Table 1 Study characteristics and outcomes reported

Bird et al., 2017 [94];

USA

Prospective cohort, single-arm;

1st-year IM residents;

81 participants

Not specified

Goal setting, managing expectations, processing stressful clinical events, identifying sources of gratitude

Chief resident

60- to 90-min sessions consisting of a didactic introduction followed by small group discussion, reflection, and skill-building exercises (e.g., reflective writing)

4 sessions over one year

Pre- and post-intervention

25% (20 of 81) pre-intervention, 21% (17 of 81) post-intervention.

Connor-Davidson Resilience Scale: 72.5 + 10.2 pre-intervention vs. 68.6 + 10.1 post-intervention (p = 0.034).

Non-proprietary single item burnout measure: 1 out of 28 participants with symptoms of burnout pre-intervention vs. 8 of 25 post-intervention (p = 0.009).

84% of participants (54 of 64) stated they feel more callous toward people post-intervention vs. 59% (36 of 61) in pre-intervention (p = 0.002).

Curriculum feedback: 75% of participants (48 of 64) supported continuation of the program, 70% stated increased comfort for discussing stress and burnout, 64% reported having the necessary stress and burnout management skills.

Brennan et al., 2016 [92];

USA

Prospective cohort, single-arm;

1st-year medical students;

42 participants

Not specified

Building relaxation skills, mindfulness meditation, adaptive coping skills, balancing life and school, positive psychology, basic nutrition

Physician, psychologist, or counsellor

Each session included educational and skill building exercises. Participants were given written worksheets and volunteered personal examples for discussion. Sessions concluded with a 10 min relaxation exercise.

8 sessions over one academic year (i.e., Sept-May; 4 per semester)

Pre- and post-intervention

26% (11 of 42)

Beck Depression Inventory-II: 7.7 + 4.8 pre-intervention vs. 7.5 + 6.3 post-intervention (p > 0.05).

Beck Anxiety Inventory: 9.9 + 6.3 pre-intervention vs. 6.7 + 5.3 post-intervention (p = 0.016).

Coping Self Efficacy Scale: 164.3 + 25.2 pre-intervention vs. 182.9 + 35.8 post-intervention (p = 0.001).

Self-reported perceived relaxation: 1.6 + 0.5 pre-intervention vs. 2.5 + 0.7 post-intervention (p < 0.001).

Brennan et al., 2019 [100];

USA

Prospective cohort, double-arm (quasi experiment);

FM residents;

19:13

Not specified

Identifying personal and professional values, improving self-awareness, balancing and prioritizing professional and personal time, using values to improve time management, maintaining supportive professional and personal relationships, and learning effective relaxation strategies

Healthcare professionals

Interactive, skill-based sessions containing handouts and short didactic presentations. Sessions concluded with a skill-based exercise such as breathing awareness, mindfulness meditation, basic relaxation, imagery, or progressive relaxation.

8 h of programming over one year

Pre- and post-intervention and after 1, 2, and 3 years

1 of 19 in intervention group, 3 of 13 in control group after 1st year; 3 of 17 in intervention group after 2nd year; 0 of 8 in intervention after 3rd year.

Immediate post-intervention

Maslach Burnout Scale:

EE: 13.5 + 9.6 intervention vs. 21.4 + 12.6 control (p < 0.05);

DP: 3.4 + 3.1 intervention vs. 7.0 + 4.1 control (p < 0.05);

PA: 35.67 + 7.7 intervention vs. 33.20 + 9.0 control (p > 0.05);

Resilience: 79.06 + 10.72 intervention vs. 72.75 + 22.3 control (p > 0.05).

Professional Quality of Life Scale:

BO: 19.44 + 5.28 intervention vs. 21.8 + 7.44 control (p > 0.05);

STS: 21.61 + 5.18 intervention vs. 24.60 + 4.97 control (p > 0.05);

CS: 41.06 + 5.80 intervention vs. 39.20 + 8.56 control (p > 0.05).

1-Year follow-up (2nd year post-intervention; intervention group only)

Maslach Burnout Scale:

EE: 15.4 + 9.9 vs. 13.9 + 9.1 baseline (p > 0.05);

DP: 4.5 + 4.2 vs. 5.2 + 4.1 baseline (p > 0.05);

PA: 39.6 + 5.9 vs. 36.1 + 7.7 baseline (p > 0.05);

Resilience: 80.1 + 10.7 vs. 77.3 + 12.2 baseline (p > 0.05).

