***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To prospect ively study the effects of an incentivized exercise program on  physical activity ( PA ) , quality of life ( QOL ) , and burnout among residents and fellows ( RFs ) in a large academic medical center . PARTICIPANTS AND METHODS In January 2011 , all RFs at Mayo Clinic in Rochester , Minnesota ( N=1060 ) , were invited to participate in an elective , team-based , 12-week , incentivized exercise program .  Both participants and non participants had access to the same institutional exercise facilities . Regardless of participation , all RFs were invited to complete baseline and follow-up ( 3-month ) assessment s of PA , QOL , and burnout . RESULTS Of the 628 RFs who completed the baseline survey ( 59 % ) , only 194 ( 31 % ) met the US Department of Health and Human Services recommendations for PA . Median reported QOL was 70 on a scale of 1 to 100 , and 182 ( 29 % ) reported at least weekly burnout symptoms .  A total of 245 individuals ( 23 % ) enrolled in the exercise program . No significant differences were found between program participants and non participants with regard to baseline demographic characteristics , medical training level , PA , QOL , or burnout . At study completion , program participants were more likely than non participants to meet the Department of Health and Human Services recommendations for exercise ( 48 % vs 23 % ; P<.001 ) . Quality of life was higher in program participants than in non participants ( median , 75 vs 68 ; P<.001 ) . Burnout was lower in participants than in non participants , although the difference was not statistically significant ( 24 % vs 29 % ; P=.17 ) . CONCLUSION A team-based , incentivized exercise program engaged 23 % of RFs at our institution . After the program , participants had higher PA and QOL than non participants who had equal exercise facility access . Residents and fellows may be much more sedentary than previously reported BACKGROUND Informed consent is required for both st and ard cancer treatments and experimental cancer treatments in a clinical trial . Effective and sensitive physician-patient communication about informed consent is difficult to achieve . Our aim was to train doctors in clear , collaborative and ethical communication about informed consent and evaluate the impact of training on doctor behaviour , stress and satisfaction . PARTICIPANTS AND METHODS Participants were 21 oncologists from 10 Australian/New Zeal and ( ANZ ) centres and 41 oncologists from 10 Swiss/German/Austrian ( SGA ) centres . Oncologists were r and omized to participate in a 1-day workshop or not .  Patients were recruited before and after the training . Doctors were asked to su bmi t 1 - 2 audiotaped consultations before and after training . Doctors completed outcome measures before and after completing the post-training cohort recruitment . RESULTS Ninety-five consultation interactions were audiotaped . Doctors strongly endorsed the training . ANZ intervention doctors demonstrated a significant increase in collaborative communication ( P = 0.03 ) . There was no effect of training on other doctor behaviours .  Trained doctors did not demonstrate reduced stress and burnout . Patient outcomes are presented elsewhere . CONCLUSIONS Training can improve some aspects of the process of obtaining informed consent . Methods to increase the impact of training are required and may include longer training and more intensive follow-up OBJECTIVES To estimate burnout prevalence among pediatric residents and to evaluate the impact of a brief intervention aim ed at controlling burnout . METHODS A r and omized controlled trial was conducted on 74 pediatric residents . The Maslach Burnout Inventory was administered to all subjects , and demographic information was gathered ( age , gender , children , cohabitants , and residency year ) . The experimental group ( n = 37 ) participated in self-care workshops over the course of 2 months , and the control group ( n = 37 ) did not receive any intervention . After the intervention , the  Maslach Burnout Inventory  was administered again to all participants . All potential predictors of burnout were included in a logistic regression model . The efficacy of the intervention was evaluated by the chi-square test . P values < 0.05 were considered significant . RESULTS The burnout prevalence among pediatric residents was 66 % . After controlling for age , gender , children , and cohabitants , the prevalence of burnout was significantly higher among third-year residents ( odds ratio = 11.8 ; 95 % confidence interval 2.3 - 59.3 ; p = 0.003 ) . There were no significant differences regarding burnout prevalence in the experimental group between the baseline and post-intervention periods ( p = 0.8 ) or between the two groups after intervention ( p = 0.8 ) . The only difference observed was an improvement regarding " depersonalization " in the experimental group ( p = 0.031 ) . CONCLUSIONS The burnout prevalence among pediatric residents was 66 % and was higher among third-year residents . A brief intervention was not effective in reducing burnout prevalence , despite the achievement of an improvement in " depersonalization . CONTEXT Data are sparse on the effect of varying the duration s of  internal medicine attending physician ward rotations .  OBJECTIVE To compare the effects of 2- vs 4-week inpatient attending physician rotations on unplanned patient revisits , attending evaluations by trainees , and attending propensity for burnout . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized crossover noninferiority trial , with attending physicians as the unit of crossover r and omization and 4-week rotations  as the active control , conducted in a US university-affiliated teaching hospital in academic year 2009 . Participants were 62 attending physicians who staffed at least 6 weeks of inpatient service , the 8892 unique patients whom they discharged , and the 147 house staff and 229 medical students who evaluated their performance . INTERVENTION Assignment to r and om sequences of 2- and 4-week rotations . MAIN OUTCOME MEASURES Primary outcome was 30-day unplanned revisits ( visits to the hospital 's emergency department or urgent ambulatory clinic , unplanned readmissions , and direct transfers from neighboring hospitals ) for patients discharged from 2- vs 4-week within-attending-physician rotations .  Noninferiority margin was a 2 % increase ( odds ratio [ OR ] of 1.13 ) in 30-day unplanned patient revisits . Secondary outcomes were length of stay ; trainee evaluations of attending physicians ; and attending physician reports of burnout , stress , and workplace control . RESULTS Among the 8892 patients , there were 2437 unplanned revisits . The percentage of 30-day unplanned revisits for patients of attending physicians on 2-week rotations was 21.2 % compared with 21.5 % for 4-week rotations ( mean difference , -0.3 % ; 95 % CI , -1.8 % to + 1.2 % ) . The adjusted OR of a patient having a 30-day unplanned revisit after 2- vs 4-week rotations was 0.97 ( 1-sided 97.5 % upper confidence limit , 1.07 ; noninferiority P = .007 ) . Average length of stay was not significantly different ( geometric means for 2- vs 4-week rotations were 67.2 vs 67.5 hours ; difference , -0.9 % ; 95 % CI , -4.7 % to + 2.9 % ) . Attending physicians were more likely to score lower in their ability to evaluate trainees after 2- vs 4-week rotations by both house staff ( 41 % vs 28 % rated less than perfect ; adjusted OR , 2.10 ; 95 % CI , 1.50 - 3.02 ) and medical students ( 82 % vs 69 % rated less than perfect ; adjusted OR , 1.41 ; 95 % CI , 1.06 - 2.10 ) . They were less likely to report higher scores of both burnout severity ( 16 % vs 35 % ; adjusted OR , 0.39 ; 95 % CI , 0.26 - 0.58 ) and emotional exhaustion ( 19 % vs 37 % ; adjusted OR , 0.45 ; 95 % CI , 0.31 to 0.64 ) after 2- vs 4-week rotations . CONCLUSIONS The use of 2-week inpatient attending physician rotations compared with 4-week rotations did not result in an increase in unplanned patient revisits . It was associated with better self-rated measures of attending physician burnout and emotional exhaustion but worse evaluations by trainees . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00930111 Background : Shorter resident duty periods are increasingly m and ated to improve patient safety and physician well-being . However , increases in continuity-related errors may counteract the purported benefits of reducing fatigue . We evaluated the effects of  3 resident schedules in the intensive care unit ( ICU ) on patient safety , resident well-being and continuity of care . Methods : Residents in 2 university-affiliated ICUs were r and omly assigned ( in 2-month rotation-blocks from January to June 2009 ) to in-house overnight schedules of 24 , 16 or 12 hours . The primary patient outcome was adverse events . The primary resident outcome was sleepiness , measured by the 7-point Stanford Sleepiness Scale . Secondary outcomes were patient deaths , preventable adverse events , and residents ’ physical symptoms