***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 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 . Background and objective Stress and burnout impact resident physicians . This prospect i ve study tests the hypothesis that a mindfulness-based resilience intervention would decrease stress and burnout  in residents . Methods Resident physicians from the Departments of Family Medicine , Psychiatry , and Anesthesia at Duke University , Durham , NC , USA , participated in two or three 1-hour sessions of mindfulness-based resilience activities , which introduced mindful-awareness and included practical exercises for nurturing resilience . Anonymous surveys were distributed before ( completed by 47 residents ) and after the intervention ( both completed by 30 residents ) ; a follow-up survey was distributed 1 month later ( seven residents completed all three surveys ) . The survey included the Depression Anxiety Stress Scale , 21- question version ( DASS-21 ) , the Oldenburg Burnout Inventory , the Mindful Attention Awareness Scale , and ten questions from the Cognitive Failures Question naire . Results At baseline , most residents ’ scores were in the normal range with respect to stress ; however , female residents had higher DASS-21 scores than male residents ( 31.7 , females vs 18.4 , males ; P=0.002 ) . Most residents ’ burnout scores were in the abnormal range , both with respect to exhaustion ( 38/47 residents , subscore ≥2.25 ) and disengagement ( 37/47 residents , subscore ≥2.1 ) . Higher perceived levels of stress correlated with the instruments . Analysis of the surveys before and after the intervention showed no significant short-term change in stress , burnout , mindful-awareness , or cognitive failure . There was a trend for females and post-medical school graduate year 1 and 2 ( PGY1 and PGY2 ) residents to have a reduction in DASS-21 scores after intervention . There was also a trend of reduced stress and burnout in residents who perceived higher stress . Conclusion Residents who are female , PGY1 and PGY2 , and who perceive residency to be stressful may benefit most from a mindfulness-based resilience intervention Objective To study the implementation of multidisciplinary structured work shift evaluations at a pediatric intensive care unit ( PICU ) to enhance team communication . Design and setting Prospect i ve , repeated measurements design , comparison of pre/post measurements and process measures in a Dutch tertiary care , university-affiliated PICU . Participants All 61 PICU staff members . Interventions Implementing multidisciplinary structured work shift evaluations . Before the implementation phase the PICU team received feedback training and eight participants ( four physicians , four nurses ) were trained as “ work shift evaluation leader .  ” Measurements and results Outcome measures covered : ( a ) quality and process of the implementation through prestructured checklists during the 3 months of implementation , ( b ) a subjective evaluation of a feedback training on team communication as anticipated action and on the level of communication ( about patients and with colleagues ) , and ( c ) emotional exhaustion complaints and work-related fatigue . The interdisciplinary structured work shift evaluations were implemented successfully as planned during the work shift ; all staff were trained ahead , and the process was followed almost completely . Almost two-thirds ( 62 % ) of the staff felt a positive influence on team communication . Almost all staff members ( 92 % ) were satisfied regarding communication with their colleagues after the intervention , compared to 76 % before . Emotional exhaustion in the PICU team decreased significantly after the implementation , but no differences in work-related fatigue levels were found . Conclusions As organizational change the implementation of a multidisciplinary structured work shift evaluation at a PICU was successful and team communication improved . Emotional exhaustion decreased during the study period 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Burnout is common in internal medicine ( IM ) trainees and is associated with depression and sub 
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INTERPRETATION The literature indicates that both individual-focused and structural or organisational strategies can result in clinical ly meaningful reductions in burnout among physicians .