Clinical effectiveness of internet-delivered self-help Aacceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): a multicentre, parallel, randomised controlled trial.

Burnout, recognized by the World Health Organization as an occupational phenomenon, is a common and serious health concern in healthcare systems worldwide . Based on Maslach’s framework, burnout includes three interrelated domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) . In this study, PA is operationalized as reduced efficacy (RE) to harmonize effect directions across instruments (see Materials and Methods). Burnout adversely affects clinicians―contributing to mood symptoms, family conflict, erosion of professional identity, and early career departure―and patients, with associations to medical errors, complications, longer hospital stays, legal risks, and lower satisfaction with care . At the system level, the economic burden is substantial (e.g., US $4.6 billion annually in the United States) . Among physicians in training, residency is widely regarded as one of the most demanding phases of medical education. An estimated one-third to half of residents experience burnout across countries and specialties , and meta-analytic summaries indicate a 28.8% prevalence of depressive symptoms in this population . Although burnout is conceptually distinct from major depressive disorder, symptoms can overlap and the conditions may co-occur in physician residents. This review focuses on burnout domains (EE/DP/RE/global burnout [GB]) as intervention targets while acknowledging related mental health burdens. Burnout in residency has also been linked to attrition, medical error, and, in a concerning minority, suicidality . Together, these concerns highlight burnout as an important target for early recognition and support during residency training. To alleviate burnout, programs have used a wide range of strategies, from individual-focused approaches (e.g., mindfulness and coaching) to organizational approaches (e.g., duty-hour redesign). Individual-focused approaches can also include reflective strategies that help residents process the emotional and interpersonal demands of clinical work, and such reflection-oriented support has been highlighted as a potentially valuable component of resident well-being efforts . However, trial results have varied across studies, and prior studies typically report small pooled effects with uncertain practical significance . Moreover, structural reforms alone (e.g., duty-hour limits) can be offset by work compression , suggesting that durable progress likely requires bundled, context-sensitive approaches that pair organizational design with individual support. Although the evidence base has expanded, important research gaps remain, such as the non-randomized designs, reliance on unblinded self-reported outcomes, and overall high risk of bias, leading to very low certainty . In addition, pairwise meta-analyses cannot compare the multiplicity of strategies simultaneously or generate a defensible ranking of options when head-to-head trials are scarce. A network meta-analysis (NMA) can address this gap by estimating comparative efficacy across competing intervention categories.