Better Together: an Online Physician Coaching Program for Medical Trainees

Study Overview
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Brief Summary
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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
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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): participation (administrative data) participant experience and reflection (interview) 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.

Official Title
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Effect of a Novel Online Physician Group-Coaching Program to Reduce Burnout in Trainees: A Randomized Controlled Trial

Conditions
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Burnout, Self-compassion, Moral Injury, Impostor Phenomenon

Intervention / Treatment
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* Behavioral: Better Together Physician Coaching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: graduate medical education trainees (residents and fellows) at the University of Colorado Female identifying Exclusion Criteria: Non trainees non- female identifying

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Enrolled into a 6 month coaching program from January 1 2021 to June 30 2021 | Behavioral: Better Together Physician Coaching<br>* 6 month, online group coaching program<br>|
| No Intervention: Control/Wait-list<br>No intervention from January 1 2021 to July 1 2021 (they were offered the coaching program from July 1 2021-Dec 31 2021) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline Burnout at 6 months, 12 months and 18 months | The Maslach's burnout inventory is a 22-item measurement of worker burnout which assesses emotional exhaustion (EE), depersonalization (DP), and personal fulfillment (PF) domains. Possible scores range from 0-6 on a Likert scale for each item. Scores oof EE ≥ 27 points, DP ≥ 10, and PF <33 would indicate a high degree of burnout. Scores of EE≤18 points, DP≤5 points, and PF≥40 points would indicate a low degree of burnout. | Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline Self Compassion at 6 months, 12 months and 18 months | Neff's Self-Compassion Scale - Short Form is a 12 item measurement of self-compassion with higher scores indicating improved or better levels of self compassion. | Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months | 
| Change from baseline Imposter Syndrome at 6 months, 12 months and 18 months | The Young Impostor Syndrome Scale is an 8 item measurement of imposter phenomenon with scores ≥ 5 indicating yes to presence of imposter phenomenon and scores less than 5 being negative for presence of imposter phenomenon. | Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months | 
| Change from baseline Moral Injury at 6 months, 12 months and 18 months | The Moral Injury Symptom Score for healthcare professionals is a 22 item measure of moral injury symptoms that assesses betrayal, guilt, shame, moral concerns, loss of trust, loss of meaning, difficulty forgiving, self-condemnation, religious struggle, and loss of religious/spiritual faith with scores of 60 or higher correlating with extreme problems, scores of 45-59 being moderate and scores of 30-45 being mild. | Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Burnout, Medical Education