JMIR Publications

ABSTRACT

Background:

Burnout in the field of medicine is a common problem with substantial costs to individual health and healthcare service provision. Onset frequently occurs during undergraduate medical training, prompting calls for early intervention strategies training medical students in adaptive psychological skills that could support well-being and mitigate burnout risks associated with unmodifiable career stressors. Although Psychological Flexibility and Inflexibility may play a role in medical student burnout and well-being, there are no RCTs assessing interventions training these skills in this group. Previous research indicates that individual tailoring of Psychological Flexibility interventions may improve outcomes. Smartphone app–delivered interventions could facilitate individualization and accessibility, and research evaluating this mode of delivery among medical students are needed.

Objective:

This study aimed to evaluate whether a standalone app–delivered Psychological Flexibility (Acceptance and Commitment Training (ACT)) intervention would reduce burnout among medical students, and to explore potential benefits to well-being and other psychological outcomes. We aimed to assess whether an individualized version of the app would demonstrate superior benefits over a nonindividualized version.

Methods:

This study was a parallel randomized controlled trial conducted with a sample of medical students from two Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list control) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to their group allocation. The intervention included an introductory module (Stage 1) and access to short skills training activities on demand (Stage 2). Stage 2 was either individualized to meet students’ identified Psychological Flexibility training needs at each app log-in, or nonindividualized. Intervention group participants were given 5 weeks to access the app at their own pace.

Results:

The mean difference in change from baseline between intervention groups and the control group were not statistically significant for self-reported burnout outcomes; Exhaustion (primary): (individualized: –0.52, 95% CI [–3.70, 2.65], P=.748; nonindividualized: 1.60, CI [–1.84, 5.03], P=.365), Cynicism, or Academic Efficacy. Following the intervention, medical students in the individualized group demonstrated greater Psychological Flexibility, reduced Inflexibility, and reduced psychological distress (stress and depression); and students in the nonindividualized group demonstrated improved well-being and reduced stress (compared with waiting list participants). High attrition (n=75, 52%) and low adherence to the recommended level of intervention engagement (n=21, 29%) was observed.

Conclusions:

This early implementation trial provides promising support for the potential benefits of ACT training for medical student well-being and psychological outcomes, and demonstrates that Psychological Flexibility and Inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were unclear, observed improvements in stress could be indicative of early mitigation of risk. Replication studies with larger samples and longer-term follow-up are required to further evaluate the potential benefits of this intervention approach to medical students. Future research should focus on improving implementation frameworks to increase engagement and optimise individualization methods. Clinical Trial: Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx