BurnoutNCT05280964
Better Together: an Online Physician Coaching Program for Medical Trainees
A study testing Better Together Physician Coaching in people with Burnout and Self-compassion, run by University of Colorado, Denver at 1 site in United States.
Trial summary
This is a single-institution randomized controlled trial. 101 female residents were recurited from the University of Colorado School of Medicine. They enrolled beginning in January 2021 and participated in the coaching program for 6 months via a web-based system. Read more about this study
- Who is it for?
- Ages 18 to 65 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Burnout, Self-compassion, Moral Injury
- What is being tested?
- Better Together Physician Coaching
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 101 participants
- Where
- 1 siteUnited States
- Study dates
- 1 Dec 2020to 1 Jan 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- graduate medical education trainees (residents and fellows) at the University of Colorado
- Female identifying
Who cannot join
- Non trainees
- non- female identifying
Trial locations and contacts
1 site in 1 country.
United States1 site
University of Colorado School of Medicine
Aurora, Colorado, 80230
About this study
Official title: Effect of a Novel Online Physician Group-Coaching Program to Reduce Burnout in Trainees: A Randomized Controlled Trial
This is a single-institution randomized controlled trial. 101 female residents were recurited from the University of Colorado School of Medicine. They enrolled beginning in January 2021 and participated in the coaching program for 6 months via a web-based system. Participants were randomized into either the intervention or wait-list control arm. Participants in the intervention arm began the 6-month coaching program in January, 2021. Participants in the wait-list control arm have received no additional resources from the Better Together program between January and June 2021. The wait-list control group was invited to begin the 6-month coaching program in July 2021. In December 2021, participants from both the intervention and wait-list control groups will be invited to complete a 2nd post survey (identical to the post-survey from June 2021). There will be no incentive for completion of the 2nd post survey. Finally, the longitudinal effect of the program will be assessed by offering the same survey measuring wellbeing via various indices to the intervention arm at 6 months (1/2022), 12 months (7/2022) and 18 months (1/2023) after their intervention. Participation in this survey will be completely voluntary and not incentivized/compensated.
Read the detailed description
Background:
Positive psychology coaching programs demonstrate efficacy in reducing emotional exhaustion (a construct of burnout) and improving coping skills among residents but rely on substantial faculty development and coordination for participants. Considering the disproportionate burnout risk faced by women trainees in medicine, novel strategies to mitigate this risk is needed. Among a national sample of resident physicians, 60% screen positive for burnout. Compared to age-matched peers, residents are significantly more likely to experience burnout and have burnout persist into early careers. Female trainees are particularly vulnerable, with long-term consequences affecting professional development and success. Disproportionate burnout among women may be a contributor to the "leaky pipeline" in academic medicine, where women start their careers as 46% of the resident workforce yet represent only 25% of full professors and 18% of department chairs. Social connectedness and the practice of self-compassion are important intervention in reducing burnout and increasing resilience among residents. Positive psychology coaching programs have specifically had demonstrated efficacy in faculty and residents. Web-based group coaching programs have not been assessed for their potential to reduce burnout and improve resilience and well-being among trainees.
- Outcome Measure(s):
- participation (administrative data)
- participant experience and reflection (interview)
- measures of burnout and self-compassion as measured on a pre- and post- program survey including the Maslach Burnout Inventory (MBI) and Neff Self Compassion Score (SCS). Semi structured qualitative interviews will be led by a PRA upon completion of the 6-month pilot. The interview script will include questions about program content, participant experience, coping skills, interpersonal connectedness, personal and professional satisfaction, and general reflections.
Description of Population to be Enrolled:
This pilot study recruited individuals from the University of Colorado graduate medical education training programs. The pilot program is limited to female trainees who have greater than 1 year of training left in order to give trainees time to complete the program prior to graduation. Enrollment in the program is entirely voluntary and trainees can cease enrollment at any time.
Study Design and Research Methods:
This is a single-institution randomized controlled trial. 101 female residents were recruited from the University of Colorado School of Medicine. They enrolled beginning in January 2021 and participated in the coaching program for 6 months via a web-based system. The website is secure and only available for program participants. There are monthly modules with asynchronous, self-directed delivery, designed to mitigate the time constraints and faculty development required of traditional in-person coaching. Video recordings of group-coaching calls will be made available to the program participants via the secure website with the intent to allow participants to benefit from group coaching even if they aren't able to attend the calls live. These recordings do contain PHI of participants.
101 women trainees from 12 ACGME training programs enrolled in the program. Participants were randomized into either the intervention or wait-list control arm. Participants in the intervention arm began the 6-month coaching program in January, 2021. Participants in the wait-list control arm have received no additional resources from the Better Together program between January and June 2021.
