Standardized mean differences of primary outcomes found in randomized controlled trials of wellness interventions among medical trainees: A systematic review and meta-analysis.

Abstract

9011 Background: In the era of physician shortages, wellness interventions among medical trainees is an area of ongoing research interest in hopes of promoting clinician wellness and preventing burnout as a means of reducing clinician attrition. To our knowledge, there has not been a systematic review and meta-analysis of randomized controlled trials among medical trainees (medical students, residents, and fellows) to characterize the overall efficacy of wellness interventions in this population. Methods: A medical librarian searched Embase, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), APA PsycINFO, and Clinicaltrials.gov from the earliest timepoint to March 2022 for randomized controlled trials of wellness interventions among medical trainees. Measures of wellness included but were not limited to depression, stress, and anxiety. Outcomes were analyzed using Standardized Mean Differences (SMD) calculated as Hedges’ g to correct for small sample bias. To ensure consistent interpretation, effect sizes were adjusted for directionality such that a positive SMD indicates a beneficial outcome for the intervention group regardless of the original scale (e.g., higher happiness or lower stress). Results: Our search strategy resulted in 3,806 unique articles. 161 articles passed initial screening of titles and abstracts, and 46 studies were included for data extraction with dates ranging from 1980 to 2022. 23 studies with means and standard deviations reported for the primary outcome were included for meta-analysis purposes. The pooled effect size was 0.017 with a 95% confidence interval of -0.501 to 0.536 with an I^2 heterogeneity of 0.904. Conclusions: Our systematic review and meta-analysis of randomized controlled trials of wellness interventions among medical trainees suggest that interventions to promote wellness and prevent burnout in medical trainees, as an aggregate, have been heterogenous in design and with little-to-no overall effect. An updated search of the literature with sub-group analyses by intervention type and/or outcome measure may yield more promising results, inform future research, and better assist training programs in weighing the opportunity cost of wellness interventions, particularly in resource-constrained settings or in fields with significant rates of burnout such as hematology and oncology.