Project Summary The Emergency Department (ED) is a central pillar of the health care system. ED physicians and nurses are exposed to high work-related stressors in addition to disruptive day-night shifts. The well- being of the 150,000 ED clinicians in the U.S. is important for public health with significant downstream effects on the well-being of the 145 million patients that are served every year. Of the 1 million U.S. physicians, 45% are reporting burnout symptoms and the number increases to 70% in ED physicians and up to 82% in ED nurses. Clinician burnout is associated with increased risk for cardiovascular diseases, mortality, medical errors, but also stress-mediated physiological alterations and cognitive decline. Yet, the knowledge about the long-term development of burnout is limited. To effectively intervene, the timely identification of ED clinicians at risk for burnout is a critical prerequisite. This study proposes an innovative approach using digital phenotyping to discover and test Digital Biomarkers as predictors of burnout symptoms and cognitive function. This proposed prospective longitudinal study will chart cognitive functioning and burnout symptom trajectories in a cohort of 350 ED clinicians to inform when, where, and how to intervene. We will use advanced computational methods to extract objective markers for burnout and cognitive decline from video and audio data. Based on our preliminary data, we hypothesize that voice and speech content, head movement, pupil dilation, gaze, and facial landmark features of emotion provide probabilistic information that will allow us to identify digital biomarkers for burnout and cognitive function. We will test the relevance of the discovered digital biomarkers and determine their discriminatory accuracy to distinguish between risk for clinically relevant vs. non-relevant burnout symptoms. We examine the association of digital biomarkers with physiological markers of chronic stress (i.e., hair cortisol concentration). We will also assess the association of digital biomarkers with the long-term job-related stress load of individual ED clinicians such as high ED crowding, patient acuity level, ED staffing, sleep, and shift schedules. This research program aims to deliver an objective, accurate, and reliable digital measure for clinician well-being. Such digital biomarkers will enable more efficient ED clinician self-management and will promote low-threshold prevention strategies. The mental and physical well-being of ED clinicians is of high value to those who work day in and day out to save the lives of others and is the foundation of a well-functioning, high-quality emergency care system.