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Are Resilience Training Models Effective in the Era of COVID-19?

  • Authors: News Author: Avery Hurt; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 8/5/2022
  • Valid for credit through: 8/5/2023
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Target Audience and Goal Statement

This activity is intended for physicians, nurses, nurse practitioners, pharmacists, physician assistants and other frontline healthcare providers.

The goal of this activity is learners will be better able to evaluate the effect of resilience training among healthcare workers.

Upon completion of this activity, participants will:

  • Assess risk factors for anxiety and depression among healthcare workers during the COVID-19 pandemic
  • Evaluate the effect of resilience training among healthcare workers
  • Outline implications for the healthcare team


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News Author

  • Avery Hurt

    Freelance writer, Medscape


    Avery Hurt has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

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This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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Are Resilience Training Models Effective in the Era of COVID-19?

Authors: News Author: Avery Hurt; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 8/5/2022

Valid for credit through: 8/5/2023


Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to the approved COVID-19 vaccines are provided in this activity in an effort to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

There is no doubt that the COVID-19 pandemic has placed a high burden of stress on the healthcare system and the workers in that system. A study by Gilleen and colleagues quantified that level of stress and mental trauma as well as risk factors for stress during the COVID-19 pandemic. Their results were published in the April 29, 2021 issue of BJPsych Open.[1]

A total of 2773 healthcare employees took a survey in mid-2020. Nearly one-third of healthcare workers reported moderate to severe levels of anxiety and depression, and the rate of severe mood symptoms had increased more than 4-fold since the time before the pandemic.

Risk factors for mood symptoms included being a frontline health worker; being female; and a prior history of a mood disorder. Age was not as significant a risk factor, and the rate of anxiety/depression was higher among managers compared with that of physicians. Being in a relationship was protective against mood symptoms compared with being single.

Could resilience training help healthcare workers to reduce stress and mood symptoms? The current study by Yi-Frazier and colleagues addresses this issue.

Study Synopsis and Perspective

Hospital workers, both persons who work directly with patients and persons behind the scenes, have faced enormous challenges during the pandemic, leading to significant mental health burdens, including increased stress, anxiety, and burnout. Although these problems have been well-documented, there has been little research on the efficacy of methods to address them, but a recent study published in JAMA Network Open looked at a program that shows promise for struggling healthcare workers.[2]

The study looked at the feasibility of Promoting Resilience in Stress Management (PRISM), a skills-based training program designed to mitigate stress and build resilience in situations of elevated stress. This study used a program called PRISM at Work,[3] a version of PRISM adapted for healthcare workers. Participants completed a baseline survey, attended classes, then completed a follow-up survey.


Of 153 participants, 140 were female, 12 were male, and 1 was nonbinary. The mean age was 40.6 ± 10.1 years, and 84% of participants were white. A little more than half (53%) were in patient-facing roles (nurses, doctors, and allied health professionals) whereas 46% were in non--patient-facing roles (such as managers, research staff, and business office workers). The baseline scores found low levels of perceived resilience, moderate levels of stress and anxiety, and high levels of burnout/exhaustion.[2]

Study investigators divided participants into 15 classes, with 8 to 12 people in each. They defined feasibility as 70% completion among the enrolled participants. Of the 153 who completed the baseline survey, 145 (95%) attended the first session. Of those participants, 78% completed 5 or 6 of the 6 total sessions. A large majority (91%) completed follow-up surveys, and 64% answered open-ended questions. None of the participants expressed concerns that prompted support greater than the program's coaches could offer.

A total of 88% of the participants who filled out follow-up surveys said they were satisfied overall with the program. Attendees were also largely satisfied or very satisfied with the frequency of the sessions (91%) and the length of the sessions (83%).


Of the participants who answered the open-ended questions, 99% said they could nominate someone at their workplace who would benefit from the program; 48% said they thought everyone at work would benefit. Individuals who responded to the open-ended questions most often mentioned community, connection, and support as the things they liked best about the program. Suggestions for improvement included extending the program by making the sessions longer or by having more sessions. These results suggest that the PRISM at Work program is both feasible and acceptable to participants.

