While there exist many individual and organisation-level initiatives aimed at reducing physician burnout and promoting wellness, there are no comprehensive frameworks or guidelines for evaluating initiatives targeted at physicians. To address this gap, we conducted a rapid review to understand the current state of initiative evaluation in this field and develop an evaluation framework for initiatives aimed at physician burnout and wellness.

A rapid review based on the Cochrane rapid review methods guidance.

MEDLINE, Embase and PsycInfo were searched from database inception to 2 May 2024 for concepts related to physicians, wellness initiatives and burnout, and organisational efforts.

We included studies with initiatives aimed at physician burnout, wellness or experience; targeted physicians, residents, fellows and/or physician faculty; were evaluated in some format; and took place within healthcare settings.

Two independent reviewers extracted data according to a standard template. For each study, we noted information related to the type of wellness initiative, evaluation approach, components measured in evaluations (‘evaluation indicators’) and gaps in evaluation. The same reviewers analysed the data quantitatively and thematically. Findings were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

The database search yielded a total of 3786 references, of which 105 were included based on predefined inclusion and exclusion criteria. Various types of wellness initiatives (eg, mindfulness, peer support programmes, communities of practice) were delivered multimodally, or via curriculums and workshops, among other formats. Common evaluation approaches included surveys (95%, n=100/105) and interviews or focus groups (17%, n=18/105). Evaluation indicators spanned five categories: impacts (94.3%, n=99/105), participants’ reactions (65.7%, n=69/105), perspective and behaviour changes (46.7%, n=49/105), implementation (45.7%, n=48/105) and continuous improvement (6.7%, n=7/105). Evaluation gaps included limited responses from participants, failure to capture certain indicators (eg, physician turnover) and limited longitudinal measures.

Based on the findings and existing models, we developed a physician-focused evaluation framework, constituting two domains: implementation and impacts. This framework can enable organisations to better understand, assess and improve initiatives aimed at physician well-being, which can have positive impacts on patient care and the healthcare system.

To explore differences in health-related benefit status over 3 years, focusing on patterns of sick leave, work assessment allowance and disability benefits, between people who underwent rehabilitation and a matched control group.

Prospective longitudinal multicentre cohort study using registry data over three consecutive years.

Secondary specialist rehabilitation services at 17 institutions across Norway.

Patients (n=2710), 42% with rheumatic and musculoskeletal diseases, aged 18–65 years referred for multidisciplinary rehabilitation at one of the participating institutions. They were propensity score matched with 37 760 controls from the national sick leave registry, based on sociodemographic factors and health-related benefit status.

Multidisciplinary rehabilitation programmes, commonly lasting 3 weeks (range: 1 week to 6 months), tailored to individual needs.

Days on health-related benefits (sick leave, work assessment allowance (WAA) and disability benefits) were quantified as lost workdays per month. Differences between groups were analysed using Generalised Estimating Equations across three consecutive years: the year before rehabilitation, the rehabilitation year and the year after rehabilitation.

The rehabilitation group had more days on health-related benefits per month than controls throughout the observation period. During the rehabilitation year, they had on average 1.7 more days on sick leave (95 % CI 1.3 to 1.9), 2.3 more WAA days (95% CI 1.9 to 2.7) and 0.2 more days on disability benefits (95% CI 0.1 to 0.3). In the year after rehabilitation, they had 0.6 fewer days on sick leave (95% CI –0.8 to –0.3), but 3.7 more days on WAA (95% CI 3.1 to 4.2) and 0.6 more days on disability benefits (95% CI 0.4 to 0.8). Patterns were similar for the subgroup with rheumatic and musculoskeletal diseases.

People undergoing rehabilitation had more days on health-related benefits and a greater increase in long-term benefits, even after matching, indicating a higher disease and support burden than controls. Tailoring interventions and health-related benefits is an essential aspect of rehabilitation for people with complex work participation needs. Future research should include longer observation periods to explore long-term outcomes of rehabilitation.

NCT03764982