Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial

Abstract

Background Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches. Objective This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated. Methods In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants’ identified PF training needs at each log-in or nonindividualized. Results Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group. Conclusions The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. Trial Registration Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/32992

Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study

“…We aimed to recruit approximately 10 to 15 participants, consistent with sample size recommendations for feasibility studies [ 35 ]. As the app had not been trialed previously, we limited the number of participants to allow for a smaller-scale, detailed end-user evaluation before broader implementation in a planned larger efficacy trial [ 57 ]. Recruitment occurred over a 3-week period in June 2021.…”

“…In the planned efficacy trial, we aim to explore whether engagement with the intervention app improves medical students’ Psychological Flexibility and Inflexibility and evaluate whether changes in these processes mediate burnout and well-being outcomes [ 57 ]. As there is growing evidence that Psychological Flexibility and Inflexibility are “conceptually distinct” processes that can exert independent effects on outcomes and may respond differently to interventions [ 54 , 55 ], we selected the Multidimensional Psychological Flexibility Index-Short Form [ 54 ], which assesses Psychological Flexibility and Inflexibility as separate processes rather than as a single dimension [ 55 ].…”

Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial

“…Sustain it.”) created for this study. A more detailed protocol for this study is available elsewhere [ 79 ]. BiSi was developed by clinical psychologists (ED and BK) with extensive experience in the psychological flexibility model and involved the adaptation of existing ACT concepts and training activities to suit the app-based context and target participant group.…”