Original Research

An Interprofessional Group Intervention to Promote

Faculty Well-Being: A Randomized Clinical Trial
Susan R. Hata, MD; Lori R. Berkowitz, MD; Kaitlyn James, PhD; Arabella L. Simpkin, MD, MMSc

Introduction: To evaluate the effect on engagement, relational connection, and burnout of an intervention involving clinical faculty
meeting in interprofessional self-facilitated groups and to determine whether a written discussion guide is necessary to achieve
benefit.
Methods: This is a randomized controlled trial, conducted at a large US academic medical center from May to August 2018.
Subjects included 25 clinical physicians, nurse practitioners, and certified nurse midwives. The intervention involved three monthly
Downloaded from http://journals.lww.com/jcehp by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 05/09/2022

self-facilitated groups for faculty. Groups were randomized to have no discussion guide, or to receive a one-page guide. Outcomes
of burnout, engagement, and empowerment in work, and stress from uncertainty were assessed using validated metrics.
Results: Rates of emotional exhaustion and depersonalization decreased significantly over the course of the 3-month study
(56%–36%; P < .001; and 20%–15%; P = .006) and overall burnout decreased from 56% to 41% of faculty (P = .002). The
percentage of faculty who felt engaged in their work increased from 80% to 96% (P = .03). No statistically significant differences in
empowerment at work or in reaction to uncertainty were seen. The groups without a discussion guide had equivalent outcomes
and benefits. Cost per participant was under $100.
Discussion: A three-month, low-cost, self-facilitated series of dinner meetings for interprofessional clinical faculty decreased
burnout and improved engagement, sense of connection to colleagues, and sense of departmental commitment to well-being.
Structured discussion guides were not necessary to achieve benefit. This study broadens the possibilities for cost-effective
opportunities to transform institutional culture and effectively enhance faculty well-being.
Keywords: burnout, interprofessional, well-being, resilience, faculty groups
DOI: 10.1097/CEH.0000000000000404

P rofessional burnout is a critical issue affecting the health

care environment with numerous adverse consequences
to quality and safety, faculty well-being, and patient satis-
for accelerating burnout,6–9 together with a lack of feeling
valued and respected.10 The consequences of burnout in health
care professionals are wide-reaching: from increased rates of
faction.1–10 Many research studies have explored the drivers of depression and suicide11–15 and decreased patient safety,16–22
burnout, drawing attention to distress caused by uncer- to increased health care costs through loss in productivity and
tainty,1–3 and the consequences of reduced relational con- turnover of staff, with recent estimates of the organizational
nection with patients and colleagues because of increased time cost to replace a physician in the realm of $500,000 to
spent on administrative tasks.4,5 Studies also cite increasing $1,000,000.23–26
bureaucracy, loss of autonomy, organizational culture, and Despite the widespread awareness of the dangers of burnout,
increased medical-malpractice litigation as potential reasons interventions that are effective, evidence-based, sustainable,

Disclosures: The authors declare no conflict of interest. S.H., A.S.B., and L.B. contributed significantly to the conception and design of the work. S.H., A.S.B., L.B., and K.J.
contributed significantly to data collection, analysis, and interpretation of the work. All authors were involved in the drafting and revision of the work for important intellectual
content and approved the final version of the manuscript before publication. S.H. and A.S.B. are the manuscript’s guarantors. The corresponding author attests that all listed
authors meet authorship criteria and that no others meeting the criteria have been omitted. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/
coi_disclosure.pdf and declare: all authors had financial support from Massachusetts General Hospital for the submitted work; no financial relationships with any organizations
that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Transparency declaration: S.H. and A.S.B. affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects
of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. All authors had full access to all the
data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Supported by The Eric M. Mindich Research Fund for the Foundations of Human Behavior, Agreement number 2017D009430.
Trail Registration: Clinicaltrials.gov Registration number: NCT04305886.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the
journal’s Web site (http://www.jcehp.org).
Dr. Hata: Assistant Professor, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, Department of Medicine, Massachusetts
General Hospital, Boston, MA, and Harvard Medical School, Boston, MA. Dr. Berkowitz: Harvard Medical School, Boston, MA and Vice Chair of Education and Wellness,
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA. Dr. James: Epidemiologist, Department of Obstetrics and Gynecology,
Massachusetts General Hospital, Boston, MA. Dr. Simpkin: Assistant Professor, Department of Medicine, Massachusetts General Hospital, Boston, MA, Harvard Medical
School, Boston, MA, and Department of Pharmacology, University of Oxford, Oxford, United Kingdom.
Correspondence: Susan R. Hata, MD, Massachusetts General Hospital, Back Bay Health Center, 388 Commonwealth Ave, Boston, MA 02215; e-mail: shata@mgh.
harvard.edu.
Copyright ª 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing
Medical Education

