Effectiveness of a mindfulness- and compassion-based online intervention for physician burnout: A randomized controlled trial with mediation and clinical outcome analyses

Abstract

Background

Physician burnout remains a persistent global challenge, yet most mindfulness-based interventions are limited by small samples, short follow-up, and lack of ethical integration. This study evaluated the efficacy of a culturally adapted, ethically grounded mindfulness- and compassion-based program (IBAP) in reducing burnout among physicians.

Methods

In a randomized controlled trial, 474 Chilean physicians were assigned to an eight-week online IBAP program (n = 120) or a waitlist control (n = 354). Assessments were conducted at baseline, post-intervention, and 6-month follow-up. The primary outcome was burnout (MBI-HSS); secondary outcomes included mindfulness, self-compassion, well-being, and perceived medical errors. Analyses used linear mixed-effects models (LMMs), Bonferroni-adjusted p-values, and Cohen's d. Sensitivity analyses included multiple imputation, per-protocol, and tipping-point models.

Results

IBAP significantly reduced total burnout at post-intervention (B = −9.74, SE = 1.77, p < 0.001; d = −0.91) and follow-up (B = −11.55, SE = 1.84, p < 0.001; d = −1.08). Improvements were also observed in emotional exhaustion (p < 0.001), depersonalization (p = 0.030), and personal accomplishment (p = 0.008). Gains in mindfulness, self-compassion, and psychological well-being remained significant after Bonferroni correction. Mediation analyses showed that mindfulness and self-compassion each accounted for ∼30 % of the burnout reduction. Additionally, reductions in burnout significantly mediated lower self-reported medical errors.

Conclusion

IBAP produced large, sustained reductions in physician burnout, with effects confirmed across sensitivity analyses. The program also reduced perceived medical errors via burnout reduction, supporting its clinical relevance and scalability.