All participants in both intervention and wait-list control groups will be invited to complete the quantitative post-program survey in June 2021. At the time of the post-program survey in 6/2021, the wait-list control group will not have received the coaching intervention. Following the quantitative and qualitative data collection, the control group was be offered the 6-month coaching program from July-December 2021.
The wait-list control group was invited to begin the 6-month coaching program in July 2021. In December 2021, participants from both the intervention and wait-list control groups will be invited to complete a 2nd post survey (identical to the post-survey from June 2021). There will be no incentive for completion of the 2nd post survey.
Finally, the longitudinal effect of the program will be assessed by offering the same survey measuring wellbeing via various indices to the intervention arm at 6 months (1/2022), 12 months (7/2022) and 18 months (1/2023) after their intervention. Participation in this survey will be completely voluntary and not incentivized/compensated.
- Conditions
- Burnout, Self-compassion, Moral Injury, Impostor Phenomenon
- Being tested
- Better Together Physician Coaching
- Keywords
- Burnout, Medical Education
- Medical subject headings
- Burnout, Psychological, Stress Disorders, Post-Traumatic, imposter syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Better Together Physician CoachingBehavioural
6 month, online group coaching program
| Study group | Role | What they receive |
|---|---|---|
| Intervention | Experimental | Enrolled into a 6 month coaching program from January 1 2021 to June 30 2021 Receives: Behavioral: Better Together Physician Coaching |
| Control/Wait-list | No intervention | No intervention from January 1 2021 to July 1 2021 (they were offered the coaching program from July 1 2021-Dec 31 2021) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change from baseline Burnout at 6 months, 12 months and 18 months
The Maslach's burnout inventory is a 22-item measurement of worker burnout which assesses emotional exhaustion (EE), depersonalization (DP), and personal fulfillment (PF) domains. Possible scores range from 0-6 on a Likert scale for each item. Scores oof EE ≥ 27 points, DP ≥ 10, and PF <33 would indicate a high degree of burnout. Scores of EE≤18 points, DP≤5 points, and PF≥40 points would indicate a low degree of burnout.
Measured: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
Secondary outcomes (3)
Change from baseline Self Compassion at 6 months, 12 months and 18 months
Neff's Self-Compassion Scale - Short Form is a 12 item measurement of self-compassion with higher scores indicating improved or better levels of self compassion.
Measured: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
Change from baseline Imposter Syndrome at 6 months, 12 months and 18 months
The Young Impostor Syndrome Scale is an 8 item measurement of imposter phenomenon with scores ≥ 5 indicating "yes" to presence of imposter phenomenon and scores less than 5 being negative for presence of imposter phenomenon.
Measured: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
Change from baseline Moral Injury at 6 months, 12 months and 18 months
The Moral Injury Symptom Score for healthcare professionals is a 22 item measure of moral injury symptoms that assesses betrayal, guilt, shame, moral concerns, loss of trust, loss of meaning, difficulty forgiving, self-condemnation, religious struggle, and loss of religious/spiritual faith with scores of 60 or higher correlating with extreme problems, scores of 45-59 being moderate and scores of 30-45 being mild.
Measured: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Mar 2022
- Study start1 Dec 2020
- Primary completion1 Jan 2023
- Study completion1 Jan 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for BurnoutStudies of the same condition, open and under way.
- More trials run by University of Colorado, DenverThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Enrolment
- 101 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Colorado, Denver
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05280964
- Sponsor's protocol ID
- 20-2035
- Status last verified
- Apr 2023
- First submitted
- 23 Feb 2022
- Last updated
- 10 Apr 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018 Sep 18;320(11):1131-1150. doi: 10.1001/jama.2018.12777.
PubMed 30326495Pommier E, Neff KD, Toth-Kiraly I. The Development and Validation of the Compassion Scale. Assessment. 2020 Jan;27(1):21-39. doi: 10.1177/1073191119874108. Epub 2019 Sep 13.
PubMed 31516024Mantri S, Lawson JM, Wang Z, Koenig HG. Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP. J Relig Health. 2020 Oct;59(5):2323-2340. doi: 10.1007/s10943-020-01065-w.
PubMed 32681398Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016 Oct 31;7:364-369. doi: 10.5116/ijme.5801.eac4.
PubMed 27802178Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial. JAMA Intern Med. 2019 Oct 1;179(10):1406-1414. doi: 10.1001/jamainternmed.2019.2425.
PubMed 31380892Palamara K, Chu JT, Chang Y, Yu L, Cosco D, Higgins S, Tulsky A, Mourad R, Singh S, Steinhauser K, Donelan K. Who Benefits Most? A Multisite Study of Coaching and Resident Well-being. J Gen Intern Med. 2022 Feb;37(3):539-547. doi: 10.1007/s11606-021-06903-5. Epub 2021 Jun 7.
