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Original Investigation |

Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism:  A Randomized Clinical Trial

Colin P. West, MD, PhD1,2; Liselotte N. Dyrbye, MD, MHPE3; Jeff T. Rabatin, MD, MSc4; Tim G. Call, MD5; John H. Davidson, MD1; Adamarie Multari, MD6; Susan A. Romanski, MD1; Joan M. Henriksen Hellyer, RN, PhD7; Jeff A. Sloan, PhD2; Tait D. Shanafelt, MD5
[+] Author Affiliations
1Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
2Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
3Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
4Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
5Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
6Division of Preventive, Occupational, and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
7Program in Professionalism and Ethics, Mayo Clinic, Rochester, Minnesota
JAMA Intern Med. 2014;174(4):527-533. doi:10.1001/jamainternmed.2013.14387.
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Importance  Despite the documented prevalence and clinical ramifications of physician distress, few rigorous studies have tested interventions to address the problem.

Objective  To test the hypothesis that an intervention involving a facilitated physician small-group curriculum would result in improvement in well-being.

Design, Setting, and Participants  Randomized clinical trial of 74 practicing physicians in the Department of Medicine at the Mayo Clinic in Rochester, Minnesota, conducted between September 2010 and June 2012. Additional data were collected on 350 nontrial participants responding to annual surveys timed to coincide with the trial surveys.

Interventions  The intervention involved 19 biweekly facilitated physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small-group learning for 9 months. Protected time (1 hour of paid time every other week) for participants was provided by the institution.

Main Outcomes and Measures  Meaning in work, empowerment and engagement in work, burnout, symptoms of depression, quality of life, and job satisfaction assessed using validated metrics.

Results  Empowerment and engagement at work increased by 5.3 points in the intervention arm vs a 0.5-point decline in the control arm by 3 months after the study (P = .04), an improvement sustained at 12 months (+5.5 vs +1.3 points; P = .03). Rates of high depersonalization at 3 months had decreased by 15.5% in the intervention arm vs a 0.8% increase in the control arm (P = .004). This difference was also sustained at 12 months (9.6% vs 1.5% decrease; P = .02). No statistically significant differences in stress, symptoms of depression, overall quality of life, or job satisfaction were seen. In additional comparisons including the nontrial physician cohort, the proportion of participants strongly agreeing that their work was meaningful increased 6.3% in the study intervention arm but decreased 6.3% in the study control arm and 13.4% in the nonstudy cohort (P = .04). Rates of depersonalization, emotional exhaustion, and overall burnout decreased substantially in the trial intervention arm, decreased slightly in the trial control arm, and increased in the nontrial cohort (P = .03, .007, and .002 for each outcome, respectively).

Conclusions and Relevance  An intervention for physicians based on a facilitated small-group curriculum improved meaning and engagement in work and reduced depersonalization, with sustained results at 12 months after the study.

Trial Registration  clinicaltrials.gov Identifier: NCT01159977

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Figure 1.
Study Flow

Consolidated Standards of Reporting Trials diagram for participant flow through the trial.

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Figure 2.
Changes From Baseline for Nontrial Cohort vs Randomized Arms of Trial

Proportion of participants who (A) strongly agreed that work is meaningful (P = .04) and rates of (B) high emotional exhaustion (P = .007), (C) high depersonalization (P = .03), and (D) overall burnout (P = .002).

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