Better Together: A Novel Online Physician Group-Coaching Program to Improve Wellbeing in Trainees

Overview: Better Together is an online physician group-coaching intervention created for trainees in medicine to improve wellbeing. Specifically, it is a multimodal program with customizable features. This study, implemented by an interdisciplinary team, used mixed methods to study the impact over time on burnout, imposter syndrome, self-compassion, and moral injury.Proposal text:

Background: In training programs, physicians experience tremendous clinical growth, however little time is dedicated to metacognition (“thinking about your thinking”), which is a necessary tool for processing experiences, forming professional identities, and creating individualized definitions of values and success. A 6-month, web-based group coaching program, "Better Together", was developed and facilitated by trained life coaches and physicians to improve wellbeing. Here, we describe both quantitively, rates of wellbeing, and qualitatively, the participant experiences with the intervention.

Methods: This is a prospective, randomized control trial of a professional coaching intervention. Female-identifying resident physicians in Graduate Medical Education at a large academic institution voluntarily enrolled in a 6-month, multi-modal, web-based group coaching program developed and facilitated by trained life coaches and physicians. All participants completed a pre-survey using validated indices to measure burnout (primary outcome) and self-compassion, moral injury and imposter syndrome (secondary outcomes). They were then randomized into either the intervention arm (6 months of coaching) or the control group (no coaching) from January-June of 2021. A post-survey mirroring the pre-survey was distributed at 6 months, and statistical analysis was performed. Then, seventeen semi-structured interviews of participants who had completed 6 months of the Better Together coaching program were conducted in June of 2021. Both inductive and deductive methods were used in collecting and analyzing the data. Rapid domain analysis was used to analyze the data as it was collected.

Results: Among the 101 residents, 6 months of professional coaching decreased emotional exhaustion in the intervention group by a mean of 3.26 points compared to an increase of 1.07 points in the control group by the end of the study (p=0.03). The intervention group experienced a significant reduction in imposter syndrome imposter syndrome compared to controls (-1.16 vs +0.11; p=0.002). Self-compassion increased in the intervention group by a mean of 5.55 points compared to a reduction of 1.32 points in the control group (p < 0.001). No statistically significant differences in depersonalization, professional accomplishment or moral injury were observed.
Three major themes emerged from the qualitative data: 1) Trainees benefitted from practicing metacognition used in coaching specifically around the sub-themes of burnout, self-compassion, imposter syndrome, and managing interpersonal relationships, 2) The sense of community and normalized experiences created among the coaching participants built rapport, trust, and a sense of belonging, and 3) Participants enjoyed the multiple modalities available for coaching. These options made the experience customizable to individual schedules, needs, personalities, and learning styles.

Conclusions: We found that professional coaching was an effective strategy to reduce emotional exhaustion and imposter phenomenon, while increasing self-compassion amongst trainees. Participants found the program contributed to improved wellbeing by using metacognition as a coping tool, and through the vulnerable shared experiences they navigated together which combated isolation and burnout. Overall, workplace wellbeing, especially in healthcare, is a human right that will better improve patient care. Therefore, this study highlights many implications for the healthcare social work profession; prominently, social workers also could benefit from a paralleled wellbeing intervention.