Burnout is a growing problem among medical students and professionals. A number of burnout interventions exist, but sadly a recent review found few successes. Clough et al. completed a comprehensive review of interventions to address stress and burnout in physicians. Unfortunately, they found low-quality research and minimal guidance from the literature. However, there are lessons to learn from their research.
Clough Bonnie A, March Sonja, Chan Raymond J, Casey Leanne M, Phillips Rachel, Ireland Michael J. Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review. Syst Rev. July 17, 2017;6. doi:10.1186/s13643-017-0526-3.
An important finding was that support-based interventions did not demonstrate benefit. Support is indeed helpful, but it doesn’t fix the problem. Given that burnout is likely due to internal and external causes, the finding is not unrealistic. To address burnout, we must address those internal and external elements.
The research also found that, for an intervention targeting factors that the individual can modify, it will need to focus on creating new learning and skills or alter existing patterns related to coping or management strategies. That’s not to say all such interventions are effective. For example, they found that existing CBT-focused intervention research impacted stress reduction as opposed to the prevention of burnout. That is, CBT is useful for reducing stress, but may not be sufficient to impact burnout.
It is disturbing that the review found an insufficient quality of research in psychosocial interventions to make clear recommendations. Despite the clear articulation of the problem and the many interventions, the science of burnout intervention is inadequate. The authors recommended more rigorous research and consistent use of standardized instruments to clarify the role of an intervention in impacting stress and burnout. Before we widely deploy solutions, we need to determine that they impact burnout.
With that in mind, other blog posts here have discussed measures that assess burnout. Without accurate measures, we cannot determine interventions with positive impact. Additionally, we have discussed the various scales and approaches to measuring burnout from a detection/screening perspective or an intervention perspective. As an example, although the Maslach Burnout Inventory is the most highly-used instrument, it has not led to clarity regarding burnout interventions; potentially due to its inability to measure short-term impact.
For this reason, we are pursuing a 4-pronged approach with our interventions.
- First, we are developing and testing useful and freely available scales to assess symptomatology associated with burnout. Existing scales were essential to start the conversation, but they are not up to the task of measuring impact in the near-term on the full range of factors associated with burnout.
- Secondly, we are conducting a thorough review of the literature and existing interventions, as seen in the blogs, to design an intervention that has the greatest chance of impacting burnout at a reasonable cost.
- Thirdly, we are designing research protocols to assess the impact of our intervention and thus guide others who seek to replicate an evaluation approach and assess their own intervention.
- Fourth, we’ve created a public ecosystem to share findings and aid discussion and collaboration and dissemination. A solution to burnout will not come from an individual or the efforts of a small group. We need an ecosystem of interested parties who seek to share and build a lasting solution.
Addressing the surrounding issues is key in overcoming burnout in medicine. In light of that, we seek to educate medical students about the issue of burnout through game-based learning. In Lift, medical students will be immersed in a virtual reality environment where they practice coping strategies to improve resilience. The Lift role-playing experience will deliver targeted, realistic narratives and hands-on scenarios to deepen medical student understanding of how to address and overcome burnout during game-play and beyond.