COVID-19 Impact on Resident Mental Health and Well-Being

A model for teaching radiology to clinical specialty trainees: A pilot study in pediatric neuroradiology and neonatology

This article describes the development and assessment of a neuroimaging curriculum for neonatology fellows. The curriculum is focused on topics that are relevant to the practice of neonatology and employs contemporary teaching methods, such as flipped classroom, learner engagement, and spaced repetition. Since its implementation 2018 the curriculum has been appreciated by our trainees and demonstrated improvements in trainee knowledge.

Transformations in postgraduate medical education following the COVID-19 pandemic: lessons learned from advances and challenges

The COVID-19 pandemic has profoundly reshaped postgraduate medical education, driving immediate and significant adaptations in teaching methodologies and educational frameworks. This review examines the multifaceted transformations within medical education environments, particularly in response to the pandemic. Through a structured narrative review of recent literature, we identify key lessons learned and the subsequent shifts in educational practices. Our analysis underscores the critical importance of flexibility in educational delivery, the integration of technology, and the emphasis on mental health and resilience among medical trainees. We also explore the challenges and successes associated with maintaining equality and diversity in a rapidly evolving educational landscape. The findings highlight the necessity for continuous professional development and robust support systems to navigate future challenges effectively. Recommendations are provided for educational institutions to enhance adaptability, foster inclusive learning environments, and prepare for unforeseen global health emergencies. This study aims to contribute to the ongoing discourse on optimizing postgraduate medical education to better prepare health professionals for a dynamic and uncertain future.

Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review

BACKGROUND

The occupational burnout epidemic is a growing issue, and in the United States, up to 60% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers.

OBJECTIVE

This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs).

METHODS

A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies.

RESULTS

The initial search yielded 505 papers, from which 10 (1.95%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ≥12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements.

CONCLUSIONS

With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation.

Suicidal ideation, perception of personal safety, and career regret among emergency medicine residents during the COVID-19 pandemic

Objectives

The COVID-19 pandemic was disruptive for trainees and may have affected career decisions for some learners. This study examined the impact of the pandemic on emergency medicine (EM) resident perceptions of their mental health, perceptions of personal safety, and career choice regret.

Methods

This was a cross-sectional survey study administered following the 2021 American Board of Emergency Medicine In-Training Examination (ITE). Survey measures included suicidal ideation (SI), COVID concerns in terms of infection prevention and control (IPC) training, COVID risk to self and/or COVID risk to family, and COVID-related career regret. COVID concerns were compared by gender and race/ethnicity using Pearson's chi-square tests. Multivariable logistic regression models were used to test the association between SI and COVID concerns, resident characteristics, and program characteristics.

Results

A total of 6980 out of 8491 EM residents (82.2%) from 244 programs completed the survey. Only 1.1% of participants reported insufficient training in COVID IPC practices. Participants were concerned about COVID risk to themselves (40.3%) and to their families (63.3%) due to their job roles. These concerns were more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); senior residents (vs. PGY-1, PGY-2 residents); and residents who were married or in relationships (vs. single or divorced). A total of 6.1% of participants reported that COVID made them reconsider choosing EM as their career. Career regret in this cohort was higher than that in the proportion (3.2%) expressing career regret in the 2020 ITE (p < 0.001). Career regret was more common among women or nonbinary (vs. men); all other races/ethnicities (vs. non-Hispanic Whites); and senior residents (vs. PGY-1, PGY-2 residents). The overall SI rate was 2.6%, which did not differ from that of the 2020 sample of EM residents (2.5%, p = 0.88).

Conclusions

Many EM residents reported concerns about COVID risks to themselves and their families. Although the rate of SI remained unchanged, more EM residents reported career regret during the COVID pandemic.

Experiences with Racism Among Asian American Medical Students

Importance

Asian American physicians have experienced a dual pandemic of racism and COVID-19 since 2020; understanding how racism has affected the learning environment of Asian American medical students is necessary to inform strategies to promoting a more inclusive medical school environment and a diverse and inclusive workforce. While prior research has explored the influence of anti-Asian racism on the experiences of Asian American health care workers, to our knowledge there are no studies investigating how racism has impacted the training experiences of Asian American medical students.

Objective

To characterize how Asian American medical students have experienced anti-Asian racism in a medical school learning environment.

Design, Setting, and Participants

This qualitative study included online video interviews of Asian American medical students performed between July 29, 2021, and August 22, 2022. Eligible participants were recruited through the Asian Pacific American Medical Students Association and snowball sampling, and the sample represented a disaggregated population of Asian Americans and all 4 medical school years.

Main Outcomes and Measures

The medical school experiences of Asian American medical students.

Results

Among 25 participants, Asian ethnicities included 8 Chinese American (32%), 5 Korean American (20%), 5 Indian American (20%), 3 Vietnamese American (12%), 2 Filipino American (8%), and 1 (4%) each Nepalese, Pakistani, and Desi American; 16 (64%) were female. Participants described 5 major themes concerning their experience with discrimination: (1) invisibility as racial aggression (eg, "It took them the whole first year to be able to tell me apart from the other Asian guy"); (2) visibility and racial aggression ("It transitioned from these series of microaggressions that every Asian person felt to actual aggression"); (3) absence of the Asian American experience in medical school ("They're not going to mention Asian Americans at all"); (4) ignored while seeking support ("I don't know what it means to have this part of my identity supported"); and (5) envisioning the future.

Conclusions and Relevance

In this qualitative study, Asian American medical students reported feeling invisible within medical school while a target of anti-Asian racism. Addressing these unique challenges related to anti-Asian racism is necessary to promote a more inclusive medical school learning environment.

A national qualitative investigation of the impact of service change on doctors' training during Covid-19

BACKGROUND

The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors' training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated.

METHODS

Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding.

RESULTS

Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees' grades. Trainees' jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic.

CONCLUSIONS

The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors' training. This impaired trainees' development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.

Predictors of posttraumatic stress symptoms, COVID-related functional impairment, and burnout among medical professionals during the COVID-19 pandemic

Physicians are particularly vulnerable to mental health symptoms during global stressors such as the COVID-19 pandemic. Such stressors can increase death anxiety, which is a vulnerability factor for psychological dysfunction. Thus, exposure to COVID-related death may play a unique role in physicians' mental health during the pandemic. This cross-sectional study collected self-reported data from 485 resident physicians and fellows. Participants reported mental health symptoms, including posttraumatic stress symptoms (PTSS), burnout, and functional impairment due to the pandemic. Participants also reported death anxiety, COVID-19 anxiety, cognitive accessibility of death-related thoughts (DTA), and workplace exposure to COVID-19. Death anxiety, COVID-19 anxiety, DTA, and workplace COVID-19 exposure all independently predicted PTSS. Furthermore, COVID-19 anxiety and DTA interacted to predict PTSS, such that high levels of COVID-19 anxiety predicted higher PTSS, regardless of DTA level. Death anxiety and COVID-19 workplace exposure interacted to predict PTSS as well, such that death anxiety predicted PTSS only when COVID-19 exposure was high. Burnout was predicted by COVID-19 anxiety and workplace exposure, and COVID-related functional impairment was predicted by death anxiety and COVID anxiety. These findings demonstrate that death-related and COVID-related concerns, independently and in interaction with each other, play an important role in psychological distress among physicians.

The challenges, coping mechanisms, and recovery from the initial waves of the COVID-19 pandemic among academic radiographers

Introduction

The COVID-19 pandemic arrived in Europe in March 2020 and created major challenges across healthcare provision and for healthcare education programmes as well as having a major impact on society. Within the profession of Radiography changes in medical imaging, radiotherapy, and teaching practices have been reported along with the negative impact on radiographers and students. The aim of this study was to investigate key challenges relating to academic practice during the COIVD-19 pandemic; how radiography academics have coped and to identify recommendations for further support required to facilitate recovery of the academic faculty as the pandemic ebbs.

Methods

A survey was circulated using SurveyMonkey™ via personal, national and international networks, including the European Federation of Radiographer Societies (EFRS), to reach as many academic radiographers as possible. Open questions relating to the challenges of providing radiography education during the COVID-19 pandemic and the and coping strategies used were included. Thematic analysis was conducted using NVivo (QSR International, MA).

Results

533 academic radiographers responded to the whole survey from 43 different countries, with 340 responses relating to challenges and 327 for coping strategies. The main themes for the challenges were clinical practice, communication with colleagues, lack of face to face, managing change, students (support), and staff support. The coping strategy themes were communication with colleagues, physical exercise, self-care and wellbeing.

Conclusion

These data demonstrate a multitude of challenges for academic radiographers and the pressure they worked under during the first year of the COVID-19 pandemic was clear. However, the majority employed healthy coping strategies to help them deal with the pressure, uncertainty and trauma of the situation.

Implications for practice

COVID-19 had a significant impact on academic radiographers and while many reported good strategies for coping, the level of pressure is unsustainable. This study highlights the need to support academic radiographers to ensure a sustainable workforce.