- Title
- Development and evaluation of an individualised, app-delivered psychological flexibility skills training intervention for medical student burnout and wellbeing
- Creator
- Ditton, Elizabeth
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Burnout is an adverse psychological response to persistent imbalances between work-related demands and coping resources. Among medical physicians, burnout is an epidemic problem that has worsened during the global COVID-19 pandemic, and which has detrimental consequences for individual health and organisational healthcare delivery. With recent evidence demonstrating that burnout frequently emerges during medical education and persists throughout a physician’s professional life, there are increasing calls for the early implementation of interventions that can prevent burnout and its associated outcomes. Interventions that train medical students in adaptive psychological resources for responding to challenges could strengthen wellbeing and buffer medical students against burnout, particularly given the likelihood of ongoing exposure to unmodifiable stressors that are inherent to this career path. Rigorous research is needed to identify psychological resources that can be targeted by an intervention to produce beneficial impacts on medical students’ burnout and wellbeing. Further, identification of methodologies that facilitate accessibility (e.g. app-delivered) and individual differences (e.g. tailored, or “individualised”) are identified research priorities. The purpose of this research thesis was to develop a theory-driven psychological resource-building intervention for medical students, and to evaluate its feasibility and effectiveness with respect to burnout and psychological wellbeing outcomes. Psychological flexibility processes were identified as adaptive resources of potential importance to medical students’ burnout risk, and this model formed the basis of a two-stage Acceptance and Commitment Training intervention that was developed for this research thesis. Stage 1 provided education regarding the full psychological flexibility model, and stage 2 delivered “on-demand” access to brief skill training activities in specific processes. To address methodological issues related to individual heterogeneity, stage 2 was either individualised (i.e. delivered training in psychological flexibility processes that aligned with students’ identified present moment needs) or non-individualised. Delivery via a smartphone app was implemented to facilitate intervention accessibility and individualisation procedures. This research thesis provides a literature review outlining the rationale for the approaches adopted; an overview of the app-delivered Acceptance and Commitment Training intervention and its development process; the results of a small feasibility trial (Study 1) of the individualised app (published manuscript); an overview of how medical student end-user feedback from the feasibility trial was incorporated into the intervention development process; and the study protocol (published manuscript) and results (published manuscript) of a randomised controlled trial (Study 2) evaluating the effectiveness of the individualised and non-individualised intervention (compared with a waitlist group) with respect to burnout, wellbeing, psychological flexibility/inflexibility, and psychological distress outcomes. Studies 1 and 2 were conducted with samples of medical students from two Australian universities. Behavioural and subjective user experience data from Study 1 demonstrated the functional feasibility and usability of the app, and supported its subsequent implementation in Study 2. Subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge that may have been affected by time constraints, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. In Study 2, the mean differences in change from baseline to post-intervention (5 weeks) between the intervention groups and the waitlist group were not statistically significant for self-reported burnout outcomes (exhaustion, cynicism, and academic efficacy). However, compared with the waitlist group, the individualised group demonstrated statistically significant post-intervention improvements in psychological flexibility, inflexibility, and stress, and the non-individualised group demonstrated improvements in wellbeing and stress. Between-group differences for the individualised and non-individualised arms were not statistically significant. This thesis provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimise individualisation methods.
- Subject
- burnout, psychological; burnout, interventions; acceptance and commitment training; ACT; psychological flexibility; stress; mobile health; well-being; medicine; medical student; digital intervention; app-delivered intervention; individualized intervention; randomized controlled trial; acceptance and commitment therapy; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1507014
- Identifier
- uon:55946
- Rights
- Copyright 2023 Elizabeth Ditton
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 376 KB | Adobe Acrobat PDF | View Details Download |