Optimizing the Work of Learning for Flourishing: A Randomized Pilot Study of a Digital CBT-Based Intervention in Medical Students

OBJECTIVE: This study aimed to evaluate the feasibility, acceptability, and impact of a digital cognitive behavioral therapy (CBT)-based intervention to improve well-being in medical students. METHODS: The authors conducted a 16-week randomized (1:1) controlled trial of a digital CBT-based intervention (OptimalWork) compared to a podcast listening control in medical students. Both interventions were fully remote, self-paced, and designed to take 10-15 min per day, 5 days per week for 4 weeks. Primary outcomes were feasibility and acceptability; measures of impact included flourishing (Flourish Index) and burnout (Professional Fulfillment Index) at 8 weeks. Qualitative analysis of open-ended feedback and exit interviews was performed to understand participants' experience with the intervention, as well as barriers and facilitators of implementation. RESULTS: Thirty-five medical students were enrolled and randomized. The OptimalWork group showed improvements in work engagement, burnout, anxiety, and stress, and an increase in overall flourishing. Dropout rates were high in both arms (46% by 4 weeks, 56% by 16 weeks), with lower baseline work engagement and higher stress predicting attrition. Qualitative analysis revealed that students who completed OptimalWork found it feasible, relevant, and helpful, while participants who dropped out cited time constraints and difficulty with daily habit formation. CONCLUSIONS: This pilot study demonstrates the feasibility of delivering a CBT-based digital intervention designed to improve well-being at work for medical students and offers insights into barriers and facilitators that can guide implementation efforts. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06914843 (July 24, 2024, retrospectively registered).