Professional Quality of Life Scale:

BO: 19.3 + 5.2 vs. 20.7 + 5.9 baseline (p > 0.05);

STS: 21.6 + 4.8 vs. 23.3 + 6.6 baseline (p > 0.05);

CS: 41.5 + 4.8 vs. 40.8 + 6.4 baseline (p > 0.05).

2-Year follow-up (3rd year post-intervention; intervention group only)

Maslach Burnout Scale:

EE: 17.5 + 11.0 vs. 13.9 + 9.1 baseline (p > 0.05);

DP: 3.5 + 3.7 vs. 5.2 + 4.1 baseline (p > 0.05);

PA: 36.8 + 8.2 vs. 36.1 + 7.7 baseline (p > 0.05);

Resilience: 82.1 + 14.9 vs. 77.3 + 12.2 baseline (p > 0.05).

Professional Quality of Life Scale:

BO: 18.0 + 6.7 vs. 20.7 + 5.9 baseline (p > 0.05);

STS: 19.5 + 5.8 vs. 23.3 + 6.6 baseline (p > 0.05);

CS: 41.9 + 5.8 vs. 40.8 + 6.4 baseline (p > 0.05).

Chaukos et al., 2018 [98];

USA

Prospective cohort, single-arm;

IM and PSYC interns;

75 participants

Stress Management and Resiliency Training Program for Residents (SMART-R)

Developing mind-body techniques, stress awareness skills, meaningful goal-setting techniques, positive perspective-taking approaches

Residents

Group sessions utilizing a resident curriculum workbook and corresponding instructor manual.

Three group-based sessions totalling 6 h over 6 months

Pre- and post-intervention

59% (44 of 75)

Maslach Burnout Inventory:

EE: 19.0 + 11.1 pre-intervention vs. 29.0 + 12.2 post-intervention (p = 0.000017);

DP: 8.9 + 6.6 pre-intervention vs. 13.5 + 7.9 post-intervention (p = 0.0000058);

PA: 37.3 + 6.3 pre-intervention vs. 36.2 + 7.0 post-intervention (p = 0.3).

Perceived Stress Scale 10-item: 15.7 + 7.0 pre-intervention vs. 17.8 + 6.3 post-intervention (p = 0.07).

PHQ-9: 3.7 + 4.9 pre-intervention vs. 7.4 + 6.0 post-intervention (p = 0.001).

FACIT: 12.0 + 9.5 pre-intervention vs. 21.9 + 12.5 post-intervention (p = 8.4 × 10^-6).

PSWQ: 48.2 + 11.7 pre-intervention vs. 45.5 + 13.5 (p = 0.25).

MOCS-A: 24.9 + 8.2 pre-intervention vs. 26.4 + 7.8 post-intervention (p = 0.184).

SEQS: 31.3 + 3.4 pre-intervention vs. 31.0 + 4.3 post-intervention (p = 0.57).

LOT-R: 16.0 + 4.24 pre-intervention vs. 15.1 + 5.3 post-intervention (p = 0.047).

CAMS-R: 31.2 + 7.0 pre-intervention vs. 30.7 + 5.8 post-intervention (p = 0.56).

IRI-PT: 17.3 + 4.3 pre-intervention vs. 18.4 + 4.2 post-intervention (p = 0.09).

Dyrbye et al., 2017 [95];

USA

Prospective cohort, single-arm;

1st-year medical students;

54 (cohort 1^a), 51 (cohort 2^a)

SMART

Developing intentional attention and awareness, positive perspective-taking approaches, compassion, personal and professional goal-setting, forgiveness skills, creating and nurturing meaningful relationships

Social worker, psychologist, physicians

Didactic teaching and facilitated small group discussion with skill-based learning (e.g., journaling, reflective exercises).

Eight group-based sessions totalling 12 h (cohort 1) or 10 h (cohort 2) over one year

Pre- and post-intervention

18.5% (10 of 54; cohort 1), 57% (29 of 51; cohort 2)

Cohort 1

Maslach Burnout Inventory: 14.6% of participants experienced burnout pre-intervention vs. 28.2% post-intervention (p = 0.11).