Baseline scores of resilience increased by a mean of 1.74 points, stress decreased by a mean of 2.4 points, anxiety was down by 2.04, and burnout/exhaustion dropped by 0.37, a slight improvement post-PRISM.

The authors pointed out that it is unclear if the baseline low-resilience scores were due to the COVID-19 pandemic or whether they were common before the pandemic.

"Regardless," they wrote, "opportunities to learn, reflect on, and develop one's resilience resources are necessary."

This study showed that programs such as PRISM at Work are feasible, acceptable, and could potentially be effective in addressing such issues; however, the authors also warned that efforts must come from both healthcare workers themselves and the healthcare organizations for which they are a part.

Abby Rosenberg, MD, associate professor of pediatrics, division of hematology/oncology, at the University of Washington School of Medicine in Seattle, Washington, and lead author of the study, noted that people seem to be hungry for a means of coping with the stress and burnout that has plagued health care in recent years, but she added that programs like this, although well-received and helpful, are "not a panacea, not a singular fix."

We need to fix the system that has created the problem in the first place.

This study was funded by an internal grant sponsored by the Seattle Children's Research Institute COVID funds. Rosenberg disclosed grants for unrelated work from the National Institutes of Health, the American Cancer Society, Arthur Vining Davis Foundations, Cambia Health Solutions, Conquer Cancer Foundation of ASCO®, CureSearch for Children's Cancer, the National Palliative Care Research Center, and the Seattle Children's Research Institute.

Study Highlights

  • The study was conducted at one university medical center in the United States. Recruitment began in September 2020 and concluded in April 2021.
  • Participants were healthcare workers recruited to participate in groups of 10 to 12 in PRISM, a skills-based training program with strict protocols and trained coaches. Participants were asked to complete 6 one-hour sessions, which focused on topics such as stress management, cognitive reframing, and meaning making.
  • The main study outcome was attendance at the seminars, with a target of ≥ 70%. Other outcomes were measured at baseline and 7 weeks (1 week after the termination of seminars) and included satisfaction. Researchers measured self-perceived resilience, stress, anxiety, burnout, and hope were with validated instruments.
  • The analysis was done for pre- and post-intervention. The researchers adjusted the results for age, job category, marital status, and period when the staff took the PRISM course.
  • 153 participants entered the study. The mean age was 40.6 ± 10.1 years, and 92% were female. 84% of the cohort was White. 53% of participants were in patient-facing roles.
  • At baseline, participants had low levels of self-perceived resilience. They also reported moderate stress and anxiety along with high levels of burnout.
  • 95% of randomized staff attended the first PRISM visit. 78% of these participants went on to attend 5 or 6 sessions of the 6-session course. 100% of PRISM courses filled to capacity, with an average of 5 people on the wait-list.
  • The overall satisfaction rate for the PRISM program was 88%; 48% of participants felt that all healthcare workers should attend the program.
  • There was a significant mean 1.74-point improvement (of 40 total points) in resilience scores after the program, and stress levels decreased by a mean of 2.4 points (of 40 total points) after the program.
  • Reductions in anxiety and burnout were similar and significant after the PRISM program, and benefit finding and hope increased after the training.
  • Results were similar in comparing workers from patient-facing and non-patient-facing roles.

Clinical Implications

  • In a previous study by Gilleen and colleagues of healthcare workers during the COVID-19 pandemic, risk factors for mood symptoms included being a frontline healthcare worker, being female, and a prior history of a mood disorder. Age was not as significant a risk factor, and the rate of anxiety/depression was higher among managers compared with that of physicians. Being in a relationship was protective against mood symptoms compared with being single.
  • The current study by Yi-Frazier and colleagues demonstrates excellent attendance and satisfaction of healthcare workers attending resilience training, with significant improvements in stress, anxiety, burnout, and hope immediately after the training.
  • Implications for the healthcare team: As increasing numbers of healthcare workers experience burnout following the COVID-19 pandemic, resilience training should be considered as a resource to improve well-being and foster community and connection among team members.


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