The Effect of Community Building Through Virtual, Team-Based Exercise on Burnout

Study Overview
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Brief Summary
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This study is a randomized controlled trial that will look at whether virtual, team-based exercise improves burnout, sense of community, and mentorship connections among medical students, residents, fellows, and physicians.

Detailed Description
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Participants will be randomized to either a control group or an intervention group. The intervention group will be further randomized onto teams that will exercise for 3 months. All exercise (including walking, biking, lifting, yoga, and 40+ exercises) will be tracked via user's smartwatches (ie Apple, Garmin), smartphone fitness apps (ie MapMyRun), or manual upload, converted into Metabolic Equivalent of a Task (MET) minutes, and displayed on online leaderboards. Group activities will be encouraged by awarding raffle tickets for prizes to those who submit pictures with their teammates. Primary outcomes will be burnout, sense of community, and mentorship connections, with the hypothesis that getting everyone together for this team-based exercise will improve these metrics. After 3 months, both the control and intervention group will be enrolled in 3 months of the intervention to assess secondary outcomes: long-term burnout, sense of community, and mentorship connections, as well as adherence.

Official Title
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The MedMotion Trial on Community Building Through Virtual, Team-Based Exercise and Affects on Physician and Trainee Burnout: A Randomized, Controlled, Multi-Center Trial

Conditions
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Burnout, Professional, Burnout, Student, Community Building, Mentorship, Exercise

Intervention / Treatment
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* Behavioral: First 3 months of virtual, team-based exercise
* Behavioral: Second 3 months of virtual, team-based exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Harvard Medical Students (HMS) Massachusetts General Hospital (MGH) Residents, Fellows, or Attendings Exclusion Criteria: Non HMS Students or MGH Residents, Fellows, or Attendings