PubMed 34100238Mann A, Fainstad T, Shah P, Dieujuste N, Thurmon K, Dunbar K, Jones C. "We're all going through it": impact of an online group coaching program for medical trainees: a qualitative analysis. BMC Med Educ. 2022 Sep 13;22(1):675. doi: 10.1186/s12909-022-03729-5.
PubMed 36100880Fainstad T, Mann A, Suresh K, Shah P, Dieujuste N, Thurmon K, Jones CD. Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial. JAMA Netw Open. 2022 May 2;5(5):e2210752. doi: 10.1001/jamanetworkopen.2022.10752.
PubMed 35522281
Study at a glance
From the registry record, last updated by the sponsor on 10 Apr 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of a Novel Online Physician Group-Coaching Program to Reduce Burnout in Trainees: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT05280964
- Acronym / sponsor ID
- 20-2035
- Conditions
- Burnout, Self-compassion, Moral Injury, Impostor Phenomenon
- Keywords
- Burnout, Medical Education
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 101 participants (actual)
- Lead sponsor
- University of Colorado, DenverUniversity, hospital or other
- Study start
- 1 Dec 2020 (actual)
- Primary completion
- 1 Jan 2023 (actual)
- Study completion
- 1 Jan 2023 (actual)
- First posted
- 15 Mar 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a single-institution randomized controlled trial. 101 female residents were recurited from the University of Colorado School of Medicine. They enrolled beginning in January 2021 and participated in the coaching program for 6 months via a web-based system. Participants were randomized into either the intervention or wait-list control arm. Participants in the intervention arm began the 6-month coaching program in January, 2021. Participants in the wait-list control arm have received no additional resources from the Better Together program between January and June 2021. The wait-list control group was invited to begin the 6-month coaching program in July 2021. In December 2021, participants from both the intervention and wait-list control groups will be invited to complete a 2nd post survey (identical to the post-survey from June 2021). There will be no incentive for completion of the 2nd post survey. Finally, the longitudinal effect of the program will be assessed by offering the same survey measuring wellbeing via various indices to the intervention arm at 6 months (1/2022), 12 months (7/2022) and 18 months (1/2023) after their intervention. Participation in this survey will be completely voluntary and not incentivized/compensated.
Detailed description
Background:
Positive psychology coaching programs demonstrate efficacy in reducing emotional exhaustion (a construct of burnout) and improving coping skills among residents but rely on substantial faculty development and coordination for participants. Considering the disproportionate burnout risk faced by women trainees in medicine, novel strategies to mitigate this risk is needed. Among a national sample of resident physicians, 60% screen positive for burnout. Compared to age-matched peers, residents are significantly more likely to experience burnout and have burnout persist into early careers. Female trainees are particularly vulnerable, with long-term consequences affecting professional development and success. Disproportionate burnout among women may be a contributor to the "leaky pipeline" in academic medicine, where women start their careers as 46% of the resident workforce yet represent only 25% of full professors and 18% of department chairs. Social connectedness and the practice of self-compassion are important intervention in reducing burnout and increasing resilience among residents. Positive psychology coaching programs have specifically had demonstrated efficacy in faculty and residents. Web-based group coaching programs have not been assessed for their potential to reduce burnout and improve resilience and well-being among trainees.
- Outcome Measure(s):
- participation (administrative data)
- participant experience and reflection (interview)
- measures of burnout and self-compassion as measured on a pre- and post- program survey including the Maslach Burnout Inventory (MBI) and Neff Self Compassion Score (SCS). Semi structured qualitative interviews will be led by a PRA upon completion of the 6-month pilot. The interview script will include questions about program content, participant experience, coping skills, interpersonal connectedness, personal and professional satisfaction, and general reflections.
Description of Population to be Enrolled:
This pilot study recruited individuals from the University of Colorado graduate medical education training programs. The pilot program is limited to female trainees who have greater than 1 year of training left in order to give trainees time to complete the program prior to graduation. Enrollment in the program is entirely voluntary and trainees can cease enrollment at any time.
Study Design and Research Methods:
This is a single-institution randomized controlled trial. 101 female residents were recruited from the University of Colorado School of Medicine. They enrolled beginning in January 2021 and participated in the coaching program for 6 months via a web-based system. The website is secure and only available for program participants. There are monthly modules with asynchronous, self-directed delivery, designed to mitigate the time constraints and faculty development required of traditional in-person coaching. Video recordings of group-coaching calls will be made available to the program participants via the secure website with the intent to allow participants to benefit from group coaching even if they aren't able to attend the calls live. These recordings do contain PHI of participants.
