This study aimed to share experiences of post-graduate trainees with an intervention for mental well-being during COVID-19 pandemic. While other support programs for stress reduction in healthcare workers have been implemented, a reluctance in use has been reported(8). In our setting, we chose to recruit trainees for active participation and utilization of an intervention.
Cognitive behavior therapy based intervention has proven efficacy in stress reduction(16). We, for the first time, introduced a group CBT intervention at our institution, which was well-received. This strategy is effective both in stress reduction and self-efficacy(17). Other strategies like empathic listening and mindfulness also have a role in stress reduction but require greater time and commitment from participants(18, 19). The ABC model also had the advantage of ease of use for participants who were mostly naive to this approach.
Opening the workshop with sharing the overall stress level helped set the stage for the interaction between participants. Moderate stress as seen in our study has been reported in postgraduate trainees and other healthcare workers (20, 21). Residents with higher stress had a higher perceived helplessness & lower self-efficacy, and vice versa. The relationship between increased rates of burn-out, high stress and low efficacy has been found in post-graduate trainees(22, 23) and further highlights the need for resilience building and support programs.
The participants reported that the stress scale equipped them with a tool to quantify their stress, however, stress level varied. As a participant stated, ‘quantifying our stress at one place in time was helpful.’ Another stated ‘My stress level varies at different times.’
The workshops allowed participants to deconstruct their individual stressors. The reasons for stress were largely similar across all six training programs and to those reported in other studies(24, 25) suggesting a collective experience for trainees across varying locations.
The experience of “A-adversity” (in the ABC model) being collective in this case, allowed most participants to share personal stories and accounts during the workshop. This exchange of experiences also validated emotions and beliefs. As quoted by two participants: ‘the good thing was to listen to others speak about the COVID experience they had’, ‘That everyone is going through difficult time, not only me.’
The reframing of stress was found to be very useful as quoted ‘The reframing part was a very good strategy to help oneself….’ Another participant stated, ‘I learnt the reframing technique, where you focus on the controllable and your strengths. Had I known this in past, many days of futile overthinking would not have happened.’
Use of a CBT model was however a completely new strategy for the trainees. As one participant said, ‘Actually it was the first time that somebody made us actually think about what stress is right now and how we can cope with it’. Another trainee stated, ‘So this was a new thing for us.’
For those who were offered a follow-up workshop, the concept and process became easier to use. As quoted ‘I think when we practice again and again, we can apply this better.’ Other participants also highlighted the need to have more time in a session and to have a series of workshops for better understanding of the concept and its application.
The reflective exercise was particularly helpful and participants recognized its application in future stressful events. In the words of one participant, ‘I will try to incorporate reflection into my daily life so I can better understand what is going on and how I can effectively cope with a situation and help others.’ Reflection has been suggested as a way to improve learning from a workshop and its impact on practice (26).
At our institution, this was an initial attempt to formally introduce cognitive reframing for stress management and coping. Not much literature exists on use of such techniques in similar programs. Emotional well-being of postgraduate trainees has implications on patient safety, communication skills and professionalism(27); essential competencies of the Accreditation Council for Graduate Medical Education (28). With increasing rates of burn-out in healthcare workers and trainees(29) and emergence of global health crises, inclusion of such techniques as part of self-care and resilience building becomes increasingly important(30).
Study limitations
This study was an attempt to introduce a cognitive tool for coping and resilience. While the individual responses affirmed that self-understanding of stress was helpful, a post-workshop stress was not measured, which would have strengthened the study findings. Additionally, the small sample may have limited our ability to derive concrete results. Triangulation of the three data sets, however, did help validate the usefulness of the workshop in stress alleviation while offering a method for resilience building.