JCEHP n Winter 2022 n Volume 42 n Number 1 www.jcehp.org e75

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
e76 JCEHP n Winter 2022 n Volume 42 n Number 1 www.jcehp.org

scalable, and applicable to the interprofessional environment, In light of the impact of faculty burnout, and the limita-
are elusive. The strategies that have been shown to be effective tions of current interventions, proactive strategies are needed
are limited in three key ways. First, many of the practices that that transform institutional culture, have realistic time and
have emerged as evidence-based solutions, such as stress man- cost footprints, and include the full community of health care
agement training, self-care behaviors, and mindfulness tech- clinicians. We present the results of a randomized clinical
niques,27–32 may be limited in efficacy by focusing on the trial evaluating a departmental intervention to decrease
behavior of individual faculty. Framing burnout as an indi- burnout, increase relational connection, and enhance
vidual problem, with solutions to be implemented by individual engagement for interprofessional clinical faculty. Table 1
faculty, may unintentionally exacerbate the problem by outlines the rationale for the design of the intervention,
absolving institutions from the responsibility to change the building on limitations of previous initiatives and gaps in the
systemic factors that contribute to burnout.9,33 Second, studies literature. It has been shown that creating a social culture
show that feeling valued and respected is significantly associ- where faculty feel supported and cared about by the
ated with job satisfaction10 and that promoting a culture that department is significantly associated with increased satis-
encourages vulnerability and sharing of uncertainty and con- faction at work20 and this influenced our decision to host
cerns is important32; but there are significant barriers to this in dinner meetings. Our primary aim was to determine whether
health care.33 One study in internal medicine physicians dem- well-being is enhanced in a setting of self-facilitated, inter-
onstrated that strengthening connections between colleagues professional groups meeting regularly for three months, and
increased empowerment and a sense of meaning at work, while our secondary aim was to determine whether a series of
reducing depersonalization34,42,45 In that intervention, physi- written discussion guides were necessary to achieve benefit.
cians met fortnightly for 9 months in small groups with a We hypothesized that increased relational connections
trained facilitator discussing topics related to well-being. between faculty would build trust and community at work
Although interventions such as this go beyond individual and result in measurable reductions in burnout, with an
practices and invest in a broader sense of community among increased sense of professional satisfaction and support from
faculty, the costs of trained facilitators, and long-term com- their department.
mitments may pose challenges with regard to sustainability.
Third, most studies of well-being interventions in health care
MATERIALS AND METHODS
have tended to focus on faculty who share the same professional
role, such as physicians-only or nurses-only, rather than Study Design, Setting, and Participants
studying the inclusive interprofessional groups that make up the We conducted a single-center randomized trial of obstetric
departments in most academic medical centers, in which phy- and gynecology (ob-gyn) faculty at a large US academic
sicians, nurse practitioners, and other advanced practice pro- medical center, the Massachusetts General Hospital. Data
viders work collegially together.10,35,36 There are many benefits were collected between May and August 2018. Clinical
of interprofessional education and team-based collaborative workload in these months is typically high and represents an
practice;37,38 the literature is lacking in evidence-based inter- educationally challenging time of year as the new academic
professional interventions that enhance workplace engagement year begins in late June, with a new group of residents and
and reduce burnout for these faculty. fellows to supervise. The study was open to all faculty in the

TABLE 1.
Rationale for Features of the Interprofessional Intervention Designed for This Study
Strategy Rationale
Self-facilitated Prevents need for trained facilitators, which can be both costly and hard to find, limiting scalability and sustainability.45
Interventions that engage faculty in their process may heighten their sense of control and engagement, which may be expected to effectively reduce
burnout.48
Interprofessional Most studies to date have focused on faculty who share the same professional role, rather than studying the inclusive interprofessional groups that make up
most academic departments.11,15,16 As we move toward more collaborative practice and interprofessional education, efforts in the wellbeing space should
match this format.
Three-mo time period Long-term commitments can pose challenges regarding feasibility, sustainability, and cost.36
Group meetings at work Moves away from concept of burnout as an individual problem to be addressed in faculty’s personal time to a team-based and organizationally embedded
strategy which is more likely to have longevity and sustainability.41,42,49
Dinner provided Creating a social culture where faculty feel supported and cared about by the department has been shown to be significantly associated with increased
satisfaction at work.11
Structured discussion In other studies that show benefit from group discussion meetings, it is unclear whether the benefit that results is from simply bringing people together, or
guide whether a structured discussion guide that addresses themes relevant to challenges in the health care environment enhances group bonding. Strategies
that foster communication between members of the health care team, cultivating a sense of community tend to be most effective in reducing burnout,50
and as loss of meaning from work is a common driver of burnout, explicit discussion around this may be an effective solution.
We designed this aspect of the study as a randomized controlled trial, which is a rigorous study design rarely reported in the well-being literature.36 The
control group had no guide; the intervention group had a structured discussion guide