SF-8:

Mental QOL: 51.2 + 7.3 pre-intervention vs. 45.57 + 10.61 post-intervention (p < 0.001);

Physical QOL: 53.0 + 5.9 pre-intervention vs. 52.81 + 6.78 post-intervention (p = 0.85).

Perceived Stress Scale: 11.1 + 5.8 pre-intervention vs. 15.32 + 5.56 post-intervention (p < 0.0001).

Connor Davidson Resilience Scale: 6.7 + 1.2 pre-intervention vs. 6.2 + 1.58 post-intervention (p = 0.05).

Happiness and Gratitude Scale: 5.3 + 0.9 pre-intervention vs. 4.99 + 0.79 post-intervention (p = 0.02).

IRI:

Cognitive: 22.2 + 3.4 pre-intervention vs. 20.56 + 3.87 post-intervention (p < 0.01);

Emotive: 20.1 + 4.0 pre-intervention vs. 18.03 + 4.46 post-intervention (p < 0.01).

Cohort 2

Maslach Burnout Inventory: 17.8% of participants experienced burnout pre-intervention vs. 41.6% post-intervention (p = 0.13).

SF-8:

Mental QOL: 48.7 + 8.8 pre-intervention vs. 43.55 + 8.1 post-intervention (p = 0.015);

Physical QOL: 54.5 + 5.0 pre-intervention vs. 52.69 + 3.9 post-intervention (p = 0.14).

Perceived Stress Scale: 11.2 + 6.0 pre-intervention vs. 14.82 + 7.1 post-intervention (p < 0.003).

Connor Davidson Resilience Scale: 6.6 + 1.3 pre-intervention vs. 6.5 + 0.9 post-intervention (p = 0.79).

Happiness and Gratitude Scale: 5.3 + 1.2 pre-intervention vs. 4.9 + 0.7 post-intervention (p = 0.01).

IRI:

Cognitive: 21.9 + 3.0 pre-intervention vs. 21.0 + 3.0 post-intervention (p = 0.18);

Emotive: 21.0 + 3.6 pre-intervention vs. 20.14 + 3.4 post-intervention (0.26).

Forbes et al., 2020 [104];

Australia

Prospective cohort, double-arm (quasi experiment);

1st-year interns;

24:29

Resilience on the Run (RoR)

Understanding mindfulness and self-awareness, practical mindfulness exercises, effective and healthier interpersonal communication strategies, role-play scenarios for managing difficult work-related situations, understanding burnout and compassion fatigue and their risk factors, information to enhance peer support

Psychiatrist

90-min group sessions focusing on interactive real life scenarios with integrated mindfulness exercises.

4 sessions during second half of intern year

Pre- (T0) and post-intervention (T1) and after 3 months (T2)

4 of 24 in intervention group, 5 of 29 in control group immediately post-intervention; 4 of 24 in intervention group, 8 of 29 in control group after 3 months.

ProQOL^b:

# of participants with compassion fatigue (score < 44): 5 intervention vs. 9 control at T0; 4 vs. 7 at T1; 5 vs. 3 at T2;

# of participants with burnout (score > 56): 7 intervention vs. 5 control at T0; 5 vs. 6 at T1; 3 vs. 5 at T2;

# of participants with secondary traumatic stress (score > 56): 4 intervention vs. 7 control at T0; 4 vs. 7 at T1; 2 vs. 8 at T2.

K10^b:

T0: 19.13 intervention vs. 16.97 control;

T1: 19.2 intervention vs. 17.83 control;

T2: 19.35 intervention vs. 17.05 control.

Holtzworth-Munroe et al., 1985 [87];

USA

Randomized controlled trial;

1st and 2nd-year medical students;

20:20

Not specified

Recognizing and changing maladaptive cognitions that precipitate stressful feelings, developing meditation and progressive muscle relaxation techniques as coping mechanism.

Doctoral student in clinical psychology

1-h group sessions focusing on developing and practicing coping skills involving cognitive restructuring, meditation, and progressive muscle relaxation.

