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

Abstract

Background Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. Objective This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. Methods This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. Results Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. Conclusions This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field.

Knowledge attainment, learning approaches, and self-perceived study burnout among European veterinary students

“…Increasing teacher interaction to support them in understanding the cumulative knowledge building in the curriculum could also benefit the students. In addition to improving the learning environment, the interventions could also be targeted to enhance the students' psychological flexibility ( 51 , 52 ), which in working life has been shown to mitigate burnout ( 53 , 54 ).…”

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

“…This provided students with the opportunity to participate in the study during the semester while reducing participation burden by ensuring that the timing of outcome measures did not correspond with critical assessment periods. This duration was considered appropriate as Levin et al [ 75 ] observed intervention effects for a similar 4-week program, and feasibility trialing of the current app demonstrated that medical students engaged most frequently during the early weeks of access [ 68 ].…”

“…The version of BiSi implemented in this study incorporated medical student feedback from a small feasibility trial of the app [ 68 ] with the aim of enhancing intervention relevance and engagement. This included clear explanations of what to expect during each stage of the intervention, providing progress indicators for all app components, providing earlier opportunities for personally relevant experiential learning and self-reflection (during stage 1), and delivering content in both written and audio formats where practical (during stage 1).…”

“…Psychological skill generalization may also be enhanced because of the accessibility of training opportunities in everyday life situations [ 67 ]. However, feasibility trials of app-based psychological interventions for medical students also indicate that maintaining engagement in this accessible medium can be challenging [ 63 , 68 ].…”