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
Interprofessional Groups Promote Well-being Hata et al. e77

department. Participants were recruited through electronic Data Collection

departmental communications, and announcements at Participants in both arms of the study completed a short 5-
departmental meetings. Participants provided written minute online survey that included several validated instru-
informed consent and precautions were taken to ensure the ments, including burnout, stress from uncertainty, work
confidentiality of participants from other faculty in the engagement, and work empowerment, together with questions
department and department leaders, to prevent faculty from relating to their perception and experience of well-being ini-
any pressure to participate or not participate from depart- tiatives in the ob-gyn department. Demographic characteristics
ment leaders or peers. One of the authors (L.B.) is the were also collected, together with information on length of
department wellness champion and works with the partici- practice and years at the institution. The secure, web-based
pants as a fellow faculty member, so this author was blinded application, Research Electronic Data Capture (REDcap), was
to the identity of the participants throughout the duration of used to manage survey distribution and collect responses.39
the study. All data used were strictly anonymized; only a Each participant received an individualized link to the survey.
research coordinator, who was not involved in this study, The initial email was sent a few days before the first dinner, with
had access to the file linking responses with identifiers. The reminders sent to non-respondents. The 3-month survey was
study was approved by the Partners Institutional Review sent a few days after the final dinner, approximately 8 to 10
Board (Protocol Number 2018P000415). weeks from the baseline survey. Again, reminders were sent to
nonrespondents. The final survey included additional questions
Randomization, Allocation Concealment, and Evaluation about satisfaction with the groups, likelihood of future partic-
Participants were randomized in a concealed fashion into ipation or recommending the groups to others, and ideas for
control or intervention group via a computer-generated algo- future topics to discuss. Participants in the intervention arm
rithm that factored in their schedule availability. Participants were asked for thoughts on the discussion guides. Questions of
were surveyed at baseline and at the end of the 3-month study gradation were rated on a 5-point Likert scale. Participants
period. Participants were aware that the groups were part of a were included in the data analysis if they attended at least two
departmental wellness initiative, but were not informed of the dinners.
hypotheses of the study. Following the completion of the dinners and the final survey,
all study subjects were invited to participate in an optional focus
Study Arms group about their experience in the study. Feedback about use
Volunteers in both arms of the trial were invited to three din- of the discussion guides and content of the discussion guides
ners, spaced approximately one month apart. Participants was elicited in that focus group, and control subjects who were
randomized to the intervention group were given a one-page not offered a discussion guide were invited to share themes
discussion guide and self-facilitated their discussion over din- discussed in their groups. Focus group moderators used a semi-
ner. There was no prework required and groups were free to use structured interview guide, developed through expert investi-
the guide as much or as little as they wished. The participants gator consensus, to elicit faculty responses and ensure broad
within each arm were randomly divided into small groups (6–8 exploration of the experiences in the groups. The focus groups
interprofessional participants in each) with similar composi- occurred in a private conference room and were audiotaped and
tions. The one-page discussion guides each addressed one theme transcribed verbatim by a professional transcription service. All
chosen through expert consensus and literature review. The individuals were de-identified. The transcripts were analyzed
topics for the three discussion guides were (in order): using a qualitative general inductive approach in an iterative
“Reframing Challenging Patient Interactions”; “Embracing coding process described by Strauss and Corbin40 to identify
Uncertainty in Our Work”; and “Coping with Errors, Near themes in faculty experiences. Investigators met to discuss,
Misses, and Bad Outcomes” (see Supplementary Material, clarify, and refine themes until thematic saturation was reached
http://links.lww.com/JCEHP/A150, http://links.lww.com/ and all data within the transcripts was fully described and
JCEHP/A151, http://links.lww.com/JCEHP/A152). Each categorized.41 The results of this focus group will be discussed in
guide followed the same general structure: (1) introductory more detail in a future paper.
check-in; (2) brief explanation of the topic; (3) discussion
prompts to guide conversation; (4) closing time for reflection; Outcome Measures
and (5) resources for further reading if interested. The 11 par- To determine stress from uncertainty, we used the Physicians’
ticipants randomized to the control group were also randomly Reaction to Uncertainty Scale, developed by Gerrity et al,42
divided into small groups (5–6 interprofessional participants in which measures affective reactions to uncertainty in clinical
each) and were not given a discussion guide or any other situations. The items are rated on a 6-point Likert-type scale.
instructions about what to discuss during the dinner session, The subscales are scored so that higher values indicate more
being aware only that this initiative was organized as a well- stress from uncertainty.
being activity and that they were free to discuss anything they We used single item measures of emotional exhaustion and
liked. depersonalization from the Maslach Burnout Inventory to
All groups conducted their first and third dinner in a con- assess the prevalence of burnout. Although the 22-item Mas-
ference room at the hospital, with catered food, with their lach Burnout Inventory is the criterion standard in medical
second dinner held in a local restaurant. Groups were not given research literature for the assessment of burnout,43 its length
a time limit for the duration of their dinner, and sessions ranged limits feasibility for use in surveys and we therefore chose to use
between one to 2 hours. The cost per faculty member per the two single-item measures. Emotional exhaustion was
dinner was $29.40 (total cost per faculty member of under $90 assessed by the statement “I feel burned out from my work” and
for the intervention), and the department covered this cost. depersonalization by the statement “I’ve become more callous