6 weekly meetings

Pre- and post-intervention and after 10 weeks

2 of 20 in intervention group, 4 of 20 in control group immediately post-intervention; 5 of 20 in intervention group, 11 in control group after 10 weeks.

Spielberger Trait Anxiety Inventory:

Post-intervention: No significant difference between intervention vs. control groups in anxiety before test, anxiety during test, general worry, nervousness, social anxiety, weekly tension, weekly depression, trait anxiety, and self-esteem;

10-week follow-up: Significant improvement for intervention group seen in anxiety before test measure (p < 0.005). No significant difference in other domains.

Non-proprietary questionnaires:

Compared to control, the intervention group reported greater awareness of their tension (p < 0.001 at post-intervention and 10-wk follow-up) and better management of school stress (p < 0.04 at post-intervention and 10-wk follow-up).

Kelly et al., 1982 [86];

USA

Prospective cohort, double-arm (quasi experiment);

1st, 2nd, 4th-Year medical students (80%), residents and nurses (20%);

34:14

Not specified

Understanding causes and consequences of stress, relaxation training (i.e., deep-muscle relaxation, relaxing imagery), priority-setting, schedule-planning, time management techniques, cognitive modification skills to decrease stress.

Clinical psychologist, psychology residents, and psychology graduate student

60- to 90-min seminar sessions with didactic presentations, scenario-based group discussions, and stress reduction exercises.

6 sessions over 3 weeks

Pre- and post-intervention

None

Stress Knowledge Inventory: 21.7 + 2.2 intervention vs. 16.6 + 2.7 control (p < 0.0001).

Jenkins Activity Schedule (for stress level):

Jenkins Type A Scale: 227.2 + 63.8 intervention vs. 252.0 + 66.6 control (NS);

Jenkins Speed/Impatience Scale: 149.6 + 50.7 intervention vs. 154.5 + 72.1 control (NS);

Jenkins Hard Driving Scale: 97.8 + 27.1 intervention vs. 116.4 + 38.3 control (p < 0.1).

Spielberger State-Trait Anxiety Inventory: 38.6 + 9.3 intervention vs. 42.8 + 8.9 control (NS).

Stressful Situations Rating: 53.3 + 18.2 intervention vs. 71.2 + 11.4 control (p < 0.005).

McCue et al., 1991 [88];

USA

Prospective cohort, double-arm (quasi experiment);

IM, IM/PEDS & PEDS residents;

43:21

Not specified

Developing interpersonal and relationship skills, task prioritization, techniques to enhance stamina and attend to self-care needs, understanding and preventing maladaptive coping responses, positive perspective taking.

Not specified

4-h group workshop with didactic lectures, group discussions, self-reflection, videotaped vignettes to stimulate discussion on coping under stressful situations, role-playing, experiential exercises.

One time

Pre- and post-intervention after 6 weeks

None

ESSI Stress Systems Instrument: Composite mean score increased from 16.67 at baseline to 17.94 at 6 wks after workshop for intervention group vs. 16.72 to 16.07 for control group (p < 0.001). Significant improvement seen in self-care (p < 0.05), support seeking (p < 0.01), behavioural stress symptoms (p < 0.01), and emotional stress symptoms (p < 0.05).

Maslach Burnout Scale (reported in net change):

EE: 1.23 intervention vs. -3.38 control;

DP: -0.26 intervention vs. -1.09 control;

PA: -0.58 intervention vs. -0.57 control.

Orr et al., 2019 [101];

USA

Prospective cohort, single-arm;

IM residents;

17 participants

Fostering Resilience through Art in Medical Education (FRAME)

Increasing awareness of the importance of thoughtful and flexible thinking, practicing relational communication skills, identifying difficult or stressful aspects of work, reflecting on important, meaningful, or satisfying aspects of work.

Art museum instructors, IM faculty facilitators

4-h workshop with interactive activities involving artwork at the Philadelphia Museum of Art. After each activity, participants reflect on how the experience can be applied to medical or clinical environment.

One time

Pre- and post-intervention and after 3 months

0 of 17 in intervention group post-intervention; 9 of 17 in intervention group after 3 months.

