The impact of a smartphone meditation application on anesthesia trainee well-being

Online Mindfulness-Based Interventions for Healthcare Professionals: A Scoping Review

BACKGROUND

Healthcare professionals work in challenging environments with extended working hours and excessive workloads to provide high-quality care. However, they hardly get the time to care for themselves. Online mindfulness-based interventions-which are not restricted by time or location-can be a powerful strategy to help healthcare professionals.

OBJECTIVES

This scoping review aims to explore the current evidence about online mindfulness-based interventions for healthcare professionals.

DESIGN

A scoping review was conducted.

METHODS

A literature search was conducted to retrieve articles published between October 2016 and March 2023 in seven databases, including backward and forward citation tracking from the included articles. Among 1,278 articles retrieved, 33 met the criteria for review.

RESULTS

Two-thirds of the studies utilized commercialized mindfulness programs (n = 22). Duration of the mindfulness interventions varied from 1 week to 4 months, and half of the studies used audio-guided programs. Online mindfulness-based intervention studies were targeted to reduce burnout (n = 26), and the majority reported reduction in burnout (n = 18).

CONCLUSION

Most studies used individual audio-guided programs that warrant the use of diverse delivery methods such as video media, simulation, and virtual reality for interactions in the future. Although the literature has accumulated evidence for commercialized online mindfulness-based interventions, further studies are needed to develop and test tailored interventions for healthcare professionals.

Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis

BACKGROUND

Burnout among resident physicians during training has been prevalent, prompting training centers to introduce interventions at the individual or organizational level. However, empirical evidence is crucial before implementing such programs in practice.

METHODS

A systematic review and meta-analysis was carried out to evaluate the effectiveness of individual and organizational interventions in reducing burnout among resident physicians. Searching was done across five databases-PubMed, Scopus, ScienceDirect, Embase, and Cochrane Library from 1 December 2023 to 26 August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for our reporting of study selection process. Eligibility criteria were randomized or non-randomized designs, with prospective intervention, with a comparator group focused on individual or organizational interventions reducing burnout, in any language and publication date. The Maslach Burnout Inventory scores for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were the three outcome measures. Two investigators independently extracted the data. The risk of bias was evaluated using Cochrane risk-of-bias tool for randomized trials (RoB2) and non-randomized studies of interventions (ROBINS-I). Cohen's d and heterogeneity was estimated using a random-effects DerSimonian-Laird model and visualized by forest plots. Sensitivity analyses were carried out by leave-one-out meta-analysis.

RESULTS

We identified 33 eligible studies (n = 2536), comprising 25 (75.8%) individual intervention studies and 8 (24.2%) organizational intervention studies. Cohen's d for individual intervention versus control were as follows: EE -0.25 (95% CI -0.40 to -0.11, p < 0.01, I2 = 49.3%), and DP -0.17 (95% CI -0.32 to -0.03, p = 0.02, I2 = 50.0%). The organizational intervention showed no significant association with any domain. Sensitivity analyses were robust in all outcomes, with differences in intervention description and design identified as potential contributors to heterogeneity.

CONCLUSIONS

Various interventions, including individual coaching, meditation, and organization interventions, have been implemented to improve resident burnout. The effectiveness of intervention demonstrated none to small practical significance in improving burnout. Data inconsistency and high risk of bias across studies limited the validity of the pooled results. Further studies should focus on a combined approach.

REGISTRATION

The study was registered on PROSPERO, under PROSPERO registration number CRD42022349698.

Online Well-Being Group Coaching Program for Women Physician Trainees: A Randomized Clinical Trial

Importance

Physician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking.

Objective

To assess the generalizability of a coaching program (Better Together Physician Coaching) in a national sample of women physician trainees.

Design, Setting, and Participants

A randomized clinical trial involving trainees in 26 graduate medical education institutions in 19 states was conducted between September 1, 2022, and December 31, 2022. Eligible participants included physician trainees at included sites who self-identified as a woman (ie, self-reported their gender identity as woman, including those who reported woman if multiple genders were reported).

Intervention

A 4-month, web-based, group coaching program.

