Better Together Physician Coaching to Mitigate Burnout in Male-Identifying Trainees

Study Overview
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Brief Summary
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Better Together Physician Coaching (Better Together, or BT), a 4-month, web-based positive psychology multimodal coaching program was built to decrease burnout in medical trainees. Here, the investigators seek to understand it's efficacy in male-identifying trainees at the University of Colorado Aim 1: Implement Better Together in for male-identifying trainees in Graduate Medical Education at the University of Colorado. Aim 2: Assess outcomes: primary: reduce burnout as measured by the Maslach Burnout Index (goal: 10% relative improvement), and secondary: self-compassion, imposter syndrome, flourishing and moral injury. Aim 3: Advance the field of coaching in GME through innovation and dissemination of evidence-based approaches to GME trainee wellbeing.

Detailed Description
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Burnout refers to feelings of exhaustion, negativism, and reduced personal efficacy resulting from chronic workplace stress. In healthcare, burnout leads to increased medical errors, poorer patient care and negatively affects professional development and retention. Burnout is a growing problem that begins early in medical training. Professional coaching is a metacognition tool with a sustainable positive effect on physician well-being but typically relies on expensive consultants or time-consuming faculty development, often making it infeasible for medical training programs to offer. To overcome this barrier, the investigators created Better Together Physician Coaching (BT) a 4-month coaching program for at the University of Colorado (CU). BT includes regular online group-coaching, written coaching, and weekly self-study modules delivered by physician life coaches (Co-PIs). In 2021, the investigators studied BT in a group of female-identifying resident trainees at CU and found that the program significantly improved burnout, imposter syndrome, and self-compassion.6 This finding supports previous data that life coaching is effective for physicians and physicians in training. The investigators initially focused on women since burnout affects women to a greater degree than their male counterparts, and may have long-lasting consequences on their careers, contributing to a leaky pipeline effect. The pilot randomized controlled trial (RCT) of 101 BT women participants demonstrated a statistically significant improvement in burnout, self-compassion, and imposter syndrome in the intervention group. The investigators now seek to understand if the coaching program is also effective in male-identifying medical trainees. There is some literature suggesting that women are more likely to engage in wellness interventions, and may be more likely to report symptoms of burnout on surveys than men despite actual experiences. There is data to suggest that men and women are affected to different degrees by wellness interventions and there is also data that shows different effects (both positive and negative) of mixing genders. The investigators eventually plan to offer coaching to a co-ed group however realize that if efficacy is different in this group, it will be unknown if the difference is due to men being affected to a different degree than women, or if the difference is due to mixing the genders. Before testing the program in a co-ed group, the investigators first need to see if the coaching is effective in men. This project will test Better Together amongst male-identifying participants, and the program will be evaluated by the CU research team to see if the program has the same impacts. The hypothesis is that Better Together Physician Coaching (Better Together, or BT), a 4-month, web-based positive psychology multimodal coaching program will result in decreased burnout in male-identifying residents in medical training at CU. Aim 1: Implement Better Together in for male-identifying trainees in Graduate Medical Education at the University of Colorado. Aim 2: Assess outcomes: primary: reduce burnout as measured by the Maslach Burnout Index (goal: 10% relative improvement), and secondary: self-compassion, imposter syndrome, flourishing and moral injury. Aim 3: Advance the field of coaching in GME through innovation and dissemination of evidence-based approaches to GME trainee wellbeing.