Maslach Burnout Scale:

EE: 3.75 + 1.39 pre-intervention vs. 3.00 + 1.72 post-intervention (at 3 mo);

DP: 3.49 + 1.80 pre-intervention vs. 2.70 + 1.94 post-intervention (at 3 mo);

PA: 4.77 + 1.00 pre-intervention vs. 5.15 + 0.92 post-intervention (at 3 mo).

Peng et al., 2014 [90];

China

Prospective cohort, double-arm (quasi experiment);

Medical students (year not specified);

30:30

Penn Resilience Program (PRP)

Connecting thoughts and emotions, challenging irrational thoughts and beliefs, cognitive training, self-confidence and interpersonal communication, coping strategies, behavior modification exercises and problem-solving exercises

Not specified

90 to 120-min group sessions involving discussion and experience sharing among participants. Minimal didactic portion.

10 weekly sessions

Pre- and post-intervention

None

High-Resilience group: The positive emotion scores significantly increased, total negative emotion and expression suppression scores decreased significantly after training.

Low-Resilience group: Resilience, positive emotion and cognitive appraisal scores increased significantly, their negative emotion and expression suppression decreased significantly after training.

Follow-up interviews: 90% reported reduced negative emotions and increased positive emotions. 87% showed that they had learned different coping strategies for various complicated situations.

Pereira et al., 2015 [91];

Brazil

Prospective cohort, single-arm;

2nd, 3rd, 4th year medical students;

76 participants

Strategies of Coping with Professional Stress

Understanding stress and coping strategies, course-related stressors, psychological distress, concept of quality of life, stress coping strategies, medical career, personality and resilience, ego defence mechanisms, work psychodynamics and cognitive restructuring.

Professors/Researchers

Mix of didactic presentations and activity-based sessions. Sessions incorporated Jacobson’s progressive relaxation practice.

Fortnightly for 4 months

Pre- and post-intervention

None

45% were able to better manage their time, 57% better able to communicate and express themselves and 76% pay more attention to their feelings after taking course. 68% were more assertive in their friend and family relationships and 75% respected people and the differences between people more than before the elective. 66% had better nutrition, 83% increased self-reflection and reflection of their desires, 50-60% were more tolerant of frustration, limitations and of others. 67% reported less stress symptoms, 76% incorporated new coping strategies and 26% saw challenges in a more positive light, leading to less stress.

Riall et al., 2018 [99];

USA

Prospective cohort, single-arm;

1st-5th year surgery residents;

49 participants

Energy Leadership Well-Being and Resiliency Program

Energy Leadership, team building, communication, work-life integration, goal setting, empathy, strategic diet and exercise, posture for the surgeon/ergonomics, stress-reduction techniques and mindfulness/meditation.

Not Specified

Activity-based group experiential workshops

Monthly over the course of one year

Pre- and post-intervention

1/49 (ELI),

9/49 (Beck Depression Inventory and Perceived Stress Scale), 10/49 (Maslach Burnout Inventory), 8/49 (PWBI).

ELI: 3.16 + 0.24 pre-intervention vs. 3.24 + 0.32 post-intervention (p = 0.03).

Perceived Stress Scale: 17.0 + 7.2 pre-intervention vs. 15.7 + 6.2 post-intervention (p = 0.05).

Beck Depression Inventory: 7.43 + 7.9 pre-intervention vs. 3.24 + 0.32 post-intervention (p = 0.03).

Maslach Burnout Inventory:

EE: 16.8 + 8.4 pre-intervention vs. 14.4 + 8.5 post-intervention (p = 0.04);

Professional efficacy: 27.8 + 6.9 pre-intervention vs. 29.8 + 5.9 post-intervention (p = 0.09);

Cynicism: 10.31 + 7.9 pre-intervention vs. 12.0 + 8.6 post-intervention (p = 0.21).

PWBI: 3.2 + 0.24 pre-intervention vs. 3.2 + 0.32 post-intervention (p = 0.77).

Rogers et al., 2016 [93];

South Africa

Prospective cohort, single-arm;Final-year BCMP students;

62 participants

Educational Interventions to Enhance Personal Resilience

Understanding the importance of resilience for healthcare professionals.

Not specified

90-min workshop with a mix of didactic teaching, multimedia presentation, small group discussion and problem-solving, and reflection.