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
e78 JCEHP n Winter 2022 n Volume 42 n Number 1 www.jcehp.org

toward people since I took this job.” Each question was cussion guide randomization group was also performed. To
answered on a 7-point Likert-type scale with response options evaluate associations between burnout, work engagement,
ranging from never to daily. These two items have been shown work empowerment, and stress from uncertainty, we con-
to stratify risk of burnout in physicians and medical stu- ducted a series of bivariate analyses assessing for confounders
dents.44,45 Consistent with previous literature,43,44,46 partici- with the dependent variable by means of t-tests or one-way
pants indicating that they experienced symptoms in either analysis of variance for continuous variables and Pearson Chi-
domain at least weekly were considered to meet the criteria for square tests for categoric variables. All tests were two sided,
high burnout. In light of the debate of how to quantify burnout, with a type 1 error level of .05. All statistical analyses were
with several authors emphasizing that the burnout score should performed with the use of commercially available statistical
be seen as a continuous measure of increasing levels of pro- software (Stata version 14.0; College Station, TX: StataCorp
fessional stress as opposed to a dichotomous measure,47,48 we LP).
also report the continuous burnout score.
We used the Utrecht Work Engagement Scale to measure
RESULTS
work engagement—a positive work-related state of fulfillment
that is characterized by vigor, dedication, and absorption49 (a Sample Characteristics and Baseline Measures
total of 9 items on a 7-item Likert scale ranging from never to Twenty-five of 99 eligible faculty members volunteered to par-
daily; range 0–54). The Empowerment at Work Scale (a total of ticipate, attended at least two dinners, and were randomized
12 items on a 7-item Likert scale ranging from strongly disagree equally to the two arms of the intervention study (Figure 1).
to strongly agree; range, 12–84) was used to measure empow- Baseline characteristics and composition of study participants
erment and meaning at work.50 were similar to the characteristics and composition of the
department with no statistically significant differences observed
Statistical Analysis (Table 2). The majority were female (mirroring the composition
Standard descriptive statistics were used to characterize the of the ob-gyn department) and had been in practice for more than
sample. To evaluate changes in burnout, work engagement, 20 years. Of the study participants, 19 were physicians (76%),
work empowerment, and stress from uncertainty, scores were and 6 were certified nurse midwives or nurse practitioners
compared between the baseline and 3-month surveys using (24%). The baseline burnout rate of our study participants
paired t-tests for continuous variables and Pearson chi-square (56%) was similar to the rate of burnout found in an internal
tests for categoric variables; additional stratification by dis- survey of all physicians in this department in 2017 (59%).

FIGURE 1. Study flow.

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
Interprofessional Groups Promote Well-being Hata et al. e79

Table 2.
Baseline Demographic Characteristics of Randomized Arms of the Study
Control Arm, No Curriculum Intervention Arm, Curriculum
Variable Metric (Scale) (n = 11) (n = 14)
Sex, no. (%) Female 10 (91) 14 (100)
Years in practice, no. (%)
0–10 2 (18) 2 (14)
11–15 3 (27) 2 (14)
16–20 2 (18) 5 (36)
>20 4 (36) 5 (36)
Years at MGH, no. (%) <5 2 (18) 0 (0)
5–10 4 (36) 3 (21)
11–15 2 (18) 3 (21)
16–20 1 (9) 4 (29)
>20 2 (18) 4 (29)
Discipline, no. (%) In-patient obstetrics 8 (73) 11 (79)
Certified nurse midwife or practitioner 3 (27) 3 (21)
Burnout, no. (%) High depersonalization 2 (18) 3 (21)
High emotional exhaustion 7 (64) 7 (50)
Overall high burnout 7 (64) 7 (50)
Burnout, mean (SD) Continuous burnout 8.1 6 0.8 8.7 (0.6)
Engagement at work, no. (%) High engagement 9 (82) 11 (79)
Engagement and empowerment at work, mean (SD) Engagement at work 39.4 6 6.7 38.8 6 6.3
Empowerment at work 70.3 6 8.1 62.7 6 8.5
Reaction to uncertainty, mean (SD) Stress from uncertainty 43.3 6 9.9 42.2 6 12.2
Abbreviations: XXX, XXX, NA, not available.

Randomized Arms ments and institutions. There was no significant difference in

Domains of emotional exhaustion and depersonalization sig- outcomes between the randomized arms of the study at the end
nificantly decreased over the course of the 3-month study (56% of the 3-month intervention period.
to 36%; P < .001 and 20% to 15%; P = .006) and overall
burnout decreased from 14 faculty members (56%) at baseline Focus Group
to nine faculty members (41%) at the end of the study (P = .002), Attendees at the focus group included members of both arms of
with a significant decrease in mean score from 8.4 6 2.4 to 6.9 the study. Intervention subjects who were in groups provided
6 0.7 (P = .017). The number of faculty who felt engaged in with a discussion guide confirmed that the guide was used in
their work increased from 20 (80%) to 22 (96%) (P = .03). their groups and that the guide was helpful for eliciting dis-
There was a significant increase in number of faculty who felt cussion on topics that participants may not naturally have
that the department was committed to their well-being and who addressed and was helpful for encouraging all attendees to
felt a sense of connection and community at work from baseline speak and address the questions in the guide. Control subjects
to end of study (P = <0.001 for both). There was no significant who were in groups without a discussion guide described that
change in faculty members feeling empowered at work or in some discussions included topics of work and some discussions
reaction to uncertainty (Table 3). Nineteen (83%) faculty were focused on family or personal life. Subjects from both arms
strongly or moderately agreed that they felt satisfied with the of the study referenced that the groups brought them into
group meetings; 20 (87%) said they would be interested in conversation with both members of their department that they
attending the group meetings if they continued; and 21 (91%) knew well, and members of their department that they knew less
said they would recommend these meetings to other depart- well, and that the interdisciplinary nature of the groups was

TABLE 3.
Changes From Baseline for all Study Participants
Variable Baseline 3-mo P
High depersonalization, no. (%) 5 (20) 4 (15) .006
High emotional exhaustion, no. (%) 14 (56) 8 (36) < .001
Overall high burnout, no. (%) 14 (56) 9 (41) .002
High engagement, no. (%) 20 (80) 22 (96) .03
Continuous burnout, mean (SD) 8.4 (2.4) 6.9 (0.7) .017
Empowerment at work, mean (SD) 66.0 (9.0) 67.6 (9.9) .33
Reaction to uncertainty, mean (SD) 42.7 (11) 43.6 (13.5) .48
Feel that department is committed to faculty wellbeing, no. (%) 7 (28) 10 (43) < .001
Feel sense of connection and community at work, no. (%) 12 (48) 13 (57) < .001

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
e80 JCEHP n Winter 2022 n Volume 42 n Number 1 www.jcehp.org

novel, welcomed and beneficial. Several focus group subjects clinical work is a strength as we look to better understand
from both study arms also stated that it was valuable to hear burnout in this context.
colleagues discussing their ways of coping with stressors at This study has several limitations. First, our results are sub-
work and at home. ject to the inherent selection and reporting biases that often
occur in survey studies. To minimize any social desirability
biases, results were collected in a de-identified and confidential
DISCUSSION
manner. In addition, participants were unaware of the specific
Principal Findings hypothesis of this study, and we have no information to suggest
To our knowledge, this study is the first known randomized that they would have chosen to participate or not on the basis of
trial of an interprofessional intervention to reduce burnout and their degree of burnout. Indeed, an internal survey of faculty in
enhance professional engagement in physicians, certified nurse this ob-gyn department showed an overall burnout rate that
midwives, and nurse practitioners participating together. was not significantly different to the baseline results, suggesting
Meeting together monthly for a three-month period demon- our participants are a representative sample. Second, the sample
strated a significant reduction in burnout, and a significant size is small, and the participants were all self-selected volun-
increase in engagement (Table 3). In addition, at the end of the teers from one department at a single institution. When com-
study, participants had a significant increase in sense of pared with other randomized controlled trials of well-being
departmental commitment to their well-being and sense of interventions, the sample size of this study is not dissimilar, and
connection and community at work. As a secondary aim, fac- the strength of the statistical significance of the findings with the
ulty were randomized to participate in dinner groups with a current sample size suggests the effect would be similar or
structured self-facilitated discussion guide (intervention arm) or greater when the intervention is scaled upward. These benefits
dinner groups without the guide (control arm) to evaluate and findings may, therefore, be even more pronounced in the
whether a discussion guide would provide increased benefit. larger studies that are needed. We did not evaluate the long-
The outcomes for the groups with the written discussion guide term effect of the intervention.
did not significantly differ from the control groups that met
without it. These positive findings in both groups suggest that Comparison to Other Similar Studies
self-facilitation is an effective strategy and that the therapeutic This study was inspired by previous studies,36,42 and our study
benefit of the intervention was related to the relationships extends and expands on this work in several key ways. Although
strengthened with colleagues through time and conversation, groups in previous studies were composed only of physicians, our
rather than any specific content directed by a written guide, groups are composed of physicians and advanced practice pro-
enhancing sustainability. Participants in both control and viders, mirroring the interprofessional environment of most
intervention groups gave feedback that meeting with colleagues academic health centers. In addition, groups in prior studies
in a relaxed, social setting was invaluable and that benefit was required a trained facilitator, adding cost and limiting scalability
felt to come from the opportunity to talk and connect with of the groups, whereas our study demonstrates that self-
others who understood what their daily stress was about. The facilitation is beneficial, and that a written discussion guide or
study demonstrated benefit in a relatively short period of time assigned topic are not necessary to achieve benefit.
(three dinners in three months), with an average total cost per
participant of approximately $90, supporting feasibility in time Unanswered Questions and Future Research
and cost (Table 1). This study demonstrates a low-cost, low- Further research is needed into what triggers and drives the
time commitment intervention that can significantly decrease development of burnout, and multidisciplinary participation
burnout and increase sense of engagement and connection. is needed in burnout prevention studies to extrapolate results
to interprofessional teams. Large, prospective, longitudinal
Strengths and Limitations studies that attempt to capture how burnout and stress
This study is novel in two key ways: it is the first to test a burnout changes throughout the academic year for faculty, together
intervention in an interprofessional group of physicians, certi- with the impact to individual wellbeing, patient satisfaction
fied nurse midwives and nurse practitioners, and it is the first to and health care outcomes, and institutional goals are
test whether faculty need assigned topics to guide discussion important. Future studies could also more explicitly explore
and achieve benefit. Clinician well-being efforts in our institu- the interprofessional aspects of clinician well-being by
tion before this study had been focused on physicians only, so addressing topics of teamwork or conflict, and by involving
including a broader group of professions in the same inter- all professions in the design and planning of activities.
vention was a breakthrough step. In addition, review of the Regarding our study, further work is needed to compare
literature at the time of study design confirmed that there were groups which meet for variable numbers of months, to find
no other published studies of well-being interventions that out the optimal duration of the small groups. In addition,
included multiple professions. In addition, this study includes a participants could be followed for a longer period after the
high participation rate in the department (25%) compared with small groups finish meeting to examine the duration of benefit
other studies of similar well-being interventions36, 42. Our study and help guide how regularly the series of meetings should be
population reflects the composition of the department in gen- repeated. It would also be interesting to examine whether the
der, age, years in clinical practice, and baseline levels of burn- effect could be extended and sustained by groups continuing
out. In addition, our findings are statistically significant across to meet either monthly or less frequently, or whether periodic
all but two of the domains studied, whereas similar studies “booster shot” meetings are helpful, and if so, with what
demonstrate statistical significance in limited domains.36,42 frequency. Since March 2020, and throughout the covid-19
Conducting this research study within the context of real-life pandemic, one of the authors has been leading virtual small

