Better Together Physician Coaching: Mitigating Burnout in UME

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 University of Colorado School of Medicine (CU SOM) clinicians Aim 1: Implement Better Together in undergraduate medical education settings for medical students 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, loneliness, and moral injury. Aim 3: Advance the field of coaching for clinicians through innovation and dissemination of evidence-based approaches to medical student 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. 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 medical students of all gender identities. 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 medical students. Aim 1: Implement Better Together in the undergraduate medical student population 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, loneliness, and moral injury. Aim 3: Advance the field of coaching for clinicians through innovation and dissemination of evidence-based approaches to medical student wellbeing.

Official Title
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Better Together Physician Coaching: Mitigating Burnout in Undergraduate Medical Education

Conditions
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Burnout, Professional

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: current medical students at one of the 5 US undergraduate medical education sites Exclusion Criteria: non-medical students

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Prevention
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 duration 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, loneliness, and flourishing. All participants will be offered the survey at baseline- September 2023 (T0), post intervention- January 2024 (T1).
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Will be offered the BT coaching intervention over 4-months (Sept 1st 2023- Dec 31st 2023). | Behavioral: Better Together Physician Coaching<br>* Better Together Physician Coaching Program 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. 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>|
| No Intervention: Waitlist control<br>Will be offered the coaching intervention following 4-month waitlist control (Feb 1st 2024 - May 31st 2024). | |

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): Change from pre to post test | 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. | Time Frame: 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): Change from pre to post test | 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) Change from pre to post test | 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. | Time Frame: 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): Change from pre to post test | 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): Change from pre to post test | 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 | 
| Loneliness as defined by the UCLA 3-item Loneliness Scale: Change from pre to post test | The UCLA 3-item Loneliness Scale measures feelings of loneliness. It is a shortened version of the 20-item Revised UCLA Loneliness Scale. Possible scores range from 1-3 on a Likert scale for each item with 1 = Hardly ever; 2 = Some of the time; 3 = Often. The three items are summed to give a total score between 3 to 9 with higher scores indicating a higher degree of loneliness. | pretest will occur prior to the intervention and posttest will occur after the 4-month intervention |