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

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: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>6 months of virtual, team-based exercise | Behavioral: First 3 months of virtual, team-based exercise<br>* Participants will be randomized onto mixed teams of medical students, residents, fellows, and attendings and registered for the virtual, team-based exercise intervention on FitRankings.com. All exercise (including walking, biking, lifting, yoga, and 40+ exercises) will be tracked via user's smartwatches (ie Apple, Garmin), smartphone fitness apps (ie MapMyRun), or manual upload, converted into Metabolic Equivalent of a Task (MET) minutes, and displayed on online leaderboards. Group activities will be encouraged by awarding raffle tickets for prizes to those who submit pictures with their teammates.<br>Behavioral: Second 3 months of virtual, team-based exercise<br>* Same as above<br>|
| Other: Control<br>3 months of usual exercise and then 3 months of virtual, team-based exercise | Behavioral: Second 3 months of virtual, team-based exercise<br>* Same as above<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline Burnout at 3 months | Measured via the 2-item Maslach Burnout Inventory (MBI) The MBI is a 22-item survey that covers 3 areas: Emotional Exhaustion (EE), Depersonalization (DP), and low sense of Personal Accomplishment (PA). Each subscale includes multiple questions with frequency rating choices of Never, A few times a year or less, Once a month or less, A few times a month, Once a week, A few times a week, or Every day. The use of 2 single items from the MBI may also be used. Item 8 (I feel burned out from my work,) and item 10 (I have become more callous toward people since I took this job) correlate strongly with the emotional exhaustion and depersonalization subscale scores and concurrent validity has been demonstrated (J Gen Intern Med 2012;27:1445-52. J Gen Inter Med 2009;24:1318-21.) Individuals meet burnout criteria if they have high scores on either the EE (total score of 27 or higher) or DP (total score of 10 or higher) subscales. | 0 and 3 months | 
| Change from Baseline Burnout at 6 months | Measured via the 2-item Maslach Burnout Inventory (MBI) The MBI is a 22-item survey that covers 3 areas: Emotional Exhaustion (EE), Depersonalization (DP), and low sense of Personal Accomplishment (PA). Each subscale includes multiple questions with frequency rating choices of Never, A few times a year or less, Once a month or less, A few times a month, Once a week, A few times a week, or Every day. The use of 2 single items from the MBI may also be used. Item 8 (I feel burned out from my work,) and item 10 (I have become more callous toward people since I took this job) correlate strongly with the emotional exhaustion and depersonalization subscale scores and concurrent validity has been demonstrated (J Gen Intern Med 2012;27:1445-52. J Gen Inter Med 2009;24:1318-21.) Individuals meet burnout criteria if they have high scores on either the EE (total score of 27 or higher) or DP (total score of 10 or higher) subscales. | 0 and 6 months | 
| Change in Burnout from 3 to 6 months | Measured via the 2-item Maslach Burnout Inventory (MBI) The MBI is a 22-item survey that covers 3 areas: Emotional Exhaustion (EE), Depersonalization (DP), and low sense of Personal Accomplishment (PA). Each subscale includes multiple questions with frequency rating choices of Never, A few times a year or less, Once a month or less, A few times a month, Once a week, A few times a week, or Every day. The use of 2 single items from the MBI may also be used. Item 8 (I feel burned out from my work,) and item 10 (I have become more callous toward people since I took this job) correlate strongly with the emotional exhaustion and depersonalization subscale scores and concurrent validity has been demonstrated (J Gen Intern Med 2012;27:1445-52. J Gen Inter Med 2009;24:1318-21.) Individuals meet burnout criteria if they have high scores on either the EE (total score of 27 or higher) or DP (total score of 10 or higher) subscales. | 3 and 6 months | 
| Change from Baseline Sense of Community at 3 months | Measured via the Stanford Professional Fulfillment Index The Stanford Professional Fulfillment Index (PFI) is a 16-item survey that covers burnout (work exhaustion and interpersonal disengagement) and professional fulfillment. Response options are on a five-point Likert scale (not at all true to completely true for professional fulfillment items and not at all to extremely for work exhaustion and interpersonal disengagement items.) Items are scored 0 to 4. Each dimension is treated as a continuous variable. Scale scores are calculated by averaging the item scores of all the items within the corresponding scale. Scale scores can then be multiplied by 25 to create a scale range from 0 to 100. Higher score on the professional fulfillment scale is more favorable while higher scores on the work exhaustion or interpersonal disengagement scales are less favorable. | 0 and 3 months | 
| Change from Baseline Sense of Community at 6 months | Measured via the Stanford Professional Fulfillment Index The Stanford Professional Fulfillment Index (PFI) is a 16-item survey that covers burnout (work exhaustion and interpersonal disengagement) and professional fulfillment. Response options are on a five-point Likert scale (not at all true to completely true for professional fulfillment items and not at all to extremely for work exhaustion and interpersonal disengagement items.) Items are scored 0 to 4. Each dimension is treated as a continuous variable. Scale scores are calculated by averaging the item scores of all the items within the corresponding scale. Scale scores can then be multiplied by 25 to create a scale range from 0 to 100. Higher score on the professional fulfillment scale is more favorable while higher scores on the work exhaustion or interpersonal disengagement scales are less favorable. | 0 and 6 months | 
