Article Figures & Data
Figures
- Figure 1.
Study schema.
- Figure 2.
Mean change in distress scales from baseline visit, estimated from linear mixed effects models.
- Figure 3.
Mean change in well-being scales from baseline visit, estimated from linear mixed effects models.
Tables
Variable/Outcome Overall N = 1601 Waitlist N = 781 Intervention N = 821 P value2 Age 0.70 Mean (SD) 42.0 (8.4) 42.1 (8.1) 41.9 (8.7) Median (Range) 40.0 (26.0 to 68.0) 41.0 (31.0 to 65.0) 40.0 (26.0 to 68.0) Years since training ended 0.85 Mean (SD) 10.4 (8.2) 10.4 (7.8) 10.5 (8.6) Median (Range) 8.0 (0.0 to 36.0) 9.3 (0.0 to 30.0) 8.0 (0.0 to 36.0) Department/Specialty 0.89 Family medicine 65 (40.6%) 32 (41.0%) 33 (40.2%) Internal medicine 54 (33.8%) 28 (35.9%) 26 (31.7%) OBGYN 17 (10.6%) 9 (11.5%) 8 (9.8%) Pediatrics 13 (8.1%) 5 (6.4%) 8 (9.8%) Physical medicine and rehab 7 (4.4%) 3 (3.8%) 4 (4.9%) Other/Prefer not to answer 4 (2.5%) 1 (1.3%) 3 (1.9%) Degree 0.03 MD or DO 141 (88.1%) 64 (82.1%) 77 (93.9%) Other 12 (7.5%) 10 (12.8%) 2 (2.4%) PhD 4 (2.5%) 3 (3.8%) 1 (1.2%) PsyD 3 (1.9%) 1 (1.3%) 2 (2.4%) Behavioral health clinician 0.56 No 148 (92.5%) 71 (91.0%) 77 (94.0%) Yes 12 (7.5%) 5 (6.4%) 7 Gender identity 0.24 Cis female 131 (81.9%) 67 (85.9%) 64 (78.0%) Cis male 27 (16.9%) 11 (14.1%) 16 (19.5%) Other 2 (1.3%) 0 (0.0%) 2 (2.4%) Race and ethnic identity 0.56 Asian 6 (3.8%) 4 (5.2%) 2 (2.5%) Hispanic or Latinx 4 (2.5%) 1 (1.3%) 3 (3.7%) Other 13 (8.2%) 5 (6.5%) 8 (9.9%) Unanswered 2 (1.3%) 1 (0.6%) 1 (0.6%) White 135 (85.4%) 67 (87.0%) 68 (84.0%) Clinical Full Time Equivalents (FTE) 0.2 >76% 63 (39.4%) 33 (42.3%) 30 (36.6%) 51 to 75% 41 (25.6%) 15 (19.2%) 26 (31.7%) 26 to 50% 38 (23.8%) 22 (28.2%) 16 (19.5%) 0 to 25% 18 (11.3%) 8 (10.3%) 10 (12.2%) Outcomes at Baseline Distress outcomes: Burnout MBI mmotional exhaustion scale 0.7 Mean (SD) 30 (10) 30 (11) 30 (9) Median (IQR) 31 (23, 37) 32 (23, 38) 31 (25, 37) Range 6 to 52 6 to 52 7 to 49 MBI personal accomplishment scale 0.4 Mean (SD) 37.6 (5.9) 38.1 (5.7) 37.1 (6.1) Median (IQR) 38.0 (34.0, 42.3) 39.0 (34.0, 43.0) 38.0 (33.5, 42.0) Range 22 to 48 24 to 48 22.0 to 48.0 MBI depersonalization scale 0.6 Mean (SD, range) 9.4 (5.7) 9.2 (6.0) 9.5 (5.3) Median (IQR) 9.0 (5.0, 13.0) 8.0 (5.0, 13.0) 9.5 (5.0, 12.8) Range 0 to 24 0 to 24 0 to 22 Met definition for positive burnout 104 (66%) 48 (63%) 56 (68%) 0.5 Imposter syndrome Young imposter syndrome scale 0.4 Mean (SD) 4.83 (2.30) 4.66 (2.28) 4.99 (2.32) Median (IQR) 5.0 (3.0, 7.0) 5.00 (3.0, 6.0) 5.00 (3.0, 7.0) Range 0 to 8 0 to 8 0 to 8 Met definition for positive impostor syndrome 89 (57%) 42 (55%) 47 (59%) 0.6 Moral injury Moral injury symptom scale 0.2 Mean (SD) 39 (13) 38 (12) 41 (14) Median (IQR) 38 (30, 49) 37 (30, 45) 39 (31, 51) Range 11-79 11-66 15-79 Loneliness UCLA Loneliness scale >0.9 Mean (SD) 4.91 (1.8) 4.92 (1.8) 4.89 (1.8) Median (IQR) 5.00 (3.0, 6.0) 5.00 (3.0, 6.0) 5.00 (3.0, 6.0) Range 3.0-9.0 3.0-9.0 3.0-9.0 Well-being outcomes Self-compassion Self compassion scale score 0.9 Mean (SD) 36 (7) 36 (7) 36 (8) Median (IQR) 35 (31, 40) 36 (31, 40) 35 (31, 40) Range 17-57 22-55 17-57 Flourishing Secure flourishing index 0.2 Mean (SD) 7.02 (1.1) 7.13 (1.2) 6.91 (1.1) Median (IQR) 7.1 (6.3, 7.9) 7.21 (6.5, 8.0) 6.88 (6.2, 7.8) Range 3.1-9.3 3.1-9.3 4.50-9.08 - Table 2.
