An Analysis of Curriculum-Based Interventions on Burnout Outcomes in Resident Physicians: A Systematic Review
Poster #: 017
Session/Time: B
Author:
Julianne Ghiorzi, BS
Mentor:
Rehan Qayyum, MD, MHS, SFHM, FAHA
Research Type: Educational
Abstract
INTRODUCTION:
Physician burnout represents a critical and growing concern across the medical profession, with residents at heightened risk due to the demanding nature of training, frequent transitions, extended duty hours, increased clinical responsibility, and substantial documentation requirements. To address this challenge, residency programs have implemented structured curricula designed to reduce burnout. However, the true effectiveness of such curricular interventions remains unclear, and prior evaluations have been limited in scope and rigor. A comprehensive and up-to-date synthesis of the evidence is therefore needed. This systematic review examines studies published between July 2016 and September 2024 to evaluate the impact of curriculum-based interventions on resident physician burnout.
METHODS:
A systematic review was conducted by a six-member investigator team in accordance with updated PRISMA guidelines. A comprehensive search strategy was applied to PubMed, Embase, and Web of Science, using the terms ("resident" OR "residency" OR "intern") AND "burnout," yielding 12,550 records. All citations were imported into Covidence for duplicate removal and systematic screening. Studies were eligible if they met the following criteria: (1) published in English; (2) original research (excluding reviews, commentaries, and conference abstracts); (3) evaluated a curriculum-based intervention; and (4) reported burnout outcomes. Screening was conducted in two stages (title/abstract and full-text) by two independent reviewers, with a third reviewer adjudicating disagreements. Data extraction and risk of bias assessments were likewise performed in duplicate. Where feasible, data were pooled using inverse variance-weighted random-effects meta-analytic models. The overall strength of the evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.
RESULTS:
A total of 47 studies met inclusion criteria, including 6 randomized controlled trials and 41 observational studies. Curricular interventions addressed diverse domains, most commonly leadership training, narrative medicine, resilience and stress reduction, medical humanism, empathy, mindfulness, compassion, and self-acceptance. Several incorporated Balint-style group case discussions, while others focused on electronic medical record efficiency or patient-centered communication. Across 27 studies, curriculum-based interventions were associated with a modest reduction in emotional exhaustion (pooled mean difference [PMD] = -0.15; 95%CI: -0.31 to -0.00; p=0.05; GRADE: low certainty). No significant effects were observed for personal accomplishment (26 studies; PMD= 0.00; 95%CI: -0.12 to 0.13; p=0.95; GRADE: low certainty) or depersonalization (27 studies; PMD= -0.09; 95%CI: -0.23 to 0.06; p=0.23; GRADE: low certainty). Nine studies assessing overall burnout likewise demonstrated no significant effect (PMD= -0.16; 95%CI: -0.43 to 0.12; p=0.26; GRADE: very low certainty). Heterogeneity was substantial for emotional exhaustion (I²=76%), depersonalization (I²=73%), and personal accomplishment (I²=66%), while overall burnout also showed high heterogeneity (I²=78%). Funnel plot asymmetry suggested possible publication bias across all domains.
CONCLUSION:
In summary, curriculum-based interventions for resident physicians demonstrated only modest benefits, with a small reduction in emotional exhaustion and no significant improvements in depersonalization, personal accomplishment, or overall burnout. The certainty of evidence was rated as low to very low across all domains due to methodological limitations, heterogeneity, and potential publication bias. These findings suggest that while wellness curricula remain a widely adopted strategy, their effectiveness in meaningfully reducing burnout is uncertain.
Physician burnout represents a critical and growing concern across the medical profession, with residents at heightened risk due to the demanding nature of training, frequent transitions, extended duty hours, increased clinical responsibility, and substantial documentation requirements. To address this challenge, residency programs have implemented structured curricula designed to reduce burnout. However, the true effectiveness of such curricular interventions remains unclear, and prior evaluations have been limited in scope and rigor. A comprehensive and up-to-date synthesis of the evidence is therefore needed. This systematic review examines studies published between July 2016 and September 2024 to evaluate the impact of curriculum-based interventions on resident physician burnout.
METHODS:
A systematic review was conducted by a six-member investigator team in accordance with updated PRISMA guidelines. A comprehensive search strategy was applied to PubMed, Embase, and Web of Science, using the terms ("resident" OR "residency" OR "intern") AND "burnout," yielding 12,550 records. All citations were imported into Covidence for duplicate removal and systematic screening. Studies were eligible if they met the following criteria: (1) published in English; (2) original research (excluding reviews, commentaries, and conference abstracts); (3) evaluated a curriculum-based intervention; and (4) reported burnout outcomes. Screening was conducted in two stages (title/abstract and full-text) by two independent reviewers, with a third reviewer adjudicating disagreements. Data extraction and risk of bias assessments were likewise performed in duplicate. Where feasible, data were pooled using inverse variance-weighted random-effects meta-analytic models. The overall strength of the evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.
RESULTS:
A total of 47 studies met inclusion criteria, including 6 randomized controlled trials and 41 observational studies. Curricular interventions addressed diverse domains, most commonly leadership training, narrative medicine, resilience and stress reduction, medical humanism, empathy, mindfulness, compassion, and self-acceptance. Several incorporated Balint-style group case discussions, while others focused on electronic medical record efficiency or patient-centered communication. Across 27 studies, curriculum-based interventions were associated with a modest reduction in emotional exhaustion (pooled mean difference [PMD] = -0.15; 95%CI: -0.31 to -0.00; p=0.05; GRADE: low certainty). No significant effects were observed for personal accomplishment (26 studies; PMD= 0.00; 95%CI: -0.12 to 0.13; p=0.95; GRADE: low certainty) or depersonalization (27 studies; PMD= -0.09; 95%CI: -0.23 to 0.06; p=0.23; GRADE: low certainty). Nine studies assessing overall burnout likewise demonstrated no significant effect (PMD= -0.16; 95%CI: -0.43 to 0.12; p=0.26; GRADE: very low certainty). Heterogeneity was substantial for emotional exhaustion (I²=76%), depersonalization (I²=73%), and personal accomplishment (I²=66%), while overall burnout also showed high heterogeneity (I²=78%). Funnel plot asymmetry suggested possible publication bias across all domains.
CONCLUSION:
In summary, curriculum-based interventions for resident physicians demonstrated only modest benefits, with a small reduction in emotional exhaustion and no significant improvements in depersonalization, personal accomplishment, or overall burnout. The certainty of evidence was rated as low to very low across all domains due to methodological limitations, heterogeneity, and potential publication bias. These findings suggest that while wellness curricula remain a widely adopted strategy, their effectiveness in meaningfully reducing burnout is uncertain.