. 
 
Questionnaires/surveys:  
This study involves the administration of questionnaires to evaluate scoring changes for 
depression and anxiety symptoms as a measurement for mental health wellness before and 
after the intervention. This information is routinely collected as part of clinical care with the 
PHQ-9 and GAD-7 questionnaires. The questionnaires will be administered at baseline and at 
the end of the 4-week study period. As part of the initial questionnaire, there will be a set of 
questions that aim to determine demographics as well as work-related and home-related 
factors that contribute to mental health will be administered prior to the AI powered sessions. 
At the completion of the 4-week  session a questionnaire with a set of questions evaluating the 
use and acceptability of the AI mental health support will be administered. Finally, participants 
will be sent a questionnaire including the PHQ-9 and GAD-7 along with a set of questions 
evaluating their interest in participating in additional sessions at 3 months. The follow-up 
questionnaires will also provide information on active resources for mental health available to 
trainees at Cedas Sinai. In total, the questionnaires should take no longer than 20 minutes to 
complete at the beginning and end of the study period and no longer than 10 minutes at follow-
up. The questionnaire will be administered electronically via REDCap. The study will not 
collect personal identifying information. The questionnaire will also contain a link with 
information on how to obtain immediate mental health assistance including a hot line as 
provided by GME to all trainees at Cedars Sinai. This includes access to a mental health 
professional who is on call for any psychiatric emergencies. 
 
We will be conducting following questionnaires.  
• Patient Health Questionnaire -9 (PHQ-9) – Will be administered at the beginning and 
end of the study as part of Appendix B, C and D. 
o This questionnaire is validated. 
o The questionnaire is available in languages other than English. 
• General Anxiety Disorder- 7 (GASD-7) – will be administered at the beginning and end 
of the study as part of Appendix B, C and D. 
o This questionnaire is validated. 
o The questionnaire is available in languages other than English. 
• Work and Home Environment – will be administered only at the beginning of the study 
as part of Appendix B. 
o This questionnaire is not validated. 
o The questionnaire is not available in languages other than English. 
• Artificial Intelligence Session Assessment – will be administered only at the end of the 
sessions as part of Appendix C. 
o This questionnaire is not validated. 
o The questionnaire is not available in languages other than English 
• Post Artificial Intelligence Session Follow-up – will be administered at 3 months after 
study initiation as part of Appendix D. 
o This questionnaire is not validated 
o The questionnaire is not available in languages other than English 

 
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Behavioral Intervention:  
This study involves a behavioral intervention. The behavioral intervention is the completion of 
a self-guided AI mental health support sessions by each participant. Participants will be asked 
to complete the session once per week for four consecutive weeks. Each session should take 20 
minutes for completion. This intervention will take place at the participant’s home or at Cedars 
in a location with access to a web browser via computer, tablet or cellphone. Those who choose 
to complete the session at Cedars-Sinai, may choose to use a call room dedicated for trainees. 
The intervention will be implemented by participants themselves.   
 
The behavioral intervention will be implemented in the following manner:  
• Participants will use the link provided by our social worker to gain access to XAIA. They 
will then follow the 2 minute tutorial provided directly by the link to use the software on 
a web browser. Participants can use a computer, laptop, tablet or cellphone with a web 
browser to access the XAIA software. 
• Participants will be asked to spend 20 minutes during each session. They may choose to 
spend longer than 20 minutes but no more than 60 minutes.  
• Participants will be asked to complete 1 session per week during the 4-week study phase.  
• Participants will be asked to complete the sessions between the hours of 0700 and 2000 
in order to have immediate access to our social worker and psychiatrist if needed.  
• The email with link provided to access the XAIA software will include information for 
access to immediate mental health assistance such as a hotline provided by GME to all 
trainees at Cedars Sinai (Appendix E). This includes access to a mental health 
professional who is on call for any psychiatric emergencies. 
6.0 Data Collection and Management 
6.1 Data Procurement 
• Identification/Access/Abstraction 
☐ Members of the study team will require access to the clinical data source (e.g., 
electronic medical record) to identify eligible data/specimens and to conduct data 
abstraction or gain access to specimens.1  
☐ Electronic Information Systems (EIS) Department will identify and/or abstract 
applicable data or specimens (e.g., RISCC website, request query of Deep6 through 
EIS). 
☐ Separate registry or repository will identify, abstract, and/or provide specimens 
and/or data to the study team. 
☒ Other:  
 
 
1 Clinical records can only be accessed by study team members who are listed on the CS-IRB application and are IRB 
Certified. 
 Members of the study team will only require access to data provided by the questionnaires 
completed by participants. No personal or identifying information will be used in this study.  

 
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• Source(s) of Data/Specimens: 
No medical record data will be accessed as part of this research. 
All data collected is from the survey/questionnaire. 
6.2 Time Period of Data under Review  
• One year 
• Information will be kept for 2 years.  
6.3 Data Elements  
• The following data points will be collected: 
• Age  
• Sex / Gender Identity 
• Race/ Ethnicity 
The information to be accessed and reviewed is that which is minimally necessary to achieve 
the goals of this research.  
 