Mean Change in Response from Baseline, Established from Linear Mixed-Effects Models
Control Group No. Estimated Change, Points (S.E.) [95% CI] Intervention Group No. Estimated Change, Points (S.E.) [95% CI] Absolute Difference (S.E.) in Score Change, Intervention vs Control [95% CI] P value Distress outcomes Burnout Emotional exhaustion score Pre 76 −2.13 (1.02) 82 −3.35 (1.08) −1.22 (−4.16 to 1.72) 0.41 Post 62 53 Depersonalization Score Pre 77 −0.33 (0.53) 82 −2.05 (0.57) −1.72 (−3.26 to −0.17) 0.03 Post 64 56 Personal accomplishment score Pre 77 −0.35 (0.58) 79 1.3 (0.61) 1.65 (−0.02 to 3.32) 0.05 Post 63 56 Moral injury Moral injury symptom scale score Pre 77 −1.76 (1.18) 80 −3.71 (1.24) −1.95 (−5.32 to 1.42) 0.26 Post 62 55 Imposter syndrome Young imposter syndrome scale score Pre 76 −0.18 (0.22) 79 −1 (0.24) −0.82 (−1.47 to −0.18) 0.01 Post 62 53 Loneliness UCLA Loneliness scale score Pre 77 −0.17 (0.16) 81 −0.18 (0.16) −0.01 (−0.45 to 0.44) 0.98 Post 63 55 Well-being outcomes Self-compassion Self-compassion score Pre 76 1.54 (1.1) 79 2.48 (1.19) 0.95 (−2.25 to 4.15) 0.56 Post 64 55 Flourishing Secure flourishing index Pre 74 0.04 (0.11) 74 0.39 (0.12) 0.35 (0.03 to 0.66) 0.03 Post 60 53 Mean change in response from baseline, established from linear mixed-effects models Burnout Emotional exhaustion score Pre 76 −2.13 (1.02) 82 −3.35 (1.08) −1.22 (−4.16 to 1.72) 0.41 Post 62 53 Depersonalization score Pre 77 −0.33 (0.53) 82 −2.05 (0.57) −1.72 (−3.26 to −0.17) 0.03 Post 64 56 Personal accomplishment score Pre 77 −0.35 (0.58) 79 1.3 (0.61) 1.65 (−0.02 to 3.32) 0.05 Post 63 56 Imposter syndrome Young imposter syndrome scale score Pre 76 −0.18 (0.22) 79 −1 (0.24) −0.82 (−1.47 to −0.18) 0.01 Post 62 53 Post 63 55 Flourishing Secure flourishing index Pre 74 0.04 (0.11) 74 0.39 (0.12) 0.35 (0.03 to 0.66) 0.03 Post 60 53 Abbreviations: SE, standard error; CI, confidence interval.
Appendix 2: Follow Up Responders vs Non-Responders
Completed Variable Overall, N = 1601 Pre-Survey Only, N = 401 Both Surveys, N = 1201 p-value Age 0.93 Mean (SD) 42.0 (8.4) 41.9 (8.9) 42.0 (8.3) Median (IQR) 40.0 (35.0, 46.0) 42.0 (34.0, 46.3) 40.0 (36.0, 44.3) Range 26.0-68.0 26.0-65.0 30.0-68.0 Years since training 0.87 Mean (SD) 10.4 (8.2) 10.4 (7.7) 10.4 (8.4) Median (IQR) 8.0 (4.0, 14.3) 8.5 (3.4, 15.5) 8.0 (4.0, 14.0) Range 0.0-36.0 1.0-30.0 0.0-36.0 Behavioral health clinician 0.18 No 148 (92.5%) 35 (87.5%) 113 (94.2%) Yes 12 (7.5%) 5 (12.5%) 7 (5.8%) Specialty 0.15 Family medicine 65 (40.6%) 15 (37.5%) 50 (41.7%) Internal medicine 54 (33.8%) 12 (30.0%) 42 (35.0%) OBGYN 17 (10.6%) 8 (20.0%) 9 (7.5%) Pediatrics 13 (8.1%) 2 (5.0%) 11 (9.2%) Physical medicine and rehab 7 (4.4%) 2 (5.0%) 5 (4.2%) Other/Prefer not to answer 4 (2.5%) 1 (2.5%) 3 (2.5%) Degree 0.03 MD or DO 141 (88.1%) 34 (85.0%) 107 (89.2%) Other 12 (7.5%) 3 (7.5%) 9 (7.5%) PhD 4 (2.5%) 0 (0.0%) 4 (3.3%) PsyD 3 (1.9%) 3 (7.5%) 0 (0.0%) Prefer not to answer 0 (0.0%) 0 (0.0%) 0 (0.0%) Gender identity 0.70 Cis female 131 (81.9%) 35 (87.5%) 96 (80.0%) Cis male 27 (16.9%) 5 (12.5%) 22 (18.3%) Other 2 (1.3%) 0 (0.0%) 2 (1.7%) Race and ethnic identity 0.86 White 135 (85.4%) 33 (82.5%) 102 (85.0%) Other 13 (8.1%) 4 (10.0%) 9 (7.5%) Asian 6 (3.8%) 2 (5.0%) 4 (3.3%) Hispanic or Latinx 4 (2.5%) 1 (2.5%) 3 (2.5%) Unanswered 2 (1.3%) 1 (2.5%) 1 (0.8%) Clinical FTE 0.25 >76% 63 (39.4%) 21 (52.5%) 42 (35.0%) 51-75% 41 (25.6%) 9 (22.5%) 32 (26.7%) 26-50% 38 (23.8%) 6 (15.0%) 32 (26.7%) 0-25% 18 (11.3%) 4/40 (10.0%) 14 (11.7%) Abbreviations: SD, standard deviation; IQR, Interquartile range; FTE, full-time equivalent.
