On March 11, 2020, the World Health Organization declared a global pandemic due to the novel Coronavirus Disease 19 (COVID-19).1 Thereafter, the Centers for Medicare and Medicaid Services (CMMS) recommended that all non-emergent and elective procedures be postponed to reduce risk of exposure and conserve personal protective equipment.2 Numerous state departments of health followed suit and subsequently recommended cessation of elective procedures. As hospitals strove to comply with these recommendations, hospital admissions fell, with some operating at 50% less capacity than usual.3 Due to reduction in capacity, healthcare workers were often forced to take pay cuts, furloughed, or laid off.4 Throughout this time, healthcare workers have adapted to rapidly evolving protocols and systemic changes in an environment fraught with the stress of balancing personal risk and a poorly understood illness. Resident physicians have not been immune to these changes, commonly serving on the front lines as critical components of the hospital workforce, at times reassigned to help other specialties, with a shift in the types of illnesses and severe reduction in elective procedures which can be essential to their education.
A number of studies evaluating the impact of this pandemic on healthcare workers’ mental health have correlated COVID-19 exposure with a greater prevalence of mental health problems compared to the general population. This includes 20% reporting anxiety and/or depression and nearly double this number reporting insomnia.5,6 Prior viral pandemics have shown persistence of mental health morbidity, including post-traumatic stress, depression, and anxiety among healthcare workers long after the outbreak resolved. 7,8
At the time of this study, the COVID-19 pandemic’s effect on resident physicians and fellows in training remains limited. Studies of residents during this time have examined the use of telemedicine as a means of promoting safety while maintaining access and minimizing disruption in clinical care. Many innovative solutions have arisen in response to medical and surgical education changes, including virtual learning, videoconferencing, and social media.9 However, these have also highlighted limitations with regard to rapport development with patients, privacy and confidentiality, and access to technology.10
One study of resident mental health at a large academic medical center revealed significantly higher rates of reported stress and burnout in COVID-19 exposed physician trainees compared to non-exposed. Female and unmarried trainees demonstrated higher rates of stress and depression, respectively.11 In fact, over half of resident trainees in Brooklyn, New York expressed anxiety for at least several days over a two week period.12 Despite decrease in operating room (OR) time, a survey of otolaryngologists during the COVID-19 pandemic found that nearly half reported anxiety, depression, distress and burnout, with a greater prevalence in residents (compared to attendings), females, and those in states with over 20,000 positive cases13. Together, these studies reflect a common theme: the importance of being mindful of and supporting the mental health of frontline healthcare workers, including physician trainees.
To our knowledge, this is the first study to assess the perceived impact of the COVID-19 pandemic on residents’ and fellows’ clinical training and mental health support across multiple subspecialties at a large medical institution. This study aims to describe the impact of COVID-19 on post-graduate medical trainees and investigate what was associated with positive educational preparedness during COVID-19.
According to the Indiana State Department of health, there have been over 672K COVID cases with 12K deaths in Indiana, representing the thirteenth highest death rate in the country. The highest rate of COVID admissions and deaths occurred in December of 2020.15,16 Indiana University Health (IUH) is the largest network of physicians and hospitals in the state. IUH partners with the Indiana University School of Medicine (IUSOM), which sponsors 100 ACGME-accredited residency and fellowship programs. In 2021, there were 985 residents and 219 fellows associated with IUH and IUSOM.17,18