Better Together: an Online Physician Coaching Program for Medical Trainees
Condition: Burnout; Self-compassion; Moral Injury; Impostor Phenomenon
MeSH terms: Burnout, Psychological; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      This is a single-institution randomized controlled trial. 101 female residents were recurited
      from the University of Colorado School of Medicine. They enrolled beginning in January 2021
      and participated in the coaching program for 6 months via a web-based system. Participants
      were randomized into either the intervention or wait-list control arm. Participants in the
      intervention arm began the 6-month coaching program in January, 2021. Participants in the
      wait-list control arm have received no additional resources from the Better Together program
      between January and June 2021. The wait-list control group was invited to begin the 6-month
      coaching program in July 2021. In December 2021, participants from both the intervention and
      wait-list control groups will be invited to complete a 2nd post survey (identical to the
      post-survey from June 2021). There will be no incentive for completion of the 2nd post
      survey. Finally, the longitudinal effect of the program will be assessed by offering the same
      survey measuring wellbeing via various indices to the intervention arm at 6 months (1/2022),
      12 months (7/2022) and 18 months (1/2023) after their intervention. Participation in this
      survey will be completely voluntary and not incentivized/compensated.
    

Detailed description: 
      Background:

      Positive psychology coaching programs demonstrate efficacy in reducing emotional exhaustion
      (a construct of burnout) and improving coping skills among residents but rely on substantial
      faculty development and coordination for participants. Considering the disproportionate
      burnout risk faced by women trainees in medicine, novel strategies to mitigate this risk is
      needed. Among a national sample of resident physicians, 60% screen positive for burnout.
      Compared to age-matched peers, residents are significantly more likely to experience burnout
      and have burnout persist into early careers. Female trainees are particularly vulnerable,
      with long-term consequences affecting professional development and success. Disproportionate
      burnout among women may be a contributor to the "leaky pipeline" in academic medicine, where
      women start their careers as 46% of the resident workforce yet represent only 25% of full
      professors and 18% of department chairs. Social connectedness and the practice of
      self-compassion are important intervention in reducing burnout and increasing resilience
      among residents. Positive psychology coaching programs have specifically had demonstrated
      efficacy in faculty and residents. Web-based group coaching programs have not been assessed
      for their potential to reduce burnout and improve resilience and well-being among trainees.

      A. Outcome Measure(s):

        1. participation (administrative data)

        2. participant experience and reflection (interview)

        3. measures of burnout and self-compassion as measured on a pre- and post- program survey
           including the Maslach Burnout Inventory (MBI) and Neff Self Compassion Score (SCS). Semi
           structured qualitative interviews will be led by a PRA upon completion of the 6-month
           pilot. The interview script will include questions about program content, participant
           experience, coping skills, interpersonal connectedness, personal and professional
           satisfaction, and general reflections.

      Description of Population to be Enrolled:

      This pilot study recruited individuals from the University of Colorado graduate medical
      education training programs. The pilot program is limited to female trainees who have greater
      than 1 year of training left in order to give trainees time to complete the program prior to
      graduation. Enrollment in the program is entirely voluntary and trainees can cease enrollment
      at any time.

      Study Design and Research Methods:

      This is a single-institution randomized controlled trial. 101 female residents were recruited
      from the University of Colorado School of Medicine. They enrolled beginning in January 2021
      and participated in the coaching program for 6 months via a web-based system. The website is
      secure and only available for program participants. There are monthly modules with
      asynchronous, self-directed delivery, designed to mitigate the time constraints and faculty
      development required of traditional in-person coaching. Video recordings of group-coaching
      calls will be made available to the program participants via the secure website with the
      intent to allow participants to benefit from group coaching even if they aren't able to
      attend the calls live. These recordings do contain PHI of participants.

      101 women trainees from 12 ACGME training programs enrolled in the program. Participants were
      randomized into either the intervention or wait-list control arm. Participants in the
      intervention arm began the 6-month coaching program in January, 2021. Participants in the
      wait-list control arm have received no additional resources from the Better Together program
      between January and June 2021.

      All participants in both intervention and wait-list control groups will be invited to
      complete the quantitative post-program survey in June 2021. At the time of the post-program
      survey in 6/2021, the wait-list control group will not have received the coaching
      intervention. Following the quantitative and qualitative data collection, the control group
      was be offered the 6-month coaching program from July-December 2021.

      The wait-list control group was invited to begin the 6-month coaching program in July 2021.
      In December 2021, participants from both the intervention and wait-list control groups will
      be invited to complete a 2nd post survey (identical to the post-survey from June 2021). There
      will be no incentive for completion of the 2nd post survey.

      Finally, the longitudinal effect of the program will be assessed by offering the same survey
      measuring wellbeing via various indices to the intervention arm at 6 months (1/2022), 12
      months (7/2022) and 18 months (1/2023) after their intervention. Participation in this survey
      will be completely voluntary and not incentivized/compensated.
    

Intervention name(s): Better Together Physician Coaching
Intervention type(s): Behavioral
Intervention description(s): 6 month, online group coaching program
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Burnout; Medical Education