Official Title
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Better Together Physician Coaching: Addressing Burnout Amongst Male-Identifying Medicine Trainees

Conditions
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Burnout, Professional, Self Compassion, Flourishing, Imposter Syndrome, Moral Injury

Intervention / Treatment
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* Behavioral: Better Together Physician Coaching Program
* Behavioral: No intervention - placebo control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: trainee (resident or fellow) in graduate medical education at the University of Colorado, who identify as male (cis, transman, gender-queer, non-binary are welcome). Exclusion Criteria: non-trainee, non male-identifying
Sexes Eligible for Study
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Male

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
Interventional Model Description: This is a randomized controlled trial. All enrolled participants will complete the pretest baseline survey. After baseline data collection is completed, the participants will be randomized into either a control or intervention group. This randomized controlled trial study design will offer the BT coaching to the intervention group for the during of 4-months (February 1st 2023- May 31st 2023) and to the control group for the duration of 4-months (September 1st 2023 - December 31st 2023). At two different timepoints, all participants will be offered surveys containing the following validated indices: burnout, imposter syndrome, self-compassion, moral injury, discrimination, and flourishing. All participants will be offered the survey at baseline- January 2023 (T0), post intervention- May 2023 (T1).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Will be offered the BT coaching intervention during of 4-months (February 1st 2023- May 31st 2023). | Behavioral: Better Together Physician Coaching Program<br>* thought-based coaching. This type of coaching focuses on thoughts and beliefs. It combines a cognitive behavioral therapy (CBT) model with mindfulness-based awareness and integrates theories of acceptance and commitment therapy (ACT), nonattachment, and radical questioning from Socratic and Greek philosophies.4 BT delivers a robust coaching experience via a 4-month web-based, group-coaching model. This novel program allows residents to participate as actively as they are inclined and able, offering flexibility via multiple modalities of coaching: twice weekly group coaching calls, unlimited anonymous written coaching, and weekly self-study modules that are housed on a secure members-only website.<br>* Other names: no intervention, residency as usual;|
| Placebo Comparator: Control<br>Will NOT be offered the BT coaching intervention during of 4-months (February 1st 2023- May 31st 2023). Will be offered the coaching intervention after the study completion (from September 1st 2023 - December 31st 2023). | Behavioral: No intervention - placebo control<br>* No intervention - placebo control<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Burnout as defined by the Maslach Burnout Inventory (MBI). | The Maslach burnout inventory (MBI) 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 of 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. | pretest will occur prior to the intervention and posttest will occur after the 4-month intervention. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-Compassion as defined by Neff's Self Compassion Score Short Form (SCS-SF) | Neff's Self Compassion Score Short Form (SCS-SF) is a 12-item measurement of self-compassion. Possible scores range from 0-6 on a Likert scale for each item, where the higher scale scores indicate greater self-compassion. Scores of 1.0- 2.49 are considered to be low, between 2.5-3.5 to be moderate, and 3.51-5.0 to be high. | pretest will occur prior to the intervention and posttest will occur after the 4-month intervention | 
| Moral Injury as defined by the Moral Injury Symptom Scale for Health Professions (MISS-HP) | Moral Injury Symptom Scale for Health Professions (MISS-HP) is a 10-item measurement of moral injury. Possible scores range from 0-5 on a Likert scale for each item, where the higher scale scores indicate greater moral injury. Scores >35(on a possible score range of 10 to 100) are considered high for moral injury symptoms causing moderate to extreme problems with family, social, and occupational functioning. | pretest will occur prior to the intervention and posttest will occur after the 4-month intervention | 
| Imposter Syndrome as defined by Young's Imposter Syndrome Symptoms Scale (YISS) | Young's Imposter Syndrome Symptoms Scale (YISS) is a 8-item measurement of imposter syndrome. Scoring is yes/no where a score of >5/8 is felt to be positive for imposter syndrome. | pretest will occur prior to the intervention and posttest will occur after the 4-month intervention | 
| Flourishing as defined by the Secure Flourish Index (SFI) | The Secure Flourish Index (SFI) is a 12 item measurement of flourishing at work and includes the domains of (D1) happiness and life satisfaction; (D2) physical and mental health; (D3) meaning and purpose; (D4) character and virtue; and (D5) close social relationships plus 2 questions on having adequate stability as well as material and financial resources so that flourishing is likely to continue. Scores range from a low of 0 to a high of 120, though the secure flourishing scores are often reported as averages of the questions (rather than sums) so that all scores are on a scale of 0-10. | pretest will occur prior to the intervention and posttest will occur after the 4-month intervention |