Porter 2008.

Study characteristics
Methods	Study design: RCT Study grouping: parallel group Unit of randomisation: individuals Power (power sample size calculation, level of power achieved): not specified; according to publication maybe lack of statistical power Imputation of missing data: no imputation of missing data; available‐case analysis (only participants for whom outcomes were obtained at both time points)
Participants	Country: Canada Setting: college programme for paramedic students Age: mean = 21.69 (SD = 1.92); range = 19 ‐ 28 years Sample size (randomised): 29 Sex: 11 women, 18 men Comorbidity (mean (SD) of respective measures in indicated, if available) at baseline: depression (SCL‐90‐R): IG: 1.08 (0.42); CG: 1.57 (0.65); Anxiety (SCSL‐90‐R): IG: 0.73 (0.49); CG: 0.93 (0.51); Global Severity Index (SCL‐90‐R): IG: 0.85 (0.33); CG: 1.09 (0.52); Burnout‐emotional exhaustion (MBI): IG:17.09 (6.72); CG: 20.64 (10.20); Burnout‐depersonalisation (MBI): IG: 8.82 (4.88); CG: 9.45 (3.86); Burnout‐personal accomplishment (MBI): IG: 34.64 (8.32); CG: 32.73 (8.36) Population description: paramedic students in the final year of a 2‐year college paramedic programme Inclusion criteria: not specified Exclusion criteria: not specified Attrition (withdrawals and exclusions): 6 participants dropped out of the study before post‐intervention assessment (IG: 3/15 (20%); CG: 3/14 (21.4%)); n = 1 participant did not complete WAYS measure Reasons for missing data: not specified
Interventions	Intervention: psycho‐educational group (n = 15) delivery: face‐to‐face; group sessions providers: counsellor, not specified duration of treatment period and timing: 13 sessions over 4 months (prior to beginning a semester of full‐time clinical placement); almost weekly sessions (12 sessions) over course of 15‐week semester + 2 additional sessions prior to beginning of full‐time clinical placements description: GROUP FOCUS: 1) fostering positive peer support; 2) building positive attitudes towards emotional expression; and 3) increasing participants’ knowledge and application of adaptive coping strategies for dealing with stressful events TYPICAL FORMAT OF GROUP SESSIONS: breathing/focusing/relaxation exercise, participant check‐in; introduction to session topic; individual/small group reflective exercise; large group debriefing; breathing/focusing/relaxation exercise, and check‐out focusing on how participants might consciously use cognitive/behavioural strategies during the next week to enhance their capacity to deal with stress CONTENT OF SESSIONS: SESSION 1: welcome, introductions, ground rules, overview of topics, dyad interviews SESSION 2: individual nature of stressors and stress responses SESSION 3: personal resources for dealing with stress SESSION 4: relaxation strategies SESSION 5: identifying and evaluating automatic thoughts SESSION 6: personal rules, standards, and expectations SESSION 7: personal/professional responsibilities SESSION 8: personal power/sphere of influence SESSION 9: exploring coping styles SESSION 10: developing confidence realistic expectations on placement SESSION 11: registered massage therapy trials SESSION 12: dealing with difficult people SESSION 13: personal/professional boundaries additional relaxation strategies compliance: not specified integrity of delivery: not specified economic information: not specified theoretical basis: based on a cognitive‐behavioural counselling theory of change Control: no intervention (n = 14)
Outcomes	Outcomes collected and reported: coping strategies, confrontative coping ‐ WOC coping strategies, distancing ‐ WOC coping strategies, self‐controlling ‐ WOC coping strategies, seeking social support ‐ WOC coping strategies, accepting responsibility ‐ WOC coping strategies, escape‐avoidance ‐ WOC coping strategies, planful problem‐solving ‐ WOC coping strategies, positive reappraisal ‐ WOC psychological distress, somatization ‐ SCL‐90‐R psychological distress, depression ‐ SCL‐90‐R psychological distress, anxiety ‐ SCL‐90‐R psychological distress, interpersonal sensitivity ‐ SCL‐90‐R psychological distress, hostility ‐ SCL‐90‐R psychological distress, Global Severity Index ‐ SCL‐90‐R psychological distress, Positive Symptoms Distress Index ‐ SCL‐90‐R burnout, emotional exhaustion ‐ MBI burnout, depersonalization ‐ MBI burnout, personal accomplishment ‐ MBI attitudes towards emotion expression ‐ Attitude Towards Emotional Expression Scale perceived peer support in general ‐ Peer Support Crisis Support Questionnaire Time points measured and reported: 1) pre‐intervention; 2) 2‐month follow‐up (2‐months post‐intervention; 6‐month interval between 2 assessments) Adverse events: not specified
Notes	Contact with authors: We contacted authors for the number of dropouts and the number of participants analysed for each group at pre‐ and post‐intervention assessment (Porter 2018 [pers comm]). Study start/end date: recruitment start in fall 2007; exact study dates not specified Funding source: funding for this research provided by Fanshawe College Research Initiatives Fund Declaration of interest: not specified Ethical approval needed/obtained for study: not specified Comments by authors: not relevant Miscellaneous outcomes by the review authors: not relevant Correspondence: Shirley Porter; Fanshawe College, Student Success Centre, 1001 Fanshawe College Blvd., F2010, P.O. Box 7005, London, Ontario, Canada N5Y 5R6; saporter@fanshawec.ca
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "Fourteen participants (8 women) were randomly assigned to be part of the control group, and fifteen participants (5 women) were randomly assigned to be part of the treatment group." Quote: "Ages ranged from 20 to 25 in the control group (M = 21.82, SD = 1.72), and from 19 to 28 in the treatment group (M = 21.58, SD = 2.31). This age difference was not statistically significant." Judgement comment: insufficient information about random‐sequence generation to permit judgement of ‘Low risk’ or ‘High risk’; verified baseline comparability for sociodemographic variable age; baseline comparability for other sociodemographic characteristics and outcomes of interest unclear
Allocation concealment (selection bias)	Unclear risk	Judgement comment: insufficient information about allocation concealment to permit judgement of ‘Low risk’ or ‘High risk’
Blinding of participants and personnel (performance bias) Subjective outcomes	High risk	Judgement comment: blinding of participants and personnel probably not done (face‐to‐face intervention) and the outcome is likely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Judgement comment: insufficient information about blinding of outcome assessment; but due to potential performance bias (no blinding of participants), the review authors judge that the participants' responses to questionnaires may be affected by the lack of blinding (i.e. knowledge and beliefs about intervention they received)
Incomplete outcome data (attrition bias) All outcomes	High risk	Quote: "Six participants dropped out of the study before post‐test measures were collected. Three of these individuals (all men) were in the control group, and three of these individuals were in the treatment group (2 women)." Quote: "The final sample was, therefore, comprised of 23 individuals, 11 in the control group (8 women), and 12 in the treatment group (3 women)." Judgement comment: reasons for missing data unlikely to be related to true outcome with balance in missing data between groups (IG: n = 3; CG: n = 3); for burnout, attitudes toward emotional expression, peer support and ways of coping subscales: 1 additional missing participant; reasons for missing data not reported; available‐case analysis (only participants for whom outcomes were obtained at both time points)
Selective reporting (reporting bias)	Low risk	Judgement comment: no study protocol available but it is clear that the published reports include all expected outcomes, including those that were prespecified