DOI: 10.60854/gdn9-6m67
title: The Fiona Stanley Junior Doctors Online Mindfulness Project
title: The Fiona Stanley Junior Doctors Online Mindfulness Project: a randomised control trial of the impact of an online mindfulness program on stress levels in junior medical officers.
title: MTP

description: HeSANDA 1.0.0
description: There will be 120 interns at Fiona Stanley Hospital in 2022. The junior medical officer numbers are likely to be around 280. A planned sample size of minimum n=30 in each group (Intervention vs Control) is expected to be adequate to afford a high level of statistical power (around 0.9) to detect a difference in the levels of improvement, for Intervention participants vs Control participants, on the outcome measures (PSS, SDSI, SCS, FMI, and UWES), at an adjusted statistical significance level a=0.01. 
The hypothesized improvement is estimated to be modest for Intervention participants (i.e., of a magnitude around 9%-15% of the participants' baseline measure), compared to minimal (around 1%-5%) for Control participants.

Depending on the distribution of the outcome data, different statistical methods will be used for analysis. For example, if the score distribution is approximately normal, the MIXED procedure (for multilevel analysis) will be used. Otherwise, if the score data are not normally distributed, General Estimating Equations (GEE) will be used. Both of these approaches include key potential confounding factors such as age, gender, ethnicity, prior experience with mindfulness meditation, current practice in mindfulness, and time points (12 weeks post intervention vs 8 weeks post intervention vs baseline) as co-variates, as well as the possibly unbalanced repeated nature of the data, due to dropouts and missing data.

Thematic analysis of the qualitative data will be conducted using general inductive approach (Thomas, 2006) by the PhD candidate and an experienced qualitative researcher using NVivo software. Each transcript will be read by the PhD candidate and experienced qualitative researcher independently in order to develop a coding framework using thematic analysis. The two researchers will then compare their findings and further refine the framework. Another two investigators will apply this thematic framework on an independent analysis of a subset of qualitative interviews to ensure consistency. The outcome of the qualitative part of the study will be to identify junior doctors' perceived stressors, self-care strategies, perceived barriers to and benefits from participating in the online mindfulness training program. Further, the results will be utilised to identify system approaches and make recommendations on modifications that will reduce barriers to accessing the online mindfulness training program if the primary outcome shows benefit.
description: Randomization codes were generated using SAS PROC PLAN procedure. 
Randomization was run separately for male and female participants, as a 'surrogate' for stratification, due to 
(a) previous evidence for differential effects of mindfulness and 
(b) disproportionately more female participants.
description: The online mindfulness training intervention, referred to as the "Mindfulness Training Program (MTP)", is a novel 8-week online program developed by the coordinating principal investigator, program facilitator (PF) and PhD candidate, Dr Sarah Moore, with input from two mindfulness experts, Dr Craig Hassed and Dr Richard Chambers from Monash University. 

The MTP intervention includes: 
a) a weekly email each Monday containing a link to a 10-minute video mini-lecture. Each mini-lecture will focus on a different application of mindfulness, including mindful communication, multi-tasking vs unitasking & effective task switching, stress and performance, distraction and procrastination, regulating emotions, mindful relationships, mindfulness and self-compassion, and using mindfulness clinically.
b) a SMS sent to participants' mobile phone 5 days per week for 8 weeks with a link to a guided 5-minute mindfulness meditation practice via a central SMS delivery service that confirms messages are delivered to participants. The focus of the practice will change each week, and include themes such as body scan, mindful breathing, mindful listening, working mindfully with emotions, mountain meditation and compassion meditation.
c) the opportunity to correspond with the program facilitator (PF) throughout the program via email, telephone or videoconference to ask questions and discuss any difficulties they may be experiencing.

The PF is a GP and medical educator with 9 years of training in mindfulness.
The intervention will be delivered once for the intervention group, then repeated for the control group participants on completion of all study data collection.
Intervention adherence will be monitored via a survey sent each week for 8-weeks to participants measuring the quantity and quality of their daily mindfulness practice and uptake of the teaching video.

Participants are encouraged to practice mindfulness for 5 minutes per day, Monday to Friday.
description: This Research Project will be conducted in two parts. The first part will involve a randomised control trial of an online mindfulness training program (MTP) designed specifically for junior doctors, delivered to interns and resident medical officers working within Fiona Stanley and Fremantle Hospitals to assess the feasibility and effectiveness of the program with regards to reducing perceived stress and improving mindfulness, self-compassion and work engagement. The second part of the study will be qualitative in nature, involving an initial qualitative survey on junior doctor self-care strategies followed by interviews and focus groups with participating junior doctors to assess the underling factors contributing to their stress, as well as the barriers to and perceived benefits of participating in self-care strategies, including the online MTP. 

The MTP has been developed to include brief, daily mindfulness meditation practices and brief, weekly video teachings on the applications of mindfulness meditation for junior doctors. The program will be delivered via an online platform. This delivery mode aims to minimise the time required by busy junior doctors to invest in the program while providing stress management and self-care skills that are traditionally not taught as part of junior doctor training.

The program will be evaluated using both quantitative and qualitative methods, including quantitative surveys before and after the program (part one) as well as qualitative data collection in the form of a pre-intervention survey and post-intervention interviews and focus groups (part two).