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
Interprofessional Groups Promote Well-being Hata et al. e81

groups, suggesting that this intervention is feasible in an 6. Mechanic D. Physician discontent: challenges and opportunities. JAMA.
online format, and it will be important to study the efficacy of 2003;290:941–946.
7. Zuger A. Dissatisfaction with medical practice. N Engl J Med. 2004;350:
online faculty support meetings. Meeting virtually via an 69–75.
online platform, if effective, would increase flexibility in 8. Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship between clerical
scheduling and reduce time for commuting. burden and characteristics of the electronic environment with physician
burnout and professional satisfaction. Mayo Clin Proc. 2016;91:836–
848.
CONCLUSION 9. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-
being: nine organizational strategies to promote engagement and reduce
This study shows that a short series of self-facilitated dinner burnout. Mayo Clin Proc. 2017;92:129–146.
meetings for an interprofessional group of clinical faculty is a low- 10. Simpkin AL, Chang Y, Yu L, et al. Assessment of job satisfaction and
cost intervention to reduce burnout, increase engagement, and feeling valued in academic medicine. JAMA Intern Med. 2019:179:992–
994.
increase faculty sense of connection to colleagues. Importantly,
11. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians.
benefits were seen in both groups, with the randomized group who Am J Med. 2003;114:513–519.
received the structured written discussion guide showing no sig- 12. Bianchi R, Schonfeld IS, Laurent E. Burnout-depression overlap: a review.
nificant difference from the control groups that met without the Clin Psychol Rev. 2015;36:28–41.
discussion guide. This suggests that the therapeutic benefit of the 13. Asai M, Morita T, Akechi T, et al. Burnout and psychiatric morbidity
among physicians engaged in end-of-life care for cancer patients: a
intervention may be related to the relationships strengthened with cross-sectional nationwide survey in Japan. Psychooncology. 2007;16:
colleagues, rather than any specific assigned curricular content, 421–428.
making this a practical and sustainable strategy for departments. 14. Shanafelt TD, Balch CM, Dyrbye L, et al. Special report: suicidal ideation
At a time when concern about faculty well-being is high, and among American surgeons. Arch Surg. 2011;146:54–62.
effective interprofessional collaborative teamwork is a priority, 15. van der Heijden F, Dillingh G, Bakker AB, et al. Suicidal thoughts
among medical residents with burnout. Arch Suicide Res. 2008;12:
this study broadens the possibilities for transforming institutional 344–346.
culture and effectively enhancing faculty well-being and is an 16. Williams ES, Manwell LB, Konrad TR, et al. The relationship of
important addition to the health care profession’s urgent call to organizational culture, stress, satisfaction, and burnout with physician-
reduce burnout and increase engagement. reported error and suboptimal patient care: results from the MEMO
study. Health Care Manage Rev. 2007;32:203–212.
17. Shanafelt TD, Bradley KA, Wipf JE, et al. Burnout and self-reported
patient care in an internal medicine residency program. Ann Intern Med.
2002;136:358–367.
Lessons for Practice 18. Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between
stress and lowered clinical care. Soc Sci Med. 1997;44:1017–1022.
19. Welp A, Meier LL, Manser T. Emotional exhaustion and workload
n Physicians and advanced practice providers meeting regu- predict clinician-rated and objective patient safety. Front Psychol. 2014;5:
larly together in interprofessional small groups showed 1573.
reduced burnout (reduced emotional exhaustion and deper- 20. Halbesleben JR, Rathert C. Linking physician burnout and patient
sonalization), and an increased sense of community and outcomes: exploring the dyadic relationship between physicians and
connection at work. patients. Health Care Manage Rev. 2008;33:29–39.
21. Linzer M. Clinician burnout and the quality of care. JAMA Intern Med.
n Self-facilitated groups are effective and do not require a 2018:178:1331–1332.
written discussion guide to achieve benefit, making this a 22. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors
cost-effective, sustainable intervention. among depressed and burnt out residents: prospective cohort study. BMJ.
2008;336:488–491.
n This is the first intervention demonstrated in a randomized 23. Dewa CS, Loong D, Bonato S, et al. How does burnout affect physician
controlled trial to improve well-being in an interprofessional productivity? A systematic literature review. BMC Health Serv Res. 2014;
group of clinicians, offering an inclusive, affordable, sustain- 14:325.
24. Shanafelt TD, Dyrbye LN, West CP, et al. Potential impact of
able, evidence-based strategy for preventing burnout and
burnout on the US physician workforce. Mayo Clin Proc. 2016;91:
improving quality of life in health professionals, which will
1667–1668.
improve the quality of care provided to patients. 25. Dewa CS, Jacobs P, Thanh NX, et al. An estimate of the cost of burnout
on early retirement and reduction in clinical hours of practicing physicians
in Canada. BMC Health Serv Res. 2014;14:254.
26. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician
well-being. JAMA Intern Med. 2017;177:1826–1832.
27. Daskivich TJ, Jardine DA, Tseng J, et al. Promotion of wellness and
REFERENCES mental health awareness among physicians in training: perspective of a
1. Simpkin AL, Khan A, West DC, et al. Stress from uncertainty and national, multispecialty panel of residents and fellows. J Grad Med Educ.
resilience among depressed and burned out residents: a cross-sectional 2015;7:143–147.
study. Acad Pediatr. 2018;18:698–704. 28. West CP, Dyrbye LN, Erwin PJ, et al. Interventions to prevent and reduce
2. Cooke GP, Doust JA, Steele MC. A survey of resilience, burnout, and physician burnout: a systematic review and meta-analysis. Lancet. 2016;
tolerance of uncertainty in Australian general practice registrars. BMC 388:2272–2281.
Med Educ. 2013;13:2. 29. Weight CJ, Sellon JL, Lessard-Anderson CR, et al. Physical activity,
3. Lally J, Cantillon P. Uncertainty and ambiguity and their association with quality of life, and burnout among physician trainees: the effect of a team-
psychological distress in medical students. Acad Psychiatry. 2014;38: based, incentivized exercise program. Mayo Clin Proc. 2013;88:1435–
339–344. 1442.
4. Toll E. A piece of my mind. The cost of technology. JAMA. 2012;307: 30. Jager AJ, Tutty MA, Kao AC. Association between physician burnout and
2497–2498. identification with medicine as a calling. Mayo Clin Proc. 2017;92:415–
5. Mamykina L, Vawdrey DK, Hripcsak G. How do residents spend their 422.
shift time? A time and motion study with a particular focus on the use of 31. Iserson KV. Burnout syndrome: global medicine volunteering as a possible
computers. Acad Med. 2016;91:827–832. treatment strategy. J Emerg Med. 2018;54:516–521.

