Coaching program reduces burnout in medical residents

The study was published today in the journal JAMA Network Open.

"We did a pilot program in 2021to see if it would work and it did," said study co-author Tyra Fainstad, MD, associate professor at the University of Colorado School of Medicine. "Then we expanded it to 26 graduate medical institutions in 19 states. There were 1,017 participants. We saw significant improvement in every wellbeing outcome we assessed including all three subscales involved in burnout."

Burnout within the health care community is a national epidemic disproportionally affecting women. Last year, the U.S. Surgeon General declared it a `crisis' deserving 'bold, fundamental change' though little was known about scalable, effective solutions to the problem.

Women are hit harder by burnout for reasons that include bias and sexism at work, pay disparities as well as a disproportionate burden of home management and child/elder care, the researchers said.

Fainstad and co-author Adrienne Mann, MD, both faculty in the CU Department of Medicine, created the web-based Better Together Physician Coaching Program at CU Anschutz with the goal of reducing that burnout. Then they replicated it to a national level and published their findings.

While the pilot program saw improvements in `imposter syndrome' (feeling as if you don't really belong in the job') and self-compassion, the expanded national study also showed significant improvements in outcomes across the board including moral injury and flourishing, offering actual evidence that the program works.

"Physician trainees who received online group coaching over four months had substantial reductions in multiple dimensions of professional distress (burnout, moral injury and imposter syndrome) and improvements in well-being (self-compassion and flourishing)," said Mann.

Mann and Fainstad are both certified life coaches. Better Together is owned and operated by the University of Colorado. It's not a business, they said, and they don't personally profit financially from it. The program is available to any heath care institution, school of medicine, department, or residency program wishing to meaningfully support the wellbeing of their clinicians and trainees.

Better Together is web-based. Participants take part in two videoconferencing coaching calls per week where up to five people can be coached live on any topic with an unlimited audience. Calls are recorded for later listening on a private podcast.

Participants can also access unlimited, anonymous written coaching in a forum by submitting a narrative reflection and receive a coach's response published to Better Together's secure, members-only website. There are also weekly self-study sessions using videos and worksheets. They focus on topics pertinent to the physician lifestyle such as goal setting, cultivating a growth mindset, receiving critical feedback, imposter syndrome and perfectionism.

The researchers use the Maslach Burnout Inventory (MBI) to measure their work. The MBI has three subscales: emotional exhaustion (EE) or feeling emotionally exhausted from work; Depersonalization (DP), detached and impersonal treatment of patients; Professional accomplishment (PA), beliefs around competence and success at work.

The EE score is a key construct in health care related burnout. A one point increase in the EE scale has been associated with a 7% increase in suicidal ideation and a 5-6% increase in major medical errors.

The researchers said a reduced mean EE score among those that took part in the training and an increased EE score in those that did not.

"From what we see in this study, coaching helps in every aspect of burnout," Fainstad said. "The multi-modal nature of our program is unique. You can interact in many ways. That partially explains the powerful impact -that and the group nature of our coaching."

Mann said the majority are watching others being coached and share in the experience.

"That is deeply connecting. They try to see themselves in someone else's story," she said. "When someone is on a view screen you have compassion and empathy for them and, by extension, learn to practice compassion and empathy for yourself."

While few strategies to address burnout have shown much overall effect, Fainstad said this study demonstrates that group coaching works.

"We're now showing that we have an actual evidence-based answer to burnout," she said.

Fainstad and Mann said burnout is a product of the current, often toxic, medical culture pervading every aspect of the profession.

"Culture is a belief system," Fainstad said. "And while structural changes are absolutely necessary to fix our medical system, working with individuals who have been harmed along the way will be imperative to healing."

Mann suggested a step towards healing the culture would be making coaching programs like Better Together accessible to everyone -- not necessarily mandatory but at least made available by institutions.

"There are other coaching programs in this space but this one is rigorously evidence-based. We studied it," Mann said. "There are no downsides. It helps in all aspects of burnout."