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

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

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.

Study Overview

• Status: Completed
• Conditions: Burnout, Professional; Self Compassion; Flourishing; Imposter Syndrome; Moral Injury
• Intervention / Treatment: Behavioral: Better Together Physician Coaching Program; Behavioral: No intervention - placebo control

Detailed 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.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.

• Study Type: Interventional
• Enrollment (Actual): 41
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Aurora, Colorado, United States, 80230
      • University of Colorado School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Will be offered the BT coaching intervention during of 4-months (February 1st 2023- May 31st 2023).	Behavioral: 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.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.; Other Names: no intervention, residency as usual
Placebo Comparator: Control; 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; No intervention - placebo control

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: University of Colorado, Denver

Publications and helpful links

General Publications

• 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

Study record dates

Study Major Dates

• Study Start (Actual): January 2, 2023
• Primary Completion (Actual): September 1, 2023
• Study Completion (Actual): September 1, 2023

Study Registration Dates

• First Submitted: September 19, 2022
• First Submitted That Met QC Criteria: September 19, 2022
• First Posted (Actual): September 22, 2022

Study Record Updates

• Last Update Posted (Actual): September 28, 2023
• Last Update Submitted That Met QC Criteria: September 26, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Stress, Psychological; Occupational Stress; Occupational Diseases; Trauma and Stressor Related Disorders; Stress Disorders, Traumatic; Burnout, Professional; Burnout, Psychological; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: 22-1718

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No