Whether it’s via an online program or simply a smartwatch, healthcare professionals stand to gain skills and insights.

Patients aren’t the only ones whose mental health stands to benefit from digital tools—physicians, too, can gain skills and insights that promote well-being, two new studies suggest.

One explored the impact of a remote training program paired with a smartphone app, to teach cognitive-behavioral and contemplative techniques, while the other examined whether the mere act of wearing a smartwatch to monitor physiological measures, such as step count and heart rate, could bear fruit.

“Obviously, there are high levels of stress and burnout amongst healthcare professionals,” said Matthew J. Hirshberg, PhD (Center for Healthy Minds, University of Wisconsin-Madison), lead author the training program study. Yet skills to address the profession’s pressures are notably absent in medical training, he told TCTMD. “It’s not part of standard curricula.”

While there’s growing recognition, particularly after the COVID era, that healthcare professionals are at risk of burnout, there’s less known about tools to manage the stresses that can cause it, he noted.

High levels of distress can carry negative consequences for both providers and patients, Hirshberg explained. “When people get distressed, it dampens a lot of capacities and skills that are important to their own well-being, but also to their professional competency.”

Remote and Flexible Program

For the HCP-Well Study Group paper, published in JAMA Internal Medicine, Hirshberg and colleagues enrolled 2,315 adults (mean age 34.7 years; 73.1% female) who worked at 762 healthcare facilities across seven Mexican states. Among them, 33.4% were nurses, 31.7% physicians, 8.1% psychologists, 7.9% administrators, 6.7% dentists, and 3.2% social workers, with fewer than 3% each being nutritionists, lab technicians, physical therapists, health promotors, or other professionals.

The randomized clinical trial had two arms:

Participation in the Integrated Stress Toolbox for Healthcare Providers, a 13-week program that involved nine 2-hour Zoom sessions (recorded and available asynchronously) as well as access to the Healthy Minds Program smartphone app

Being put on a wait list, thereby serving as controls

Most patients (63.4%) randomized to the intervention viewed at least seven of the sessions, with the majority doing so asynchronously, whereas a minority (28.5%) used the app for 300 minutes or longer. Fully 29.1% did not use the app at all.

Primary outcomes were participant-reported stress, as measured by the National Institutes of Health Toolbox perceived stress and the Perceived Stress and Patient Reported Outcomes Measurement Information System anxiety and depression scales, plus well-being according to the World Health Organization-5 measure. Based on intention to treat, the intervention group was more likely than the control group to report a reduction in distress and an increase in well-being 13 weeks after the training stopped, largely due to greater awareness. The magnitude of these changes grew over the 37-week follow-up.

Secondary outcomes related to awareness, connection, purpose, burnout, personal accomplishment at work, and gratitude all improved as well. Adverse event rates were 0.05% and 0.04% in the intervention and control groups, respectively.

Hirshberg pointed out that a key element of their project was the collaboration between US investigators and their Mexican counterparts, who had connections to “state-level ministries of health and other organizations that made it possible to do the research.” The tools they developed, he added, are relevant across diverse geographic regions and to various professions—although it will likely help if the program’s wording is tailored to the needs of the audience, whether that’s educators, for example, or physicians.

Digital programs are especially useful in that they can be offered to more people without adding much cost beyond an in-person approach. For healthcare, too, “you have to provide flexibility because scheduling’s super inconsistent and people are really busy,” Hirshberg noted, adding that institutional support is necessary for clinicians to be able to fit such training into their workflow without it being burdensome.

Even better would be to prioritize these skills from the start, he stressed. “Medical education is an opportune time to offer these sorts of trainings, . . . because in some sense the goal is to prepare people for the profession.”

The Power of Self-awareness

Also encouraging is the recently published study in JAMA Network Open on leveraging smartwatch use to encourage physician well-being.

Led by Liselotte N. Dyrbye, MD (University of Colorado School of Medicine, Denver), investigators enrolled 184 physicians (mean age 37.5 years; 58.8% female), nearly half (45.4%) of whom were residents or fellows. Participants completed a baseline survey and were then randomized to one of two groups:

Immediate intervention, in which they received a smartwatch (Venu 2 Plus; Garmin) along with detailed instructions and were emailed a newsletter every other month that aggregated the data their device collected, reminders to sync their data, and information about device features

Delayed intervention, in which they received nothing for the first 6 months, were surveyed at that time, and then received a smartwatch (Venu 3S; Garmin) plus the same support as the immediate group

The devices tracked heart rate, physical activity, respiratory rate, stress, and sleep.

By 6 months, self-reported burnout—based on the Maslach Burnout Inventory’s emotional exhaustion and depersonalization subscales—was less common with immediate versus no intervention, though the difference didn’t reach statistical significance (41.2% vs 50.5%; P = 0.21). Yet, when adjusted for baseline score, demographics, physician specialty, and work hours, a difference in burnout emerged (OR 0.46; 95% CI 0.21-0.99; P = 0.046). Mean resilience score—based on the Connor-Davidson Resilience Scale—also was significantly higher among the physicians using smartwatches.

There were no improvements in quality of life, depressive symptoms, stress, or sleepiness between the two groups, so it appears that the strategy doesn’t lead to overall improvement, the researchers say. “Rather, wearing a smartwatch shows promise as an individual strategy to mitigate burnout and improve resilience, and it should be coupled with other individual and organizational efforts to address well-being more broadly.”

Although having access to physiological data does appear to encourage physician well-being, “future research should explore whether engagement with smartwatch data leads to actual behavior change (eg, adaptive coping or reflective habits) that reduces burnout risk and enhances resilience,” Dyrbye et al conclude.

Hirshberg agreed that wearables show promise but cautioned that it’s still to be determined which measurements most accurately reflect well-being and how best to communicate that information.

“Even if we could turn signals like these into a reliable metric of some internal state that we might want to act on, probably the delivery of that would need to be different depending on the person to be effective. . . . When we get into the realm of human emotion and affecting psychological states, there’s a lot work to do,” said Hirshberg.

He pointed out an issue relevant to both studies—by design, participants opted in, rather than it being “universal implementation” in a hospital or health system that captured both enthusiastic and perhaps reluctant individuals. “It actually matters to program efficacy, whether or not people want to do this. That would make sense because these aren’t passive [tools]. You have to engage in them to benefit,” Hirshberg noted. So, if such initiatives are mandated, he advised, it will be important to see how best to tailor the experience to all comers.