One time

Pre- and post-intervention after 8 weeks

31% (19 of 62)

Connor-Davidson Resilience Scale: 77.37 (95% CI 75.53-79.81) pre-intervention vs. 74.12 (95% CI = 70.79-77.45) post-intervention (p = 0.38).

Runyan et al., 2016 [57];

USA

Prospective cohort, single-arm;

2nd-year FM residents;

12 participants

Physician as Leader

Understanding mindfulness and its relevance in physician wellness and patient outcomes, mental focusing strategies, increasing self-awareness, identifying personal values, developing narrative/appreciative thinking and personal tools for maintaining resiliency, preventing burnout and enhancing empathic capacity.

Behavioural science faculty member

2 h session with a mix of didactic lectures, multimedia presentations, reflective-writing exercising/journaling, worksheets activities, meditation exercises, and group discussion

4 weekly sessions

Pre- and post-intervention after 3 months

3 of 12 in pre-intervention, 0 of 12 in post-intervention

Self-Compassion Scale:

Self-kindness: 5.67 + 1.66 pre-intervention vs. 6.56 + 0.73 post-intervention;

Self-judgment: 6.22 + 2.17 pre-intervention vs. 5.33 + 0.87 post-intervention;

Common humanities: 5.89 + 1.36 pre-intervention vs. 6.56 + 1.88 post-intervention;

Isolation: 6.11 + 1.62 pre-intervention vs. 6.67 + 1.73 post-intervention;

Mindfulness: 6.67 + 1.73 pre-intervention vs. 8.11 + 1.69 post-intervention;

Over-identified: 4.78 + 2.17 pre-intervention vs. 5.44 + 1.51 post-intervention;

Overall self-compassion: 35.33 + 6.23 pre-intervention vs. 38.67 + 4.82 post-intervention.

Maslach Burnout Inventory:

EE: 20.44 + 9.36 pre-intervention vs. 18.00 + 9.88 post-intervention;

Professional efficacy: 24.78 + 7.68 pre-intervention vs. 26.89 + 4.29 post-intervention;

Cynicism: 15.67 + 8.94 pre-intervention vs. 15.33 + 8.07 post-intervention.

Perceived Stress Scale: 18.11 + 6.70 pre-intervention vs. 14.78 + 7.05 post-intervention.

Jefferson Empathy Scale: 110.56 + 18.30 pre-intervention vs. 122.11 + 5.49 post-intervention.

Saadat et al., 2012 [89];

USA

Randomized control trial;

1st-3rd year Anesthesiology residents;

20:20:20, each in Wellness Intervention Group (WIG), No-treatment control group with release time (NTC-RT), and No-treatment control group with routine duties (NTC-RD).

Coping with Work and Family Stress

Identifying stressful situations, practicing effective problem-solving and communication skills, modifying cognitive and appraisal processes, stress management, preventing avoidance coping mechanisms.

Not Specified

1.5-h sessions incorporating didactic learning materials, group discussions, self-reflection and stress management exercises.

16 weekly sessions

Pre- and post-intervention

1 of 20 in WIG; 1 of 20 in NTC-RD group.

WIG vs. NTC-RD: Significant decrease in perceived stress and anxiety, significant increase in problem solving and social support from work. Near-significant decrease in perceived stress as a spouse/partner, avoidance, somatic symptoms and depression for the WIG group compared to the NTC-RD group.

NTC-RT vs WIG: Significant increase in social support from work. Near-significant decrease in total alcohol consumption and avoidance for the WIG group compared to the NTC-RD group.

NTC-RD vs NTC-RT: Significant increase in problem solving. Near-significant decrease in somatic symptoms and perceived stress as a parent for the NTC-RT group compared to the NTC-RD group.

Saint Martin et al., 2019 [102];

USA

Prospective cohort, single-arm;

1st-4th year Pathology residents;

17 participants

Not specified

To gain knowledge on stress management and burnout in health care, and improve self-care, group care, and patient care.

Faculty wellness advisor

60-min wellness talk sessions involving self-reflection, didactic presentations, team building activities, discussing stressful situations and encounters with patients or faculty members, and mindfulness exercises.

12 monthly sessions

Pre- and post-intervention

24% (4 of 17)

54% reported increased knowledge about causes of burnout, and improvement by 114, 144, and 166% was seen in knowledge of personal, group, and institutional resources, respectively. Significant (p = 0.00001) improvement in personal wellness knowledge.

