Resident burnout and the COVID-19 pandemic
The COVID-19 pandemic has impacted the well-being of individuals globally. There are growing reports of psychological distress, social isolation, depression, and burnout in the general population1. It is also increasingly clear that the pandemic has impacted the well-being of medical professionals and trainees2,3,4,5. In addition, the establishment of physical distancing restrictions to control the spread of COVID-19 has caused significant disruptions to medical education and clinical training. Residents are especially susceptible to developing burnout due to the demanding nature of clinical training and the work environment6,7. The unique social network that exists within residency programs may play an important protective role against the development of burnout8. However, the ability of trainees to access this network has been severely curtailed over the course of the pandemic.
In July 2021, Dr. Lemire referenced recent Canadian data that highlights the effects of COVID-19 on practicing family physicians9,10. Since the start of the pandemic, 15% of Canadian family physicians reported feeling burnt out, which represents a 3-fold increase compared to pre-pandemic rates. Among those that felt burned out, balancing personal lives and work expectations were major contributors to stress rather than burnout related to providing patient care9,10. Though burnout among healthcare providers is well-established in the literature, little is known about the specific impacts of COVID-19 on the well-being of family medicine residents in training. Preliminary findings from graduating University of Toronto Family Medicine Residents (FMR) suggest that similar to Canadian family physicians, resident well-being has been negatively impacted by COVID-19.
A total of 126 graduating FMR in the 2021 cohort completed an existing national survey instrument, the Family Medicine Longitudinal Survey (FMLS)11, which was modified to query the impact of COVID-19 on training. Sixty six percent of residents felt the COVID-19 pandemic had a negative impact on their mental health and well-being. In their narrative accounts in response to open-ended questions, several residents described sadness in losing the opportunity to connect with both peers and faculty. One resident shared that the COVID-19 pandemic has been an “extremely isolating and distressing experience both personally and professionally” and that it “absolutely contributed to burnout as a result of losing all coping strategies and in-person supports very quickly.”
Our preliminary findings suggest that graduating FMR felt a loss of connectivity and a lack of normal support available due to the pandemic. This has contributed to self-reported negative impacts on mental health and well-being. Notably, the majority (93.4%) of FMR agreed or strongly agreed that they still felt confident in their current ability to provide comprehensive care to the same group of patients over time. So, graduating FMR report feeling competent as family physicians, but at what cost to their well-being? At a time when healthcare providers are needed most, we cannot afford to lose this precious resource to burnout. As the pandemic continues, we must determine what supports are best suited to mitigate this current trend, not just among staff physicians but among resident trainees alike.
Julia Avolio, is an MD Candidate at the Temerty Faculty of Medicine, University of Toronto, Toronto, ON
Laura Diamond, is an MD Candidate at the Temerty Faculty of Medicine, University of Toronto, Toronto, ON
Dr. Kulamakan (Mahan) Kulasegaram is at the Wilson Centre for Research in Education, University Health Network and University of Toronto, Department of Family and Community Medicine, Temerty Faculty of Medicine, Temerty Chair in Learner Assessment and Program Evaluation, University of Toronto, Toronto, ON
References
1. Li, S.; Wang, Y.; Xue, J.; Zhao, N.; Zhu, T. The Impact of COVID-19 Epidemic Declaration on Psychological Consequences: A Study on Active Weibo Users. Int. J. Environ. Res. Public. Health 2020, 17 (6), 2032. https://doi.org/10.3390/ijerph17062032.
2. Sasangohar, F.; Jones, S. L.; Masud, F. N.; Vahidy, F. S.; Kash, B. A. Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit. Anesth. Analg. 2020, 10.1213/ANE.0000000000004866. https://doi.org/10.1213/ANE.0000000000004866.
3. Crowe, C. S.; Lopez, J.; Morrison, S. D.; Drolet, B. C.; Janis, J. E.; Group, O. behalf of the R. C. W. and E. S. The Effects of the COVID-19 Pandemic on Resident Education and Wellness: A National Survey of Plastic Surgery Residents. Plast. Reconstr. Surg. 2021, 148 (3), 462e. https://doi.org/10.1097/PRS.0000000000008281.
4. Khusid, J. A.; Weinstein, C. S.; Becerra, A. Z.; Kashani, M.; Robins, D. J.; Fink, L. E.; et al. Well-Being and Education of Urology Residents during the COVID-19 Pandemic: Results of an American National Survey. Int. J. Clin. Pract. 2020, 74 (9), e13559. https://doi.org/10.1111/ijcp.13559.
5. Robbins, J. B.; England, E.; Patel, M. D.; DeBenedectis, C. M.; Sarkany, D. S.; Heitkamp, D. E.; et al. COVID-19 Impact on Well-Being and Education in Radiology Residencies: A Survey of the Association of Program Directors in Radiology. Acad. Radiol. 2020, 27 (8), 1162–1172. https://doi.org/10.1016/j.acra.2020.06.002.
6. IsHak, W. W.; Lederer, S.; Mandili, C.; Nikravesh, R.; Seligman, L.; Vasa, M.; et al. Burnout During Residency Training: A Literature Review. J. Grad. Med. Educ. 2009, 1 (2), 236–242. https://doi.org/10.4300/JGME-D-09-00054.1.
7. Kumar, S. Burnout and Doctors: Prevalence, Prevention and Intervention. Healthcare 2016, 4 (3), 37. https://doi.org/10.3390/healthcare4030037.
8. Shapiro, J.; Zhang, B.; Warm, E. J. Residency as a Social Network: Burnout, Loneliness, and Social Network Centrality. J. Grad. Med. Educ. 2015, 7 (4), 617–623. https://doi.org/10.4300/JGME-D-15-00038.1.
9. Family Physicians’ Response to the COVID-19 Pandemic. Available from: https://www.cfpc.ca/CFPC/media/Resources/Research/Covid-19-Member-Survey-ENG-Final.pdf. Accessed December 10, 2021.
10. Lemire, F.; Slade, S. Family Physicians and the COVID-19 Third Wave. Can. Fam. Physician 2021, 67 (7), 550. https://doi.org/10.46747/cfp.6707550.
11. Oandasan I.F.; Archibald D.; Authier L.; Lawrence K.; McEwen L.A.; Palacios Mackay M, et al. Future practice of comprehensive care: Practice intentions of exiting family medicine residents in Canada. Can Fam Physician. 2018;64(7):520-528. Available from: https://www.cfp.ca/content/64/7/520. Accessed December 10, 2021.