***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: Background Physicians often experience work-related stress that may lead to personal harm and impaired professional performance . Biofeedback has been used to manage stress in various population s. Objective To determine whether a biofeedback-based stress management tool , consisting of rhythmic breathing , actively self-generated positive emotions and a portable biofeedback device , reduces physician stress . Design R and omized controlled trial measuring efficacy of a stress-reduction intervention over 28 days , with a 28-day open-label trial extension to assess effectiveness . Setting Urban tertiary care hospital . Participants Forty staff physicians ( 23 men and 17 women ) from various medical practice s ( 1 from primary care , 30 from a medical specialty and 9 from a surgical specialty ) were recruited by means of electronic mail , regular mail and posters placed in the physicians ’ lounge and throughout the hospital . Intervention Physicians in the intervention group were instructed to use a biofeedback-based stress management tool three times daily . Participants in both the control and intervention groups received twice-weekly support visits from the research team over 28 days , with the intervention group also receiving re-inforcement in the use of the stress management tool during these support visits . During the 28-day extension period , both the control and the intervention groups received the intervention , but without intensive support from the research team . Main outcome measure Stress was measured with a scale developed to capture short-term changes in global perceptions of stress for physicians ( maximum score 200 ) . Results During the r and omized controlled trial ( days 0 to 28 ) , the mean stress score declined significantly for the intervention group ( change –14.7 , st and ard deviation [ SD ] 23.8 ; p = 0.013 ) but not for the control group ( change –2.2 , SD 8.4 ; p = 0.30 ) . The difference in mean score change between the groups was 12.5 ( p = 0.048 ) . The lower mean stress scores in the intervention group were maintained during the trial extension to day 56 . The mean stress score for the control group changed significantly during the 28-day extension period ( change –8.5 , SD 7.6 ; p < 0.001 ) . Conclusion A biofeedback-based stress management tool may be a simple and effective stress-reduction strategy for physicians Background Mental distress among medical students is often reported . Burnout has not been studied frequently and studies using interviewer-rated diagnoses as outcomes are rarely employed . The objective of this prospect i ve study of medical students was to examine clinical ly significant psychiatric morbidity and burnout at 3rd year of medical school , considering personality and study conditions measured at 1st year . Methods Question naires were sent to 127 first year medical students who were then followed-up at 3rd year of medical school . Eighty-one of 3rd year respondents participated in a diagnostic interview . Personality ( HP5-i ) and  Performance-based self-esteem ( PBSE-scale ) were assessed at first year , Study conditions ( HESI ) , Burnout ( OLBI ) , Depression ( MDI ) at 1st and 3rd years . Diagnostic interviews ( MINI ) were used at 3rd year to assess psychiatric morbidity . High and low burnout at 3rd year was defined by cluster analysis . Logistic regressions were used to identify predictors of high burnout and psychiatric morbidity , controlling for gender . Results 98 ( 77 % ) responded on both occasions , 80 ( 63 % ) of these were interviewed . High burnout was predicted by Impulsivity trait , Depressive symptoms at 1st year and Financial concerns at 1st year . When controlling for 3rd year study conditions , Impulsivity and concurrent Workload remained . Of the interviewed sample 21 ( 27 % ) had a psychiatric diagnosis , 6 of whom had sought help . Unadjusted analyses showed that psychiatric morbidity was predicted by high Performance-based self-esteem , Disengagement and Depression at 1st year , only the later remained significant in the adjusted analysis . Conclusion Psychiatric morbidity is common in medical students but few seek help . Burnout has individual as well as environmental explanations and to avoid it , organisational as well as individual interventions may be needed . Early signs of depressive symptoms in medical students may be important to address . Students should be encouraged to seek help and adequate facilities should be available OBJECTIVE To determine the prevalence of psychiatric morbidity and burnout in final-year medical students , and changes in these measures during the intern year . DESIGN Prospect i ve longitudinal cohort study over 18 months , with assessment of psychiatric morbidity and burnout on six occasions . PARTICIPANTS All 117 students in the first graduating cohort of the University of Sydney Graduate Medical Program were invited to participate in the study ; 110 consented . OUTCOME MEASURES Psychiatric morbidity assessed with the 28-item General Health Question naire and burnout assessed with the Maslach Burnout Inventory .  