 
HIPAA Identifiers 
☐ No HIPAA Identifiers will be collected for this study (or select the 
identifiers from the following list). The investigators will not attempt 
to re-identify subjects from the collected data. 
☐ Medical Record Number 
☐ Name 
☐ Address (all geographic sub-divisions smaller than state, including street 
address, city county, and zip code) 
☐ All elements (except years) of dates (including birthdate, admission date, 
discharge date, date of death, and exact age if over 89) 
☒ Telephone Numbers 
☐ Fax Numbers 
☒ Email Address 
☐ Social Security Number 
☐ Health plan beneficiary number 
☐ Account Number 
☐ Certificate or license number 
☐ Vehicle identifiers and serial numbers, including license plate numbers 
☐ Device identifiers and serial numbers 
☐ Web URL 
☐ Internet Protocol (IP) Address 
☐ Finger or Voice Print 
☐ Photographic Image (photographic images are not limited to the face) 
☐ Any other characteristic that could uniquely identify the individual  

 
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6.4 Confidentiality and Security of Data 
• 
Secure Storage: Data will be housed in a HIPAA-compliant secure storage system, 
like REDCap within the Cedars-Sinai network with access restricted to approved 
members of the research team.  
• 
Limited Access: Private identifiable information will be accessible only to IRB 
approved study team members with current IRB training. 
• 
Unique ID Numbers and Coding: Each participant will be assigned a unique ID 
number. The linking list will be kept secure. Direct identifiers listed in section 8 will 
be separated from the study materials (data and/or specimens) as soon as possible. 
During data abstraction, no personal information is required.  
• 
Destroying Identifiers: The identifiers and the linking list will be destroyed as 
soon as scientifically possible and maintained only as long as necessary to abstract, 
analyze and verify data. 
• Retention/Destruction of Study Materials: Study data/materials will be kept 
and/or destroyed according to applicable policy. 
7.0 Data and Safety Monitoring  
7.1 Data and Safety Monitoring Plan 
The study will be monitored by the PI to ensure appropriate study conduct, including obtaining 
proper access to data, compliance with the HIPAA Privacy Rule, compliance with Cedars-Sinai 
policy, and adhering to the plans outlined in the protocol for all study procedures, abstracting 
and recording data, data security and maintenance, and data accuracy and integrity. Any 
adverse events, deviations, protocol exception requests, potential unanticipated problems 
involving risks to subjects or others, or other events will be submitted to the IRB in accordance 
with IRB reporting policy.  
7.2 Quality Control and Quality Assurance 
• The PI will delegate a study team member to conduct QC/QA activities. The PI will be 
responsible for the evaluation of data quality and how frequently this will be done 
quarterly. Data will be evaluated for adherence with the protocol and for accuracy in 
relation to source documents.  
8.0 Sample Size and Statistical Considerations  
8.1 Sample Size 
This is a single-site study at Cedars-Sinai. The sample size of this pilot study is 20 subjects.  
8.2 Statistical Sample Size Justification  
 
A statistical sample size is not required because this study involves: 
• A pilot study with at most 20 subjects. 
 

 
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8.3 Statistical Analysis Methodologies 
 
No statistical methods description is required given that the study does not require a sample 
size justification. 
9.0 References 
1. Nobleza, D., Hagenbaugh, J., Blue, S. et al. Resident Mental Health Care: a Timely and Necessary 
Resource. Acad Psychiatry 45, 366–370 (2021) 
2. Dutheil F, Aubert C, Pereira B, Dambrun M, Moustafa F, Mermillod M, Baker JS, Trousselard M, Lesage 
FX, Navel V. Suicide among physicians and health-care workers: A systematic review and meta-analysis. 
PLoS One. 2019 Dec 12;14(12) 
3. Mata  DA, Ramos  MA, Bansal  N,  et al.  Prevalence of depression and depressive symptoms among 
resident physicians: a systematic review and meta-analysis.  JAMA. 2015;314(22):2373-2383. 
4. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress 
with perceived medical errors. JAMA. 2009;302(12):1294–1300 
5. Pospos S, Tal I, Iglewicz A, et al. Gender differences among medical students, house staff, and faculty 
physicians at high risk for suicide: A HEAR report. Depress Anxiety. 2019;36(10):902-920. 
6. Guille, C., Frank, E., Zhao, Z., Kalmbach, D. A., Nietert, P. J., Mata, D. A.,Sen, S. (2017). Work-family 
conflict and the sex difference in depression among training physicians. JAMA Internal 
Medicine, 177, 1766–1772 
7. Collier, V. U., McCue, J. D., Markus, A., & Smith, L. (2002). Stress in Medical Residency: Status Quo 
after a Decade of Reform? Annals of Internal Medicine, 136, 384-390. http://dx.doi.org/10.7326/0003-
4819-136-5-200203050-00011 
8. Craig, A. G., & Pitts, F. N. (1968). Suicide by Physicians. Diseases of the Nervous System, 29, 763-772. 
9. Fahrenkopf, A. M., Sectish, T. C., Arger, L. K., Sharek, P. J., Lewin, D., Chiang, V. W., Landrigan, C. P. 
et al. (2008). Rates of Medication Errors among Depressed and Burnt out Residents: Prospective Cohort 
Study. British Medical Journal, 336, 488-491. http://dx.doi.org/10.1136/bmj.39469.763218.BE 
10. Reuben, D. B. (1985). Depressive Symptoms in Medical House Officers. Effects of Level of Training and 
Work Rotation. Archives of Internal Medicine, 145, 286-288. 
http://dx.doi.org/10.1001/archinte.1985.00360020114019 
11. West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., & Shanafelt, 
T. D. (2006). Association of Perceived Medical Errors with Resident Distress and Empathy: A 
Prospective Longitudinal Study Journal of the American Medical Association, 296, 1071-1078. 
http://dx.doi.org/10.1001/jama.296.9.1071 
12. West, C. P., Tan, A. D., Habermann, T. M., Sloan, J. A., & Shanafelt, T. D. (2009). Association of 
Resident Fatigue and Distress with Perceived Medical Errors. Journal of the American Medical 
Association, 302, 1294-1300. http://dx.doi.org/10.1001/jama.2009.1389 
13. OpenAI. ChatGPT: Optimizing Language Models for Dialogue. OpenAI. Published November 30, 2022. 
https://openai.com/blog/chatgpt