Brigham Womens Hospital Harvard Medical School Evaluation of

Brigham & Women’s Hospital Harvard Medical School Evaluation of the efficacy of an onsite Kripalu Yoga-based RISE program for burnout, stress and resilience in resident physicians J. Loewenthal 1, N. L. Dyer 2, M. Lipsyc-Sharf 1, S. Borden 2, D. H. Mehta 3, J. A. Dusek 2, S. B. S. Khalsa 1 1. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; 2. Kripalu Center for Yoga & Health, Stockbridge, MA; 3. Osher Center for Integrative Medicine, Harvard Medical School, Boston, MA Key Words: yoga, meditation, mindfulness, burnout, stress, resilience Objective: Mind-body interventions such as yoga have shown to be efficacious for addressing physician burnout, however, there have been no controlled studies of yoga-based interventions in resident physicians. The purpose of this pilot study was to assess the feasibility of a 6 -week workplace yoga and mindfulness program for improving psychological health in resident physicians. Methods: Resident physicians (N = 55) were randomized to a 6 -week onsite yoga and mindfulness program (n = 38) or a waitlist control group (n = 17). Participants completed questionnaires assessing feasibility and psychological health at baseline, post-program, and 2 -month follow-up. Between group data analysis was conducted with repeated measures ANOVAs. Paired samples t-tests were performed within groups to assess change over time. Results: The participants rated the program as not highly feasible to attend, mean = 28. 9 (SD = 25. 6) out of 100. Feasibility increased if the program were offered multiple times per week, mean = 63. 2 (SD 20. 9), or online, mean = 69. 2 (SD = 25. 98). Between group analysis revealed statistically significant improvements in mindfulness (p = 0. 004) from baseline to post in the RISE group (n = 28), compared to control (n = 15). Improvements in mindfulness were marginally significant from baseline to 2 month follow-up (p = 0. 051). Within group analysis revealed that the RISE group improved in resilience (p = 0. 013), mindfulness (p = 0. 001), stress (p = 0. 013), work exhaustion (p = 0. 015), total burnout (p = 0. 021), physician well-being (p = 0. 017), and sleep disturbance (p = 0. 014) from baseline to post; and mindfulness (p = 0. 006), stress (p = 0. 003), work exhaustion (p = 0. 001), interpersonal disengagement (p = 0. 049), total burnout (p = 0. 005), and physician wellbeing (p = 0. 026) from baseline to follow-up. The control group improved in anxiety (p =. 036) and sleep disturbance (p =

http: //www. massmed. org/News-and-Publications/MMS-News-Releases/Physician. Burnout-Report-2018/ “The prevalence of physician burnout has reached critical levels. Recent evidence indicates that nearly half of all physicians experience burnout in some form. And it appears to be getting worse. The 2018 Survey of America’s Physicians Practice Patterns and Perspectives finds that … 78% of surveyed physicians experience feelings of professional burnout at

Wayne PM, Yeh GY, Mehta DH “A growing body of clinical studies suggests that interventions, including mindfulness, yoga, and mind-body skills training, may be helpful in building the self-awareness and resilience needed for medical students, residents, and established physicians to mitigate burnout risk. ”

Purpose: To assess feasibility and preliminary efficacy of a workplace yoga and mindfulness program (RISE) for improving psychological health in resident physicians Methods: • Resident physicians at a Harvard-affiliated hospital • RISE (resilience, integration, self-awareness, engagement) a standardized program of yoga and mindfulness practices from the Kripalu Center for Yoga & Health • 1 -hr in-person onsite RISE sessions weekly for 6 weeks • Session recordings and resources available online • Randomization ratio of 2: 1 to RISE vs. waitlist control • Self-report measures of feasibility, psychological health • Outcomes: baseline, post-program, 2 -month follow-up

CONSORT Diagram

Characteristic Baseline Characteristics of Study Sample Number (%) Intervention: n=28 Control: n=16 Sex Male Female Age (mean) Ethnicity Hispanic Non-Hispanic Not Reported Race White Black Asian American Indian/Alaskan Native 7 (25. 0%) 21 (75. 0%) 29. 3 (range 26 -33) 1 (6. 3%) 15 (93. 8%) 29. 1 (range 27 -33) 2 (7. 1%) 26 (92. 9%) 0 (0. 0%) 1 (6. 2%) 14 (87. 6%) 1 (6. 2%) 18 (64. 2%) 1 (3. 6%) 7 (25. 0%) 1 (3. 6%) 10 (62. 5%) 0 (0. 0%) 4 (25. 0%) 0 (0. 0%) Multiracial Not Reported Year in Training 1 (intern) 2 3 4+ Specialty Internal Medicine Obstetrics & Gynecology (OB/GYN) 0 (0. 0%) 1 (3. 6%) 2 (12. 5%) 0 (0. 0%) 9 (32. 1%) 6 (21. 4%) 8 (28. 6%) 5 (17. 9%) 3 (18. 8%) 5 (31. 3%) 12 (42. 9%) 3 (10. 7%) 8 (50. 0%) 2 (12. 5%) Diagnostic Radiology Emergency Medicine Psychiatry Medicine-Pediatrics Anesthesiology Physical Medicine & Rehabilitation 3 (10. 7%) 2 (7. 1%) 4 (14. 3%) 1 (3. 6%) 3 (10. 7%) 0 (0. 0%) 2 (12. 5%) 0 (0. 0%) 1 (6. 3%) Previously practiced a mind-body technique 64. 3% Yes 75% Yes Currently practicing a mind-body technique 17. 9% Yes 25% Yes Average practice duration (if currently practicing) 60 minutes, 1 day per week 30 minutes, 1 day per week

Stress, Mindfulness, Mood, Sleep Perceived Stress Scale FFMQ Resilience Scale PROMIS Depression

Well-Being, Burnout Resident Well-Being Index Professional Fulfillment Index (PFI) Maslach Burnout Inventory 2 -item PFI Work Exhaustion PFI Interpersonal Disengagement

Feasibility • Mean in-person attendance 1. 93/6 sessions • 25% attended 0 sessions, 21. 4% attended 1 session, 0% attended 6 sessions • Absence: work schedule: 89%, vacation: 10%, illness: 1% • 74. 1% used online RISE resources for home practice • Feasibility/acceptability rated 28. 9/100 • If offered multiple times per week 63. 2/100 • If offered online 69. 2/100 • At 2 -month FU 44% practiced RISE techniques mean of 1. 9 days/week for 13. 0 min/ per

Conclusion: Our findings suggest that the RISE program has the potential of improving psychological wellbeing and burnout in resident physicians, but that significant program refinement is necessary to increase feasibility, especially to accommodate medical resident work schedules Funding and Support: Osher Pilot Research Award (to SBSK), Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Harvard Medical School Partners Centers of Expertise in Medical Education grant, Partners Health. Care Graduate Medical Education (to JL) Kripalu Center for Yoga & Health support for research personnel