Characterization of Medical Student Burnout Using Remote Physiologic Monitoring

Aim 1: To determine whether physiologic metrics of sleep and heart rate variability correlate with subjective assessments of medical student wellness in a 6-month period.

Hypothesis: Less total sleep hours will correlate with higher scores for Perceived Stress Scale-4, Medical Student Well-Being Index, and Patient Health Questionnaire-9, but lower heart rate variability will correlate with higher scores on Perceived Stress Scale-4, Medical Student Well Being Index, and Patient Health Questionnaire-9.

Aim 2: To determine whether physiologic metrics of sleep and heart rate variability correlate with performance on shelf examinations for clinical rotations in a 6-month period.

Hypothesis: Less total sleep hours and lower heart rate variability will correlate with poorer performance on shelf examinations.

• WHOOP strap 4.0 (full data access) (Device): The WHOOP strap 4.0 provides continuous physiologic data via remote monitoring. Subjects will have full remote monitoring data access throughout the entirety of the study (6 months).
• WHOOP strap 4.0 (partial data access) (Device): The WHOOP strap 4.0 provides continuous physiologic data via remote monitoring. Subjects will be blinded to remote monitoring data for the first 3 months of the study followed by an unblinding and full access to remote monitoring data at the 3 month mark (continued for the remainder of the study).

Primary outcomes

• Total sleep hours per night [180 days]: Sleep (hours per night) will be objectively measured nightly.
• Medical Student Well-Being Index (MSWBI) [180 days]: The MSWBI consists of 7 items, scored 0-7, with lower scores indicative of better medical student wellbeing. This survey will be administered biweekly.

Secondary outcomes

• REM sleep hours, nightly [180 days]: REM sleep hours will be measured nightly by the WHOOP strap 4.0.
• Deep sleep hours, nightly [180 days]: Deep sleep hours will be measured nightly by the WHOOP strap 4.0.
• Resting heart rate, nightly [180 days]: Resting heart rate will be measured nightly by the WHOOP strap 4.0.
• Heart rate variability, nightly [180 days]: Heart rate variability will be measured nightly by the WHOOP strap 4.0.
• Respiration rate, nightly [180 days]: Respiration rate will be measured nightly by the WHOOP strap 4.0.
• Pulse oximetry, nightly [180 days]: Pulse oximetry will be measured nightly by the WHOOP strap 4.0.
• Body temperature, nightly [180 days]: Body temperature will be measured nightly by the WHOOP strap 4.0.
• Average duty hours per week [180 days]: Duty hours will be self-reported every week
• Perceived Stress Scale-4 [180 days]: The PSS-4 consists of 4 items that assess perceived stress. The items are scored on a 4-point scale. This survey will be administered biweekly.
• Patient Health Questionnaire-9 (PHQ-9) [180 days]: The (Patient Health Questionnaire-9) PHQ-9 consists of 9 items that assess major depressive disorder. This survey will be administered biweekly. It is scored on a 0-27 scale with 27 representing most severe depression (worse outcomes).
• Scores on shelf examinations [180 days]: Subjects will self-report examination scores for shelf exams administered after each clinical rotation. Scores are reported on a 0-100 scale with 100 being the best score possible.

Sex: All, ages: 18 Years to 99 Years, accepts healthy volunteers

Inclusion Criteria:

* Third-year medical student at Thomas Jefferson University
* ≥18 years of age
* Actively participating in family medicine, internal medicine, neurology, obstetrics/gynecology, pediatrics, psychiatry, surgery, or emergency medicine rotations
* Own a smart phone for Bluetooth pairing with WHOOP strap 4.0

Exclusion Criteria:

* Allergies, contraindications, or unwillingness to wear a wrist device for the study period

• Alexander Hajduczok, MD, Principal investigator, Thomas Jefferson University Hospital, Department of Cardiology