Quantifying Impact of the COVID-19 Pandemic on Graduate Medical Education and Burnout- A Community Hospital Experience

Abstract

Background:The COVID-19 pandemic brought with it unprecedented changes to graduate medical education (GME) in order to meet the demands of the healthcare system while minimizing exposure towards trainees. Shifting to a virtual didactics model, cancelling elective rotations and ambulatory practice were some of the changes experienced by internal medicine residents across the United States. Despite literature focused on how changes affected undergraduate medical education, there is limited data on how these changes affected resident training. Objectives:Given the current increase in COVID-19 cases, residents perceptions(of their training, and burnout)will be vital when planning and preparing for future crises, all the while aiming to maintain the integrity of GME.Methods:Eighteen Internal medicine residents at a community hospital completed a non-validated Likertscale survey on how they perceived the COVID-19 pandemic and associated changes in their residency program had affected their training, paying special attention to critical care and palliative care skills. Sixteen residents also completed the Stanford Physician Wellbeing Index, which was compared to data from the same survey administered to residents in 2019 to assess perceived resident appreciation and burnout. Qualitative feedback was further elicited from respondents regarding how a similar situation could be managed differently in a future state to preserve the integrity of GME.Results:Over 60% of respondents (n=11) felt the COVID pandemic and its associated changes in their program negatively affected their medical training. Residents felt significantly more frustrated at work (n=14, 75%, p <0.001). Residents reported feeling more confident working with interdisciplinary teams (n=13, 72%) and leading rounds (n=11, 61%). Confidence in critical care management soared as managing ventilators, sedation and vasopressors all increased after the pandemic. Nevertheless, residents viewed the amount of time spent caring for critically ill patients as a detriment to their general training, and two thirds of residents did not feel an improvement in their procedural skills, including bedside ultrasound and line placement. Replacing didactics with virtual meetings and shifting work schedules to four days on and one day off were perceived as helpful for resident wellbeing, while daily email updates were not. Conclusion:Should a similar crisis arise in the future, maintaining a broader scope of learning opportunities for residents by caring for a multitude of illnesses, engaging at the bedside via procedures, and limiting the amount of e-mail communications could help preserve the perceived value of GME for residents and decrease their frustration and burnout.