Better Together Physician Coaching: Mitigating Burnout in UME

Burnout, Professional Clinical Trial

— BT for UME  

Official title:

Better Together Physician Coaching: Mitigating Burnout in Undergraduate Medical Education

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05822375
• Other study ID #: 23-0651
• Status: Active, not recruiting
• Phase: N/A
• Start date: August 1, 2023
• Est. completion date: January 1, 2028

Study information

• Verified date: September 2023
• Source: University of Colorado, Denver
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 2000
• Est. completion date: January 1, 2028
• Est. primary completion date: January 1, 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• current medical students at one of the 5 US undergraduate medical education sites

Exclusion Criteria:

• non-medical students

Related Conditions & MeSH terms

• Burnout, Professional
• Burnout, Psychological

Intervention

Behavioral:
• Better Together Physician Coaching
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.

Locations

Country	Name	City	State
United States	University of Colorado School of Medicine	Aurora	Colorado

Sponsors (1)

Lead Sponsor	Collaborator
University of Colorado, Denver

Country where clinical trial is conducted

United States, 

References & Publications (1)

Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016 Oct 31;7:364-369. doi: 10.5116/ijme.5801.eac4. Mantri S, Lawson JM, Wang Z, Koenig HG. Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP. J Relig Health. 2020 Oct;59(5):2323-2340. doi: 10.1007/s10943-020-01065-w. Kelly-Hedrick M, Rodriguez MM, Ruble AE, Wright SM, Chisolm MS. Measuring Flourishing Among Internal Medicine and Psychiatry Residents. J Grad Med Educ. 2020 Jun;12(3):312-319. doi: 10.4300/JGME-D-19-00793.1. Fainstad T, Mann A, Suresh K, Shah P, Dieujuste N, Thurmon K, Jones CD. Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial. JAMA Netw Open. 2022 May 2;5(5):e2210752. doi: 10.1001/jamanetworkopen.2022.10752. Erratum In: JAMA Netw Open. 2022 Jun 1;5(6):e2220348. Maslach, C., Jackson, S. E., & Leiter, M. P. (1997). Maslach Burnout Inventory: Third edition. In C. P. Zalaquett & R. J. Wood (Eds.), Evaluating stress: A book of resources (pp. 191-218). Scarecrow Education. Neff KD. Self-Compassion Scale. PsycTESTS Dataset. 2012. doi:10.1037/t10178-000 Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies. Res Aging. 2004;26(6):655-672. doi: 10.1177/0164027504268574.

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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	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
Secondary	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
Secondary	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
Secondary	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
Secondary	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