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
e82 JCEHP n Winter 2022 n Volume 42 n Number 1 www.jcehp.org

32. Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what 41. Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded
about the other four? Resilience strategies of experienced physicians. Acad Sourcebook. 2nd ed. Thousand Oaks, CA: Sage Publications; 1994.
Med. 2013;88:382–389. 42. Gerrity MSWK, DeVellis RF, Dittus RS. Physicians’ reactions to uncertainty:
33. Shanafelt T. Physician burnout: stop blaming the individual. NEJM refining the constructs and scales. Motiv Emot. 1995;19:175–191.
Catalyst. 2016. 43. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual.
34. West CP, Dyrbye LN, Rabatin JT, et al. Intervention to promote physician 3rd ed. Menlo Park, CA: Mind Garden Inc; 1996.
well-being, job satisfaction, and professionalism: a randomized clinical 44. West CP, Dyrbye LN, Sloan JA, et al. Single item measures of emotional
trial. JAMA Intern Med. 2014;174:527–533. exhaustion and depersonalization are useful for assessing burnout in
35. Edmondson AC. The kinds of teams health care needs. Harv Business medical professionals. J Gen Intern Med. 2009;24:1318–1321.
Rev. 2015:2–5. 45. West CP, Dyrbye LN, Satele DV, et al. Concurrent validity of single-item
36. Simpkin AL, Schwartzstein RM. Tolerating uncertainty—the next medical measures of emotional exhaustion and depersonalization in burnout
revolution?. N Engl J Med. 2016;375:1713–1715. assessment. J Gen Intern Med. 2012;27:1445–1452.
37. Reeves S, Fletcher S, Barr H, et al. A BEME systematic review of the 46. Thomas NK. Resident burnout. JAMA. 2004;292:2880–2889.
effects of interprofessional education: BEME Guide No. 39. Med Teach. 47. Eckleberry-Hunt J, Kirkpatrick H, Barbera T. The problems with burnout
2016;38:656–668. research. Acad Med. 2018;93:367–370.
38. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and 48. Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of burnout among
cost. Health Aff (Millwood). 2008;27:759–769. physicians: a systematic review. JAMA. 2018;320:1131–1150.
39. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture 49. Schaufeli WB, Bakker AB. The measurement of work engagement with a
(REDCap)—a metadata-driven methodology and workflow process for short questionnaire: a cross-national study. Educ Psychol Meas. 2006;66:
providing translational research informatics support. J Biomed Inform. 701–716.
2009;42:377–381. 50. Spretizer GM. Psychological empowerment in the workplace:
40. Strauss A, Corbin J. Basics of Qualitative Research. Newbury Park, CA: dimensions, measurement, and validation. Acad Manage J. 1995;38:
Sage; 1990. 1442–1465.

Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.