The INSPIRE Study: INvestigation of Swiss Physicians Inner-life, Resilience, and Emotions

Burnout, emotional exhaustion, and moral distress are widespread among physicians, negatively impacting patient care, job satisfaction, and physician retention in the workforce. While interventions targeting burnout exist, many require significant time commitments or institutional support, limiting accessibility.

Positive psychology interventions, which emphasize strengths-based approaches such as self-reflection, gratitude, and self-compassion, have shown promise in enhancing resilience and well-being.

The INSPIRE study is a randomized controlled trial (RCT) nested within an observational cohort using a Trial within Cohort (TwiC) design. It evaluates two web-based positive psychology interventions aimed at reducing emotional exhaustion and improving physician well-being.

A subset of cohort participants is randomized into one of three arms: a control group, a general life reflection intervention, or a work-focused reflection intervention. The interventions consist of an 8-day structured self-reflection program delivered online.

The study employs automated randomization, triple masking (participants, investigators, and outcome assessors), and longitudinal assessments over one year. Findings will inform the scalability of low-burden interventions for physician burnout prevention.

• INSPIRE Life Reflection (Behavioral): An 8-day web-based positive psychology intervention encouraging participants to reflect on positive aspects of their daily lives. Activities include gratitude exercises, self-compassion writing, and recognizing meaningful moments.
• INSPIRE Work Reflection (Behavioral): An 8-day web-based positive psychology intervention encouraging participants to reflect on positive aspects of their work experiences. Activities include gratitude exercises, self-compassion writing, and recognizing meaningful professional interactions.

Primary outcomes

• Change from baseline in Emotional Exhaustion [3 months post-intervention]: Emotional Exhaustion subscale of the MBI-HSS

Secondary outcomes

• Change in Emotional Exhaustion [Baseline to 2 weeks, 1 month, 6 months, 1 year]: Emotional Exhaustion subscale of the MBI-HSS
• Change in Depersonalization [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: Depersonalization subscale of the MBI-HSS
• Change in Personal Accomplishment [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: Personal accomplishment subscale of the MBI-HSS
• Change in Physician wellbeing [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: Physician Wellness Inventory (PWI)
• Change in Job Satisfaction [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: Physician Job Satisfaction Scale
• Change in comfort with End-of-Life Communication [Baseline to 1 month, 3 months, 6 months, 1 year]: Communication about End of Life Survey
• Change in Mindfulness [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: Mindful Attention Awareness Scale (MAAS-Trait)
• Change in Compassionate Care [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: Santa Clara Brief Compassion Scale
• Change in Emotion Regulation [Baseline to 1 month, 3 months, 6 months, 1 year]: Emotion Regulation Questionnaire (ERQ)
• Change in Positive and Negative Affect [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: Positive and Negative Affect Schedule (PANAS)
• Change in Authenticity [Baseline to 3 months, 6 months, 1 year]: Inauthenticity Scale
• Resilience [Baseline to 2 weeks, 1 month, 3 months, 6 months, 1 year]: 2-item Connor-Davidson resilience scale

Other outcomes

• Perceived impact of the INSPIRE Interventions [Within 6 months post-intervention]: Qualitative interviews with a subset of trial participants to understand perceived impact of the INSPIRE interventions.
• Acceptability of the INSPIRE Interventions [Within 6 months post-intervention]: Qualitative interviews with a subset of trial participants to understand acceptability of the INSPIRE interventions.

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

Inclusion Criteria:

1. Be a practicing physician in Switzerland
2. Working at least 40% in a clinical capacity
3. Be willing and able to provide informed consent
4. Expecting to be professionally active until 2028

Exclusion Criteria:

1. Retired physician or physician seeking retirement within 3 years from first participation in the study
2. Physician unable to participate in one of the study languages: English, German, or French

• Sofia C Zambrano, PhD, Principal investigator, University of Bern

NIH grants: 2023