TY - JOUR
T1 - Effect of a Novel Mindfulness Curriculum on Burnout during Pediatric Internship
T2 - A Cluster Randomized Clinical Trial
AU - Fraiman, Yarden S.
AU - Cheston, Christine C.
AU - Cabral, Howard J.
AU - Allen, Celeste
AU - Asnes, Andrea G.
AU - Barrett, Jefferson T.
AU - Batra, Maneesh
AU - Bernstein, William
AU - Bleeker, Tammy
AU - Dietz, Pam M.
AU - Lewis, Joanna
AU - Li, Su Ting T.
AU - Ma, T. Marsha
AU - Mahan, John D.
AU - Michelson, Catherine D.
AU - Poynter, Sue E.
AU - Vining, Mark A.
AU - Watson, Katherine
AU - Sox, Colin M.
N1 - Funding Information:
Benioff Children’s Hospital Oakland, Oakland (Allen); Yale-New Haven Hospital, New Haven, Connecticut (Asnes); Floating Hospital for Children– Tufts Medical Center, Boston, Massachusetts (Barrett); Division of Emergency Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts (Barrett); Department of Pediatrics, The Children’s Hospital at Montefiore, Bronx, New York (Barrett); Division of Neonatology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle (Batra); Department of Pediatrics, Saint Peter’s University Hospital, New Brunswick, New Jersey (Bernstein); Department of Pediatrics, University of Florida, Gainesville (Bleeker); Department of Pediatrics, Maine Medical Center, Portland, Maine (Dietz); Department of Pediatrics, Advocate Children’s Hospital, Park Ridge, Illinois (Lewis); Department of Pediatrics, University of California, Davis, Sacramento (Li); Pediatric Cardiology, Loyola Medicine, Maywood, Illinois (Ma); Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children’s, Columbus, Ohio (Mahan); Division of Critical Care, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio (Poynter); Department of Pediatrics, University of Massachusetts Medical School, Worcester (Vining); Division of General Academic Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania (Watson). Author Contributions: Drs Cabral and Sox had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Fraiman, Cheston, Ma, Mahan, Michelson, Poynter, Watson, Sox. Acquisition, analysis, or interpretation of data: Fraiman, Cheston, Cabral, Allen, Asnes, Barrett, Batra, Bernstein, Bleeker, Dietz, Lewis, Li, Mahan, Michelson, Poynter, Vining, Sox. Drafting of the manuscript: Fraiman, Cheston, Cabral, Bleeker, Poynter, Sox. Critical revision of the manuscript for important intellectual content: Cheston, Cabral, Allen, Asnes, Barrett, Batra, Bernstein, Dietz, Lewis, Li, Ma, Mahan, Michelson, Poynter, Vining, Watson, Sox. Statistical analysis: Fraiman, Cabral, Sox. Obtained funding: Fraiman, Sox. Administrative, technical, or material support: Fraiman, Cheston, Allen, Asnes, Bernstein, Bleeker, Ma, Mahan, Michelson, Poynter, Vining, Watson, Sox. Supervision: Cheston, Allen, Bernstein, Watson, Sox. Other - implementation of the mindfulness course at 1 institution: Dietz. Other - coordination and implementation of curriculum at 1 site: Barrett. Conflict of Interest Disclosures: None reported. Funding/Support: This study was supported in part by the Association of Pediatric Program Directors’ Special Projects Program (Drs Fraiman and Sox) and the Fred Lovejoy House-staff Research and Education Fund at Boston Children’s Hospital (Dr Fraiman). Dr Fraiman was supported by grant T32HS000063 from the Agency for Healthcare Research and Quality as part of the Harvard-wide Pediatric Health Services Research Fellowship Program. Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Data Sharing Statement: See Supplement 3. Additional Contributions: We acknowledge the voluntary contributions made by faculty and administrators at each site who facilitated implementing the study activities.
Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/4
Y1 - 2022/4
N2 - Importance: Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges. Objective: To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout. Design, Setting, and Participants: This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019. Interventions: The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches. Main Outcomes and Measures: The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15. Results: Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15. Conclusions and Relevance: A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout. Trial Registration: ClinicalTrials.gov Identifier: NCT03148626.
AB - Importance: Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges. Objective: To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout. Design, Setting, and Participants: This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019. Interventions: The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches. Main Outcomes and Measures: The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15. Results: Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15. Conclusions and Relevance: A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout. Trial Registration: ClinicalTrials.gov Identifier: NCT03148626.
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U2 - 10.1001/jamapediatrics.2021.5740
DO - 10.1001/jamapediatrics.2021.5740
M3 - Article
C2 - 35072694
AN - SCOPUS:85123352963
SN - 2168-6203
VL - 176
SP - 365
EP - 372
JO - JAMA Pediatrics
JF - JAMA Pediatrics
IS - 4
ER -