101 women trainees from 12 ACGME training programs enrolled in the program. Participants were randomized into either the intervention or wait-list control arm. Participants in the intervention arm began the 6-month coaching program in January, 2021. Participants in the wait-list control arm have received no additional resources from the Better Together program between January and June 2021.
All participants in both intervention and wait-list control groups will be invited to complete the quantitative post-program survey in June 2021. At the time of the post-program survey in 6/2021, the wait-list control group will not have received the coaching intervention. Following the quantitative and qualitative data collection, the control group was be offered the 6-month coaching program from July-December 2021.
The wait-list control group was invited to begin the 6-month coaching program in July 2021. In December 2021, participants from both the intervention and wait-list control groups will be invited to complete a 2nd post survey (identical to the post-survey from June 2021). There will be no incentive for completion of the 2nd post survey.
Finally, the longitudinal effect of the program will be assessed by offering the same survey measuring wellbeing via various indices to the intervention arm at 6 months (1/2022), 12 months (7/2022) and 18 months (1/2023) after their intervention. Participation in this survey will be completely voluntary and not incentivized/compensated.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Intervention | Experimental | Behavioral: Better Together Physician CoachingEnrolled into a 6 month coaching program from January 1 2021 to June 30 2021 |
| Control/Wait-list | No intervention | –No intervention from January 1 2021 to July 1 2021 (they were offered the coaching program from July 1 2021-Dec 31 2021) |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- graduate medical education trainees (residents and fellows) at the University of Colorado
- Female identifying
Key exclusion criteria (2 listed)
- Non trainees
- non- female identifying
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Better Together Physician Coaching6 month, online group coaching program | Behavioural | Intervention |
Primary outcome
Change from baseline Burnout at 6 months, 12 months and 18 months
Time frame: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
The Maslach's burnout inventory is a 22-item measurement of worker burnout which assesses emotional exhaustion (EE), depersonalization (DP), and personal fulfillment (PF) domains. Possible scores range from 0-6 on a Likert scale for each item. Scores oof EE ≥ 27 points, DP ≥ 10, and PF <33 would indicate a high degree of burnout. Scores of EE≤18 points, DP≤5 points, and PF≥40 points would indicate a low degree of burnout.
3 secondary outcomes
Change from baseline Self Compassion at 6 months, 12 months and 18 months
Time frame: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
Change from baseline Imposter Syndrome at 6 months, 12 months and 18 months
Time frame: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
Change from baseline Moral Injury at 6 months, 12 months and 18 months
Time frame: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Apr 2023.
- Results publication: PubMed 30326495Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018 Sep 18;320(11):1131-1150. doi: 10.1001/jama.2018.12777.
- Results publication: PubMed 31516024Pommier E, Neff KD, Toth-Kiraly I. The Development and Validation of the Compassion Scale. Assessment. 2020 Jan;27(1):21-39. doi: 10.1177/1073191119874108. Epub 2019 Sep 13.
- Results publication: PubMed 32681398Mantri S, Lawson JM, Wang Z, Koenig HG. Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP. J Relig Health. 2020 Oct;59(5):2323-2340. doi: 10.1007/s10943-020-01065-w.
- Results publication: PubMed 27802178Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016 Oct 31;7:364-369. doi: 10.5116/ijme.5801.eac4.
- Results publication: PubMed 31380892Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial. JAMA Intern Med. 2019 Oct 1;179(10):1406-1414. doi: 10.1001/jamainternmed.2019.2425.
- Results publication: PubMed 34100238Palamara K, Chu JT, Chang Y, Yu L, Cosco D, Higgins S, Tulsky A, Mourad R, Singh S, Steinhauser K, Donelan K. Who Benefits Most? A Multisite Study of Coaching and Resident Well-being. J Gen Intern Med. 2022 Feb;37(3):539-547. doi: 10.1007/s11606-021-06903-5. Epub 2021 Jun 7.
- Derived from this study: PubMed 36100880Mann A, Fainstad T, Shah P, Dieujuste N, Thurmon K, Dunbar K, Jones C. "We're all going through it": impact of an online group coaching program for medical trainees: a qualitative analysis. BMC Med Educ. 2022 Sep 13;22(1):675. doi: 10.1186/s12909-022-03729-5.
- Derived from this study: PubMed 35522281Fainstad T, Mann A, Suresh K, Shah P, Dieujuste N, Thurmon K, Jones CD. Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial. JAMA Netw Open. 2022 May 2;5(5):e2210752. doi: 10.1001/jamanetworkopen.2022.10752.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Better Together Physician Coaching in people with Burnout and Self-compassion, run by University of Colorado, Denver at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 10 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change from baseline Burnout at 6 months, 12 months and 18 months (time frame: Baseline measurement, post-intervention measurements at 6 months, 12 months and 18 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05280964, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Apr 2023; AzTrials last refreshed its copy on 26 Oct 2026.