Pragmatic Parental Support to Mitigate Burnout Among Pregnant and Postpartum Trainees: A Randomized Clinical Trial.

Abstract

Occupational burnout threatens care quality, workforce retention, and physician health. Childbearing physicians in training are at high risk due to stigma, low workplace support, and physical challenges compounding role transitions and increased home responsibilities, yet evaluations of mitigation strategies remain scarce. To assess the efficacy of a parental support package targeting perinatal stressors in reducing burnout and distress among childbearing physicians in training. Pragmatic, randomized, controlled, parallel-group clinical trial. Pregnant (≥12 weeks' gestation) residents and fellows were enrolled across 7 training institutions in the northeastern US from May 2023 to July 2024. Nonbirthing parents were excluded. Follow-up concluded in May 2025. Participants were randomized 1:1, stratified by site and specialty type (procedural vs nonprocedural), to receive a parental support package (n = 78) or usual support (n = 78) from early pregnancy through 24 weeks post partum. The parental support package included a smart bassinet, wearable breast pump, virtual perinatal support, and formal faculty mentorship. The primary outcome was change in burnout (Stanford Professional Fulfillment Index; score range, 0-10; and the emotional exhaustion and interpersonal disengagement subscales), from enrollment during pregnancy to 24 weeks post partum. Secondary outcomes included changes in professional fulfillment, organizational and personal values alignment, relationship strain, career dissatisfaction, and sleep-related impairment. Mixed-effects models analyzed outcomes. Effect sizes were standardized using the Cohen d (0.2: small; 0.5: medium; 0.8: large). Of 156 randomized participants, 143 were included in the primary analysis (median age, 32 [IQR, 31-34] years; 71 in the parental support package group and 72 in the usual support group). From enrollment during pregnancy to 24 weeks post partum, mean burnout scores increased from 2.96 to 3.03 in the parental support package group and from 3.13 to 3.79 in the usual support group (adjusted between-group difference in change, -0.58; 95% CI, -1.10 to -0.07; P = .03; d = 0.65). Differences were driven by interpersonal disengagement (adjusted between-group difference in change, -0.70; 95% CI, -1.24 to -0.15; P = .01; d = 0.57). Emotional exhaustion scores were not statistically different between groups. Among childbearing physicians in training, a parental support package significantly mitigated postpartum burnout. ClinicalTrials.gov Identifier: NCT06014892.