Shapiro et al., 2019 [103];

USA

Prospective cohort, single-arm;

IM Residents;

258 participants

Call to Wellness spiritual care curriculum

To build resilience and promote well-being among physician trainees, understand depression and burnout, and provide resources and support.

Representatives from Hospital Spiritual Care (HSC), including a chaplain and spiritual care staff.

60-min individual or group session with HSC representatives where participants openly discussed religious, cultural, and/or spiritual beliefs. Sessions also focused on resident stressors, resources for coping, and building resilience

One time

Pre- and post-intervention

None

Pre-intervention: 24% rated their overall well-being as negative, 51% as neutral, 25% as slightly positive, positive or very positive.

Post-intervention: 24% rated their overall well-being as negative, 25% as neutral, 51% as slightly positive, positive or very positive (p < 0.001).

Slavin et al., 2017 [96];

USA

Prospective cohort, double-arm (quasi-experiment);

1st-year Pediatric residents;

17:18

Not specified

Managing stress and finding meaning, learning resilience topics and tools, developing effective communication skills, learning how to better cope with stresses inherent in residency, and enhancing interactions with residency program leadership.

Medical faculty members

2-h group workshop involving didactic teaching followed by individual session with a faculty member on the topic of communication with colleagues and staff. A third faculty member met with the chief residents and residency directors regularly (approx 1/month with follow up by email) to try to help them reduce unnecessary stressors and enhance communication with residents.

One-time workshop and 1 h session every month or every other month

Pre- and post-intervention

None

Maslach Burnout Inventory:

EE: 21.8 + 8.1 intervention vs. 29.6 + 9.3 control (p < 0.05);

DP: 6.4 + 3.9 intervention vs. 10.2 + 4.2 control (p < 0.01).

State-Trait Anxiety Inventory: 42.8 + 6.7 intervention vs. 50.8 + 8.3 control (p < 0.01).

Center for Epidemiologic Studies Depression Scale: 13.9 + 9.7 intervention vs. 21.2 + 12.8 control (p = 0.07)

Song et al., 2020 [105];

USA

Prospective cohort, single-arm;

Surgery residents;

25 participants

Not Specified

To help participants improve resilience, well-being, and engagement at work, while reducing burnout.

Professional resilience coach

2 h group workshop followed by regular 1 h individual coaching sessions catered to each intern’s needs.

One group workshop and 8 individual coaching sessions across academic year.

Pre- and post-intervention

All participants completed the quantitative assessments. 9/25 did not participate in semi-structured interviews.

Brief Resilience Scale: 3.8 + 0.8 pre-intervention vs. 4.2 + 0.7 post-intervention (p = 0.002).

Abbreviated Maslach Burnout Inventory: No significant changes in the AMI scores or the proportion of interns at risk of burnout before (60%) and after (52%) coaching (p = 078).

Scale of Positive and Negative Experience: 6.7 + 8.2 pre-intervention vs. 8.4 + 8.3 post-intervention (p = 0.14).

Tucker et al., 2017 [97];

Canada

Prospective cohort, single-arm;

3rd-year medical students;

165 participants

Compassion Fatigue Program

To provide students an opportunity to self-reflect and understand ways of recognizing and reducing compassion fatigue and burnout.

Trained compassion fatigue educators

Group workshop incorporating didactic learning material, self-reflection and assessment exercises, and burnout and compassion fatigue reduction exercises.

One workshop

Pre-intervention (August); Time 2 (January); Time 3 (April)

106/165 pre-intervention, 147/165 at Time 2; 133/165 at Time 3

ProQOL:

Compassion satisfaction: 39.96 (95% CI 38.63-41.29) baseline vs. 39.39 (37.11-41.67) Time 2 vs. 34.84 (33.13-36.55) Time 3 (p < 0.05);

Burnout: 22.07 (20.81-23.34) baseline vs. 23.67 (21.47-25.85) Time 2 vs. 26.31 (24.67-27.95) Time 3 (p < 0.05);

Secondary Traumatic Stress: 20.37 (18.85-21.88) baseline vs. 21.06 (18.47-23.64) Time 2 vs. 20.75 (18.81-22.69) Time 3.