| Change in Sense of Community from 3 to 6 months | Measured via the Stanford Professional Fulfillment Index The Stanford Professional Fulfillment Index (PFI) is a 16-item survey that covers burnout (work exhaustion and interpersonal disengagement) and professional fulfillment. Response options are on a five-point Likert scale (not at all true to completely true for professional fulfillment items and not at all to extremely for work exhaustion and interpersonal disengagement items.) Items are scored 0 to 4. Each dimension is treated as a continuous variable. Scale scores are calculated by averaging the item scores of all the items within the corresponding scale. Scale scores can then be multiplied by 25 to create a scale range from 0 to 100. Higher score on the professional fulfillment scale is more favorable while higher scores on the work exhaustion or interpersonal disengagement scales are less favorable. | 3 and 6 months | 
| Change from Baseline Mentorship Connections at 3 months | Measured via unvalidated survey How many meaningful relationships would you say you have with [medical students, residents/fellows, attendings]? A meaningful relationship could include any of the following: a) someone you'd get coffee/meal with, b) someone you'd be comfortable talking about career/life advice, c) someone you would be comfortable catching up with, etc. | 0 and 3 months | 
| Change from Baseline Mentorship Connections at 6 months | Measured via unvalidated survey How many meaningful relationships would you say you have with [medical students, residents/fellows, attendings]? A meaningful relationship could include any of the following: a) someone you'd get coffee/meal with, b) someone you'd be comfortable talking about career/life advice, c) someone you would be comfortable catching up with, etc. | 0 and 6 months | 
| Change in Mentorship Connections from 3 to 6 months | Measured via unvalidated survey How many meaningful relationships would you say you have with [medical students, residents/fellows, attendings]? A meaningful relationship could include any of the following: a) someone you'd get coffee/meal with, b) someone you'd be comfortable talking about career/life advice, c) someone you would be comfortable catching up with, etc. | 3 and 6 months | 
| Change from Baseline Burnout (Mayo) at 3 months | Measured via the Mayo Wellbeing Index The Mayo Wellbeing Index aims to identify distress in a variety of dimensions (burnout, fatigue, low mental/physical quality of life, depression, anxiety/stress). It has separate medical student, resident/fellow, and physicians versions and is a 7-item instrument with yes/no response categories. A total score is calculated by adding the number of 'yes' responses. In a sample of physicians, medical students, and US workers, every one point increase in score resulted in a step-wise increased probability of distress and risk for adverse personal and professional consequence. Score range is 0 to 7, and threshold score to identify individuals in distress is 4 or higher for medical students, 5 or higher for residents, 4 or higher for practicing physicians, and 2 or higher for other US workers. | 0 and 3 months | 
| Change from Baseline Burnout (Mayo) at 6 months | Measured via the Mayo Wellbeing Index The Mayo Wellbeing Index aims to identify distress in a variety of dimensions (burnout, fatigue, low mental/physical quality of life, depression, anxiety/stress). It has separate medical student, resident/fellow, and physicians versions and is a 7-item instrument with yes/no response categories. A total score is calculated by adding the number of 'yes' responses. In a sample of physicians, medical students, and US workers, every one point increase in score resulted in a step-wise increased probability of distress and risk for adverse personal and professional consequence. Score range is 0 to 7, and threshold score to identify individuals in distress is 4 or higher for medical students, 5 or higher for residents, 4 or higher for practicing physicians, and 2 or higher for other US workers. | 0 and 6 months | 
| Change in Burnout (Mayo) from 3 to 6 months | Measured via the Mayo Wellbeing Index The Mayo Wellbeing Index aims to identify distress in a variety of dimensions (burnout, fatigue, low mental/physical quality of life, depression, anxiety/stress). It has separate medical student, resident/fellow, and physicians versions and is a 7-item instrument with yes/no response categories. A total score is calculated by adding the number of 'yes' responses. In a sample of physicians, medical students, and US workers, every one point increase in score resulted in a step-wise increased probability of distress and risk for adverse personal and professional consequence. Score range is 0 to 7, and threshold score to identify individuals in distress is 4 or higher for medical students, 5 or higher for residents, 4 or higher for practicing physicians, and 2 or higher for other US workers. | 3 and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Engagement in First Half of Study | Registration of >0 Metabolic Equivalent of a Task (MET) minutes on FitRankings platform | 3 months | 
| Engagement in Second Half of Study | Registration of >0 Metabolic Equivalent of a Task (MET) minutes on FitRankings platform | 6 months | 
| Change in Baseline Exercise at 3 months | On average, how many days per week do you exercise for 30 minutes or more? (0-7 days) | 0 and 3 months | 
| Change in Baseline Exercise at 6 months | On average, how many days per week do you exercise for 30 minutes or more? (0-7 days) | 0 and 6 months | 
| Change in Exercise from 3 to 6 months | On average, how many days per week do you exercise for 30 minutes or more? (0-7 days) | 3 and 6 months | 
| Change in Baseline Comfortability at work at 3 months | How comfortable do you feel about working with [medical students, residents/fellows, attending physicians] at your affiliated hospital? (1=not at all, 2=slightly, 3=moderately, 4=very, 5=extremely) | 0 and 3 months | 
| Change in Baseline Comfortability at work at 6 months | How comfortable do you feel about working with [medical students, residents/fellows, attending physicians] at your affiliated hospital? (1=not at all, 2=slightly, 3=moderately, 4=very, 5=extremely) | 0 and 6 months | 
| Change in Comfortability at work from 3 to 6 months | How comfortable do you feel about working with [medical students, residents/fellows, attending physicians] at your affiliated hospital? (1=not at all, 2=slightly, 3=moderately, 4=very, 5=extremely) | 3 and 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Burnout, Professional, Burnout, Student, Community Building, Mentorship, Exercise