RESULTS The point prevalence of participants meeting criteria for psychiatric morbidity and burnout rose steadily throughout the study period . CONCLUSIONS Internship remains a stressful time for medical graduates , despite initiatives to better support them during this period . The implication s for the doctors themselves and for the communities they serve warrant further attention , including programs specifically aim ed at reducing the rate of psychological morbidity and burnout during internship CONTEXT Medical errors are associated with feelings of distress in physicians , but little is known about the magnitude and direction of these associations . OBJECTIVE To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life , burnout , depression , and empathy using vali date d metrics . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester . Data were provided by 184 ( 84 % ) of 219 eligible residents . Participants began training in the 2003 - 2004 , 2004 - 2005 , and 2005 - 2006 academic years and completed surveys quarterly through May 2006 . Surveys included self- assessment of medical errors and linear analog scale assessment of quality of life every 3 months , and the Maslach Burnout Inventory ( depersonalization , emotional exhaustion , and personal accomplishment ) , Interpersonal Reactivity Index , and a vali date d depression screening tool every 6 months . MAIN OUTCOME MEASURES Frequency of self-perceived medical errors was recorded . Associations of an error with quality of life , burnout , empathy , and symptoms of depression were determined using generalized estimating equations for repeated measures . RESULTS Thirty-four percent of participants reported making at least 1 major medical error during the study period . Making a medical error in the previous 3 months was reported by a mean of 14.7 % of participants at each quarter . Self-perceived medical errors were associated with a subsequent decrease in quality of life ( P = .02 ) and worsened measures in all domains of burnout ( P = .002 for each ) . Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 ( 95 % confidence interval , 1.90 - 5.64 ) . In addition , increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months ( P=.001 , P<.001 , and P=.02 for depersonalization , emotional exhaustion , and lower personal accomplishment , respectively ; P=.02 and P=.01 for emotive and cognitive empathy , respectively ) . CONCLUSIONS Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress . Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors , suggesting that perceived errors and distress may be related in a reciprocal cycle Background Physician distress is common and related to numerous factors involving physicians ’ personal and professional lives . The present study was design ed to assess the effect of a Stress Management and Resiliency Training ( SMART ) program for increasing resiliency and quality of life , and decreasing stress and anxiety among Department of Medicine ( DOM ) physicians at a tertiary care medical center . Participants Forty DOM physicians were r and omized in a wait-list controlled clinical trial to either the SMART intervention or a wait-list control group for 8 weeks . The intervention involved a single 90 min one-on-one training in the SMART program . Primary outcome measures assessed at baseline and week 8 included the Connor Davidson Resilience Scale ( CDRS ) , Perceived Stress Scale ( PSS ) , Smith Anxiety Scale ( SAS ) and Linear Analog Self Assessment Scale ( LASA ) . Results Thirty-two physicians completed the study . A statistically significant improvement in resiliency , perceived stress , anxiety , and overall quality of life at 8 weeks was observed in the study arm compared to the wait-list control arm : CDRS : mean ± SD change from baseline + 9.8 ± 9.6 vs. -0.8 ± 8.2 , t(30 ) = 3.18 , p = 0.003 ; PSS : -5.4 ± 8.1 vs. + 2.2 ± 6.1 , t(30 ) = -2.76 , p = 0.010 ; SAS : -11.8 ± 12.3 vs.