Better Together

Purpose: Burnout refers to feelings of exhaustion and reduced personal efficacy resulting from the workplace and disproportionately affects female medical trainees and physicians compared to both their male and nonphysician counterparts.1,2 Physician burnout begins in training and is linked to increased errors, patient mortality, physician depression, substance abuse, and job turnover.2,3 While physicians have been shown to possess higher levels of grit, resilience, and other adaptive wellness qualities compared to other fields, physicians feel more self-condemnation and less self-compassion compared with workers in other fields.3,4 Low self-compassion contributes to burnout and likely stems from perfectionism, strong negativity biases, and frequent comparison to peers.3,4 Many interventions have attempted to improve trainee burnout, but often have no effect, or marginally improve short-term burnout.2,3,5 Little is known about their long-term impact.5 We piloted Better Together Physician Coaching (BT), a group coaching program with a focus on self-compassion for 101 female-identifying residents at the University of Colorado in a randomized controlled trial (RCT) that reduced burnout and impostor syndrome and increased self-compassion.5 Here, we evaluate long-term effects of BT, a digital, 6-month life coaching program aimed at improving resident burnout and wellness. Method: The BT program guides participants over 6 months through the application of a metacognitive tool that explores the relationship between circumstances, thoughts, feelings, actions, and results while grounding them in a psychologically safe space of nonjudgment and self-compassion.5 We performed a secondary analysis of survey data from the pilot program implementation between January 2021 and June 2022. Two-sample t tests between baseline and post 6-month results and baseline and post 12-month results were completed for outcome measures. Results: Of 101 participants, 95 completed a baseline survey (94%), 66 completed a 6-month survey (69%), and 36 completed a 12-month survey (38%). No statistically significant differences were observed when comparing baseline to 6-month or baseline to 12-month scores in emotional exhaustion, depersonalization, or personal accomplishment. Compared to baseline self-compassion scores (mean = 33.2, SD = 6.74), participant scores significantly improved after 6 months (mean = 38.2, SD = 7.79, P < .001), which remained still significantly improved after 12 months (mean = 36.7, SD = 7.59, P = .020). Impostor syndrome scores improved significantly from baseline to 6 months (mean = 5.41, SD = 2.00 versus mean = 4.38, SD = 2.37, respectively, P = .005) but were not sustained after 12 months (mean = 4.66, SD = 2.18, P =.081). Moral injury (mean = 41.2, SD = 10.7) scores improved after 6 months (mean = 37.0, SD = 11.0, P = .018) but did not remain improved at 12 months (mean = 38.1, SD = 11.1, P = .166). Discussion: This study showed significant, sustained improvement in self-compassion and a trend toward sustained improvements in emotional exhaustion, impostor syndrome, and moral injury for coaching program participants. When compared to a control group in the pilot RCT, BT mitigated the otherwise worsening burnout in residents over time. A core focus of BT coaching is grounded in self-compassion, perhaps contributing to sustainable improvements in this measure.5 A lack of self-compassion has been linked to worsening burnout, sleep-related impairment, and a habit of deferring self-care.4 Furthermore, medical training and practice environments often respond to physician mistakes with shame and blame approaches, which frame self-compassion as unnecessary and even counterproductive.4 Reframing this belief about self-compassion and then teaching hands-on tools to create and protect self-compassion is foundational to the BT program, perhaps attributing to self-compassion being the most sustainable improvement over time. Significance: This study showed sustained longitudinal wellness outcomes in medical residents after participating in the BT program. They also thank the University of Colorado (CU) office of Graduate Medical Education, and the Society for General Internal Medicine’s support of this project through support of Dr. Fainstad as the Mary O’Flaherty Horn Award recipient and are thankful to the Horn committee’s mentorship

Burnout · Coaching · Compassion fatigue · Emotional exhaustion · Feeling · Health coaching · Mindfulness · Psychiatry · Psychological intervention · Psychological resilience · Psychotherapist · Self-compassion · Clinical Psychology · Diversity and Career in Medicine · Healthcare professionals’ stress and burnout · Innovations in Medical Education · Medicine · Psychology · Social Psychology