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

Burnout, or the combination of emotional exhaustion (EE), depersonalization, and feelings of helplessness, has an adverse impact on providers and patients across the health system. It has been reported that burnout affects between 39% and 75% of pediatric interns. Burnout can adversely affect their well-being, performance during training, suicidal risk, and patient care. Those with burnout are more likely to make medical mistakes and be less empathetic to patients, and patients of those with burnout are less likely to follow theirmedical plan.One evidence-based approach to alleviate burnout is mindfulness. Amindfulness curriculummay help to reduce burnout among pediatric interns, but barriers, such as the time required to practice mindfulness and the availability of expert facilitators, make it difficult to implement. Although small, single-center trials have found mindfulness training to have variable effects, there are no knownmulticenter, randomized controlled trials to assess its effectiveness. The aim of this study was to evaluate whether a curriculum in mindfulness reduces burnout among pediatric interns. This was a cluster randomized controlled trial, conducted in 15 pediatric residency programs in the United States between June 14, 2017, and February 28, 2019. Included were pediatric residency programs whose interns would be randomized to experience a novel mindfulness curriculum (Mindfulness Intervention for New Interns [MINdI]) or social, noninstructive lunches. Interns randomized to the intervention group, MINdI, took part in 7-hour-long sessions once a month that fit into their regular training program and used scripted curriculum to cover mindfulness topics and exercises. The control group attended 6-hour-long, intern-only lunches. Surveys were conducted at baseline, 6 months, and 15 months, and measured the primary outcome of EE, as well as secondary outcomes of depersonalization, personal accomplishment, mindfulness, and empathy. A total of 359 interns gave their consent to participate in the study when they submitted the baseline survey. Of these, 340 (95%) completed the surveys at baseline, 273 (75%) at 6 months, and 195 (54%) at 15months. The analysis included 194 interns in theMINdI group and 146 in the control group. For the primary outcome, there was no significant difference at baseline in EE scores between the 2 groups (adjusted difference, -0.37; 95% confidence interval [CI], -3.03 to 3.77). At 6 months, mean EE scores were higher in both groups (35.4 in the MINdI group vs 32.4 in the control group) than at baseline (28.3 vs 25.6). However, after multivariate analysis, mean EE scores did not significantly differ at 6 months (35.4 vs 32.4; adjusted difference, 3.03; 95% CI, -0.14 to 6.21) nor at 15 months (33.8 vs 32.9; adjusted difference 1.42; 95% CI, -2.42 to 5.27). No significant differences were observed among the secondary outcomes at baseline, 6 months, and 15 months. In this study, a novel mindfulness curriculum conducted early in pediatric residency programs did not affect measures of EE, depersonalization, personal accomplishment, mindfulness, and empathy. However, interns did report improved knowledge and behaviors around mindfulness. Further research may focus on developing more robust mindfulness curricula that can reduce burnout among pediatric interns.