+ 2.9 ± 8.9 , t(30 ) = -3.62 , p = 0.001 ; and LASA : + 0.4 ± 1.4 vs. -0.6 ± 1.0 , t(30 ) = 2.29 , p = 0.029 . Conclusions A brief training to enhance resilience and decrease stress among physicians using the SMART program was feasible . Further , the intervention provided statistically significant improvement in resilience , stress , anxiety , and overall quality of life . In the future , larger clinical trials with longer follow-up and possibly wider dissemination of this intervention are warranted Objective The main goal of this research was to investigate the complex relationships among coping styles , personality , burnout , and anxiety using a moderated mediation analysis . Methods A r and om cluster sampling procedure was used to select a total of 1274 physicians from two tertiary grade A hospitals in Heilongjiang Province , which is located in northeast China . The  Zung Self-Rating Anxiety Scale ( SAS ) , Chinese Maslach Burnout Inventory ( CMBI ) , Chinese version of the EPQ-revised Short Scale , and the Trait Coping Style Question naire ( TCSQ ) were used to gather data . Moderated mediation analysis was used in this study ; it was executed using the PROCESS macro so that the mediators and moderator could function together in the same model . Results The  prevalence of anxiety symptoms among the physicians was 31 % , and there were no differences between the sexes . The results showed that positive and negative coping styles partially mediated the association between burnout and anxiety symptoms in physicians . The mediated effect of positive coping styles was moderated by Eysenck ’s Psychoticism traits . Conclusions Personality traits moderate the strength of the relationships between burnout and anxiety mediated by positive coping styles ; however , personality traits do not moderate the strength of the relationships between burnout and anxiety mediated by negative coping styles CONTEXT Primary care physicians report high levels of distress , which is linked to burnout , attrition , and poorer quality of care . Programs to reduce burnout before it results in impairment are rare ; data on these programs are scarce . OBJECTIVE To determine whether an intensive educational program in mindfulness , communication , and self-awareness is associated with improvement in primary care physicians ' well-being , psychological distress , burnout , and capacity for relating to patients . DESIGN , SETTING , AND PARTICIPANTS Before- and -after study of 70 primary care physicians in Rochester , New York , in a continuing medical education ( CME ) course in 2007 - 2008 . The course included mindfulness meditation , self-awareness exercises , narratives about meaningful clinical experiences , appreciative interviews , didactic material , and discussion . An 8-week intensive phase ( 2.5 h/wk , 7-hour retreat ) was followed by a 10-month maintenance phase ( 2.5 h/mo ) . MAIN OUTCOME MEASURES Mindfulness ( 2 subscales ) , burnout ( 3 subscales ) , empathy ( 3 subscales ) , psychosocial orientation , personality ( 5 factors ) , and mood ( 6 subscales ) measured at baseline and at 2 , 12 , and 15 months . RESULTS Over the course of the program and follow-up , participants demonstrated improvements in mindfulness ( raw score , 45.2 to 54.1 ; raw score change [ Delta ] , 8.9 ; 95 % confidence interval [ CI ] , 7.0 to 10.8 ) ; burnout ( emotional exhaustion , 26.8 to 20.0 ; Delta = -6.8 ; 95 % CI , -4.8 to -8.8 ; depersonalization , 8.4 to 5.9 ; Delta = -2.5 ; 95 % CI , -1.4 to -3.6 ; and personal accomplishment , 40.2 to 42.6 ; Delta = 2.4 ; 95 % CI , 1.2 to 3.6 ) ; empathy ( 116.6 to 121.2 ; Delta = 4.6 ; 95 % CI , 2.2 to 7.0 ) ; physician belief scale ( 76.7 to 72.6 ; Delta = -4.1 ; 95 % CI , -1.8 to -6.4 ) ; total mood disturbance ( 33.2 to 1 
    Output:
    
Cognitive behavioural interventions demonstrated the strongest evidence , particularly for reducing stress .
Some evidence was identified to support the efficacy of relaxation-based approaches , but no such evidence was found for the efficacy of discussion -based interventions , such as Balint groups .
Conclusion This review found that despite increased scientific attention , the quality of research examining the benefits of psychosocial/behavioural interventions for occupational stress and burnout in medical doctors remains low .
Despite this , interventions focused on cognitive and behavioural principles appear to show promise in reducing doctor stress and burnout .