Effect of a Novel Mindfulness Curriculum on Burnout During Pediatric Internship: A Cluster Randomized Clinical Trial

Author: Yarden S Fraiman1,2,3, Christine C Cheston4, Howard J Cabral5, Celeste Allen6, Andrea G Asnes7, Jefferson T Barrett8,9,10, Maneesh Batra11, William Bernstein12, Tammy Bleeker13, Pam M Dietz14, Joanna Lewis15, Su-Ting T Li16, T Marsha Ma17, John D Mahan18, Catherine D Michelson4, Sue E Poynter19, Mark A Vining20, Katherine Watson21, Colin M Sox4
1 Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
2 Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
3 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
4 Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
5 Deparment of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
6 University of California, San Francisco Benioff Children's Hospital Oakland, Oakland.
7 Yale-New Haven Hospital, New Haven, Connecticut.
8 Floating Hospital for Children-Tufts Medical Center, Boston, Massachusetts.
9 Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
10 Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, New York.
11 Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle.
12 Department of Pediatrics, Saint Peter's University Hospital, New Brunswick, New Jersey.
13 Department of Pediatrics, University of Florida, Gainesville.
14 Department of Pediatrics, Maine Medical Center, Portland, Maine.
15 Department of Pediatrics, Advocate Children's Hospital, Park Ridge, Illinois.
16 Department of Pediatrics, University of California, Davis, Sacramento.
17 Pediatric Cardiology, Loyola Medicine, Maywood, Illinois.
18 Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, Ohio.
19 Division of Critical Care, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio.
20 Department of Pediatrics, University of Massachusetts Medical School, Worcester.
21 Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Conference/Journal: JAMA Pediatr
Date published: 2022 Jan 24
Other: Special Notes: doi: 10.1001/jamapediatrics.2021.5740. , Word Count: 334

Mindfulness curricula can improve physician burnout, but implementation during residency presents challenges.

To examine whether a novel mindfulness curriculum implemented in the first 6 months of internship reduces burnout.

Design, setting, and participants:
This pragmatic, multicenter, stratified cluster randomized clinical trial of a mindfulness curriculum randomized 340 pediatric interns to the intervention or control arm within program pairs generated based on program size and region. Fifteen US pediatric training programs participated from June 14, 2017, to February 28, 2019.

The intervention included 7 hour-long sessions of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) and a monthly mindfulness refresher implemented during internship. The active control arm included monthly 1-hour social lunches.

Main outcomes and measures:
The primary outcome was emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale (range, 7-63; higher scores correspond to greater perceived burnout). Secondary outcomes were depersonalization, personal accomplishment, and burnout. The study assessed mindfulness with the Five Facet Mindfulness Questionnaire and empathy with the Interpersonal Reactivity Index subscales of perspective taking and empathetic concern. Surveys were implemented at baseline, month 6, and month 15.

Of the 365 interns invited to participate, 340 (93.2%; 255 [75.0%] female; 51 [15.0%] 30 years or older) completed surveys at baseline; 273 (74.8%) also participated at month 6 and 195 (53.4%) at month 15. Participants included 194 (57.1%) in the Mindfulness Intervention for New Interns and 146 (42.9%) in the control arm. Analyses were adjusted for baseline outcome measures. Both arms' EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses (6 months: 35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21; 15 months: 33.8 vs 32.9; adjusted difference, 1.42; 95% CI, -2.42 to 5.27). None of the 6 secondary outcomes significantly differed by arm at month 6 or month 15.

Conclusions and relevance:
A novel mindfulness curriculum did not significantly affect EE, burnout, empathy, or mindfulness immediately or 9 months after curriculum implementation. These findings diverge from prior nonrandomized studies of mindfulness interventions, emphasizing the importance of rigorous study design and suggesting that additional study is needed to develop evidence-based methods to reduce trainee burnout.

Trial registration:
ClinicalTrials.gov Identifier: NCT03148626.

PMID: 35072694 DOI: 10.1001/jamapediatrics.2021.5740