and burnout . Continuity of care and perceptions of ICU staff were also assessed . Results : We evaluated 47 ( 96 % ) of 49 residents , all 971 admissions , 5894 patient-days and 452 staff surveys . We found no effect of schedule ( 24- , 16- or 12-h shifts ) on adverse events ( 81.3 , 76.3 and 78.2 events per 1000 patient-days , respectively ; p = 0.7 ) or on residents ’ sleepiness in the daytime ( mean rating 2.33 , 2.61 and 2.30 , respectively ; p = 0.3 ) or at night ( mean rating 3.06 , 2.73 and 2.42 , respectively ; p = 0.2 ) . Seven of 8 preventable adverse events occurred with the 12-hour schedule ( p = 0.1 ) . Mortality rates were similar for the 3 schedules . Residents ’ somatic symptoms were more severe and more frequent with the 24-hour schedule ( p = 0.04 ) ; however , burnout was similar across the groups . ICU staff rated residents ’ knowledge and decision-making worst with the 16-hour schedule . Interpretation : Our findings do not support the purported advantages of shorter duty schedules . They also highlight the trade-offs between residents ’ symptoms and multiple secondary measures of patient safety . Further delineation of this emerging signal is required before widespread system change . Trial registration : Clinical Trials.gov , no. NCT00679809 RATIONALE Around-the-clock intensivist presence in intensive care units ( ICUs ) has been promoted as necessary to optimize outcomes . Little data have addressed how it affects the multiple stakeholders in such care . OBJECTIVES To assess effects of around-the-clock intensivist presence on intensivists , patients , families , housestaff , and nurses . METHODS This 32-week , crossover pilot trial of two intensivist staffing models , performed in two Canadian ICUs , alternated 8-week blocks of two staffing models : the st and ard model , where one intensivist worked for 7 days , taking night call from home ; and the shift work model , where one intensivist worked 7 day shifts , while other intensivists remained in the ICU at night . MEASUREMENTS AND MAIN RESULTS Surveys scaled from 0 - 100 points assessed outcomes for 24 intensivists ( primary outcome : burnout ) ; 119 families ( satisfaction ) ; 74 nurses  ( satisfaction with collaboration and communications , role conflict ) ; and 34 housestaff ( autonomy , supervision , and learning opportunities ) . Outcomes for 501 patients included mortality , length of stay , and re source use . Intensivists doing shift work experienced less burnout ( -6.9 points ; P = 0.04 ) . Adjusted hospital mortality ( odds ratio , 1.22 ; P = 0.44 ) , ICU length of stay ( -6 h ; P = 0.46 ) , and family satisfaction ( 0.9 points ; P = 0.79 ) did not differ between staffing models . Under shift work staffing , nurses reported more role conflict ( 9 points ; P < 0.001 ) , whereas nighttime housestaff reported less autonomy , more supervision , but no difference in learning opportunities . CONCLUSIONS Shiftwork staffing was better for intensivists and most were receptive once they had experienced it . Although there were no evident negative outcomes for patients or families , further evaluation is needed to clarify how around-the-clock intensivist staffing influences the various stakeholders in ICU care , given power considerations in this study . Clinical trial registered with www . clinical trials.gov ( NCT 01146691 ) Background Internship and residency are difficult times with novice practitioners facing new challenges and stressors . Junior doctors may experience burnout , a syndrome that encompasses three dimensions : emotional exhaustion , depersonalisation and reduced personal accomplishment . While there is some existing literature on the prevalence of burnout in junior doctors , there are few studies on interventional strategies . 
    Output:
    
This systematic review and meta- analysis showed that ( 1 ) organization-directed interventions were associated with moderate reduction in burnout score , ( 2 ) physician-directed interventions were associated with small reduction in burnout score , ( 3 ) organization-directed interventions reduced more the depersonalization than physician-directed interventions , ( 4 ) organization-directed interventions were related to a more improvement of the personal accomplishment than physician-directed interventions .
This meta analysis found that physicians could gain important benefits from interventions to reduce burnout , especially from organizational strategies , by viewing burnout rooted in issues related to the working environment and organizational culture