Main Outcomes and Measures

The primary outcomes were change in burnout (measured using subscales for emotional exhaustion, depersonalization, and personal achievement from the Maslach Burnout Inventory). Secondary outcomes included changes in impostor syndrome, moral injury, self-compassion, and flourishing, which were assessed using standardized measures. A linear mixed model analysis was performed on an intent-to-treat basis. A sensitivity analysis was performed to account for the missing outcomes.

Results

Among the 1017 women trainees in the study (mean [SD] age, 30.8 [4.0] years; 540 White participants [53.1%]; 186 surgical trainees [18.6%]), 502 were randomized to the intervention group and 515 were randomized to the control group. Emotional exhaustion decreased by an estimated mean (SE) -3.81 (0.73) points in the intervention group compared with a mean (SE) increase of 0.32 (0.57) points in the control group (absolute difference [SE], -4.13 [0.92] points; 95% CI, -5.94 to -2.32 points; P < .001). Depersonalization decreased by a mean (SE) of -1.66 (0.42) points in the intervention group compared with a mean (SE) increase of 0.20 (0.32) points in the control group (absolute difference [SE], -1.87 [0.53] points; 95%CI, -2.91 to -0.82 points; P < .001). Impostor syndrome decreased by a mean (SE) of -1.43 (0.14) points in the intervention group compared with -0.15 (0.11) points in the control group (absolute difference [SE], -1.28 (0.18) points; 95% CI -1.63 to -0.93 points; P < .001). Moral injury decreased by a mean (SE) of -5.60 (0.92) points in the intervention group compared with -0.92 (0.71) points in the control group (absolute difference [SE], -4.68 [1.16] points; 95% CI, -6.95 to -2.41 points; P < .001). Self-compassion increased by a mean (SE) of 5.27 (0.47) points in the intervention group and by 1.36 (0.36) points in the control group (absolute difference [SE], 3.91 [0.60] points; 95% CI, 2.73 to 5.08 points; P < .001). Flourishing improved by a mean (SE) of 0.48 (0.09) points in the intervention group vs 0.09 (0.07) points in the control group (absolute difference [SE], 0.38 [0.11] points; 95% CI, 0.17 to 0.60 points; P < .001). The sensitivity analysis found similar findings.

Conclusions and Relevance

The findings of this randomized clinical trial suggest that web-based professional group-coaching can improve outcomes of well-being and mitigate symptoms of burnout for women physician trainees.

Trial Registration

ClinicalTrials.gov Identifier: NCT05222685.

Efficacy and Feasibility of the Minimal Therapist-Guided Four-Week Online Audio-Based Mindfulness Program 'Mindful Senses' for Burnout and Stress Reduction in Medical Personnel: A Randomized Controlled Trial

Previous online mindfulness-based interventions for burnout and stress reduction in medical personnel had limited effect size and high dropout rate, so we developed a new online mindfulness program 'Mindful Senses (MS)' with aims to increase effect size and lower dropout rate. To test its efficacy and feasibility, ninety medical personnel with moderate or high levels of burnout and stress from across Thailand were recruited and randomly allocated into Group A and Group B equally. Group A read psychological self-help articles (PSA) and attended MS program through smartphone application during weeks 1-4. Group B read PSA during weeks 1-4 and attended MS program during weeks 9-12. Burnout, stress, anxiety, depression, mindfulness, and quality of life were measured at baseline, week 4, and week 8 for both groups, and at weeks 12 and 16 for Group B. Group x time interaction was analyzed by repeated-measures ANOVA. The results showed that, compared to PSA only, MS + PSA had statistically significant improvement of burnout, stress, anxiety, depression, mindfulness, and quality of life with moderate-to-very large effect sizes at week 4 (d = 1.33, 1.42, 1.04, 1.14, 0.70, and 1.03, respectively) and moderate-to-large effect sizes at week 8 (d = 0.84, 0.98, 0.73, 0.73, 0.66, and 0.94, respectively). The dropout rate was 4.4%. In conclusion, the MS program has potential to be an alternative intervention for medical personnel suffering from burnout and stress.