SBIR-STTR Award

We propose to produce a simulation experience to ensure that clinical year medical students are prepared for, have coping strategies to deal with, and are more resilient to the stresses and challenges that await them as they transition to clinical practice and learning in a clinical environment. The experience will guide institutional level change by anonymously communicating students' concerns during clinical training. The product, BurntOut, is a Unity-based PC and Console role-playing simulation in which medical students explore common stresses and challenges in the clinical years of medical school, identify potential coping strategies, make decisions, and perceive negative and positive outcomes associated with those choices. Students gain confidence in how to best apply attitudes and actions that ameliorate the stresses identified, investigate external wellness resources if coping mechanisms fail, and anonymously communicate the challenges to the institution in order to foster institutional change. The need for the product is clear: 1) physician burnout has downstream negative effects on patient care; 2) burnout and resiliency are best addressed early in medical training so physicians recognize poor coping strategies and are resilient to the stresses of clinical practice; 3) burnout and use of alcohol are related, as addressing burnout decreases the risk of alcohol use in professionals; 4) supporting resources exist, but students are often reluctant to seek help and express concerns at an individual level; and 5) wellness centers for undergraduate medical centers need feedback from clinical year students to guide institutional change that can decrease burnout. The specific aims of Phase I demonstrate product feasibility and acceptability via usability and alpha/experience testing of a functional prototype. Phase II completes the agile development of BurntOut and a case-control evaluation.

Public Health Relevance Statement:
The product targets the health of medical students in the short-term and in their future as practicing physicians. It also targets the potential effect of physician burnout on the provision of care to patients under their care. By addressing burnout early in medical student training, practicing physicians can later recognize poor coping strategies such as excessive alcohol use, be resilient to the stresses of clinical practice, and be able to provide the best care possible to their patients.

Project Terms:
Address; Alcohol consumption; alcohol risk; analog; Attitude; Awareness; base; burnout; Caring; case control; Clinical; clinical practice; coping; coping mechanism; Coping Skills; Data; Data Aggregation; Decision Making; design; Development; diet and exercise; Education; Ensure; Environment; Equipment and supply inventories; Evaluation; experience; Face; Fatigue; Feedback; Fostering; Future; gender difference; Goals; Health; help-seeking behavior; Hunger; Hygiene; improved; Individual; Institution; Interview; intrinsic motivation; Lead; Learning; Measures; Medical; Medical center; medical schools; Medical Students; Mission; Modification; Outcome; Patient Care; Patients; Phase; Physicians; Play; Process; Protocols documentation; prototype; Quality of life; Reaction; Readiness; Reporting; resilience; Resources; Role; Role playing therapy; satisfaction; Self Assessment; Services; simulation; social; Standardization; Stress; Structure; student training; Students; Surveys; Testing; tool; Training; undergraduate student; usability; Vision; Wellness Center; Work

BurntOut: Role-Play Simulation for Building Medical Student Resiliency Medical student and physician burnout rates are high. Rates correlate with alcohol and other substance use problems, and negatively impact patient care. This project will create a 3D simulation BurntOut: Role- Play Simulation for medical students to practice and respond to stressful situations, enhance coping, and develop ways to respond that decrease use of unhealthy behaviors such as alcohol misuse. During Phase I, we created and evaluated a prototype simulation. We conducted needs analysis to identify stresses, associated impact on clinical medicine, research-based interventions, and assessment tools based on literature review, faculty consultation, and formative analysis. We created a design document for the simulation focused on exposing students to challenges associated with clinical care and highlighting well-being resources. The document outlines a strategy to expand coping skills, counter the misuse of alcohol and other substances, decrease depression, build resiliency, and decrease burnout during their clinical training and future career. After creating a proof of concept prototype, we conducted iterative rounds of formative analysis and revision. Dr. Tanner also presented the work at the International Conference on Physician Health and received significant positive feedback. The approach was well received as a unique and valuable contribution; they provided guidance as well. In Phase II, we will complete development incorporating frequent and regular input from a variety of stakeholders. Adopting the role of a medical student character in the simulation, students can engage challenges and conflicts, make decisions to avoid stress or use coping strategies, enhance their resiliency, and experience the impact of their choices. The final interactive experience will include: 1. 20 short scenarios, lasting 5-15 minutes, in simulated hospital, clinic, home, and wellness environments. 2. A simulated break room with a computer-generated peer/mentor character providing guidance to support lessons learned and to assist in setting goals to apply to real world choices and behaviors. 3. A tailored resource guide based on the break room experience that provides direction to online, institutional, and organizational resources and support. Examples include mindfulness training opportunities, exercise/diet/sleep tips, wellness centers, and popular student communication boards run by respected organizations. Usability and pilot testing will ensure the final product and evaluation design has maximum potential for success. A final summative study will be a randomized pre/post, wait-list control evaluation with 80 students (40/group) and a 3 month follow up. We will assess impact on burnout symptoms, quality of life, resiliency, alcohol use, depression, and product satisfaction using standardized scales. The above work will determine the potential of a 3D simulation to enable medical students to build resiliency by practicing decision making, deploying beneficial coping skills, rejecting alcohol and substance-based coping strategies, reducing depression, and decreasing burnout.

Public Health Relevance Statement:
PUBLIC HEALTH RELEVANCE STATEMENT This project addresses the common problem of burnout among medical students by providing an experiential intervention via a 3D role-playing simulation. In the simulation, medical students face challenges typical of clinical training in medical school, make choices, experience realistic outcomes, and learn to replace ineffective coping strategies, such as alcohol use and emotional withdrawal, with strategies that build resilience and promote well-being. The proposed BurntOut simulation, a Unity-based 3D experience, prepares medical students for the challenges of clinical training and clinical care. We seek to decrease medical student burnout and its impact on alcohol and substance abuse, depression, suicide, and inadequate treatment of patients.

NIH Spending Category:
Alcoholism, Alcohol Use and Health; Basic Behavioral and Social Science; Behavioral and Social Science; Bioengineering; Brain Disorders; Clinical Research; Clinical Trials and Supportive Activities; Depression; Health Disparities; Mental Health; Minority Health; Substance Abuse

Project Terms:
3-Dimensional; Address; Adopted; Alcohol abuse; Alcohol consumption; alcohol misuse; Alcohol or Other Drugs use; Alcohols; Assessment tool; base; Behavior; burnout; career; Choice Behavior; Clinic; Clinical; clinical care; Clinical Medicine; Clinical Trials; commercialization; Communication Board; computer generated; Computer software; Conflict (Psychology); Consultations; coping; Coping Skills; Data; Decision Making; Depression and Suicide; design; Development; diet and exercise; document outlines; Emotional; Ensure; Environment; Evaluation; experience; Face; Faculty; Feedback; follow-up; Future; Goals; Health; Home environment; Hospitals; improved; Institution; instrument; International; Intervention; Journals; Learning; Manuscripts; Medical; medical schools; Medical Students; Mental Depression; Mindfulness Training; model development; Modification; Outcome; Participant; Patient Care; Patients; peer coaching; Peer Review; Personal Satisfaction; Phase; Physicians; Pilot Projects; Play; Protocols documentation; prototype; public health relevance; Publications; Quality of life; Randomized; recruit; Reporting; Research; resilience; resource guides; Resources; Review Literature; Role; Role playing therapy; Running; satisfaction; simulation; Sleep; social; Standardization; Stress; Students; Substance abuse problem; success; suicidal; symposium; Symptoms; Testing; Training; training opportunity; usability; Waiting Lists; Wellness Center; Withdrawal; Work; Writing