Experiences of a Health System's Faculty, Staff, and Trainees' Career Development, Work Culture, and Childcare Needs During the COVID-19 Pandemic

A Longitudinal Survey on Canadian Emergency Physician Burnout

STUDY OBJECTIVE

Since Canada eased pandemic restrictions, emergency departments have experienced record levels of patient attendance, wait times, bed blocking, and crowding. The aim of this study was to report Canadian emergency physician burnout rates compared with the same physicians in 2020 and to describe how emergency medicine work has affected emergency physician well-being.

METHODS

This longitudinal study on Canadian emergency physician wellness enrolled participants in April 2020. In September 2022, participants were invited to a follow-up survey consisting of the Maslach Burnout Inventory and an optional free-text explanation of their experience. The primary outcomes were emotional exhaustion and depersonalization levels, which were compared with the Maslach Burnout Inventory survey conducted at the end of 2020. A thematic analysis identified common stressors, challenges, emotions, and responses among participants.

RESULTS

The response rate to the 2022 survey was 381 (62%) of 615 between September 28 and October 28, 2022, representing all provinces or territories in Canada (except Yukon). The median participant age was 42 years. In total, 49% were men, and 93% were staff physicians with a median of 12 years of work experience. 59% of respondents reported high emotional exhaustion, and 64% reported high depersonalization. Burnout levels in 2022 were significantly higher compared with 2020. Prevalent themes included a broken health care system, a lack of societal support, and systemic workplace challenges leading to physician distress and loss of physicians from the emergency workforce.

CONCLUSION

We found very high burnout levels in emergency physician respondents that have increased since 2020.

The Impact of the COVID-19 Pandemic on Black and Hispanic Americans' Work Outcomes: a Scoping Review

In early 2020, it was hypothesized that COVID-19 would lead to disproportionately negative health and work outcomes for Black and Hispanic adults, but sufficient data had yet been collected to fully support this claim. Now, we have empirical evidence, but little has been done to aggregate this information to fully understand its impact on these communities. Utilizing 44 articles from a scoping review of three databases (PubMed, Web of Science, and Business Source Complete), this study seeks to identify the primary work-related risks that help explain Black and Hispanic adults' disparate COVID-19-related work outcomes (e.g., loss of hours, job disruption, stress). Findings illuminate four primary risks faced by Black and Hispanic workers: (1) being an essential worker, (2) type of work performed, (3) workplace factors; and (4) community and geographic factors. We conclude with policy recommendations that will help inform policy and practice for economic recovery from the pandemic for other marginalized populations.

Childcare disruptions and maternal health during the COVID-19 pandemic

During the COVID-19 pandemic, nearly all US states enacted stay-at-home orders, upending usual childcare arrangements and providing a unique opportunity to study the association between childcare disruptions and maternal health. Using data from the 2021-2022 National Survey of Children's Health, we estimated the association between childcare disruptions due to the COVID-19 pandemic and self-reported mental and physical health among female parents of young children (ages 0-5 years). Further, we assessed racial, ethnic, and socioeconomic disparities in (1) the prevalence of childcare disruptions due to the COVID-19 pandemic and (2) the association between childcare disruptions and mental or physical health. Female parents who experienced childcare disruptions due to the COVID-19 pandemic were less likely to report excellent or very good mental (-7.4 percentage points) or physical (-2.5 percentage points) health. Further, childcare disruptions were more common among parents with greater socioeconomic privilege (ie, higher education, higher income), but may have been more detrimental to health among parents with less socioeconomic privilege (eg, lower education, lower income, and single parents). As state and federal policymakers take action to address the maternal health crisis in the United States, our findings suggest that measures to improve childcare stability may also promote maternal health and health equity.

Group peer mentoring to improve faculty connections and enhance mentoring networks

BACKGROUND

Difficulty finding mentors and forging connections in academic departments can be challenging and became even more so when the COVID-19 pandemic reduced opportunities for informal networking. Even as restrictions on in-person meetings eased, many faculty preferred meetings to remain virtual. Because some of the most powerful predictors of faculty vitality are positive professional relationships and feelings of inclusion and belonging to an institution, attending to faculty needs in this area is important to mitigate undesired lingering consequences.

APPROACH

We created structured peer mentoring groups for our department's physicians and psychologists that meet virtually. Groups span career stages, academic appointments and clinical interests. The purpose was to establish a deeper culture of mentoring, increase feelings of connection to a supportive community within the department, facilitate career planning and enhance the development of skills necessary in academic medicine such as teaching skills, scholarly productivity and personal wellness.

EVALUATION

A survey conducted after the first year of the programme was completed by 70% of eligible faculty (31/45). Ninety-six percent felt the programme had created an inclusive and appreciative culture, 86% met faculty members they had never met before and 79% sought mentoring advice from a colleague they would not usually have interacted with in that manner. All participants appreciated hearing their colleagues' perspectives on topics they do not typically discuss.

IMPLICATIONS

Departmentally based group peer mentoring that spans career stages and interests can facilitate faculty connections and enhance a supportive culture of mentorship.

Socioeconomic impacts of airborne and droplet-borne infectious diseases on industries: a systematic review

BACKGROUND

Recent pandemics have had far-reaching effects on the world's largest economies and amplified the need to estimate the full extent and range of socioeconomic impacts of infectious diseases outbreaks on multi-sectoral industries. This systematic review aims to evaluate the socioeconomic impacts of airborne and droplet-borne infectious diseases outbreaks on industries.

METHODS

A structured, systematic review was performed according to the PRISMA guidelines. Databases of PubMed, Scopus, Web of Science, IDEAS/REPEC, OSHLINE, HSELINE, and NIOSHTIC-2 were reviewed. Study quality appraisal was performed using the Table of Evidence Levels from Cincinnati Children's Hospital Medical Center, Joanna Briggs Institute tools, Mixed Methods Appraisal Tool, and Center of Evidence Based Management case study critical appraisal checklist. Quantitative analysis was not attempted due to the heterogeneity of included studies. A qualitative synthesis of primary studies examining socioeconomic impact of airborne and droplet-borne infectious diseases outbreaks in any industry was performed and a framework based on empirical findings was conceptualized.

RESULTS

A total of 55 studies conducted from 1984 to 2021 were included, reporting on 46,813,038 participants working in multiple industries across the globe. The quality of articles were good. On the whole, direct socioeconomic impacts of Coronavirus Disease 2019, influenza, influenza A (H1N1), Severe Acute Respiratory Syndrome, tuberculosis and norovirus outbreaks include increased morbidity, mortality, and health costs. This had then led to indirect impacts including social impacts such as employment crises and reduced workforce size as well as economic impacts such as demand shock, supply chain disruptions, increased supply and production cost, service and business disruptions, and financial and Gross Domestic Product loss, attributable to productivity losses from illnesses as well as national policy responses to contain the diseases.

CONCLUSIONS

Evidence suggests that airborne and droplet-borne infectious diseases have inflicted severe socioeconomic costs on regional and global industries. Further research is needed to better understand their long-term socioeconomic impacts to support improved industry preparedness and response capacity for outbreaks. Public and private stakeholders at local, national, and international levels must join forces to ensure informed systems and sector-specific cost-sharing strategies for optimal global health and economic security.

Knowledge, attitude, and practice of diabetes in patients with and without sight-threatening diabetic retinopathy from two secondary eye care centres in India

BACKGROUND/AIMS

Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India.

METHODS

400 consecutive patients (mean age = 58.5 years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria.

RESULTS

Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month.

CONCLUSION

Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early.

Genetic counselors' perceptions of student supervision across service delivery models

Genetic counseling (GC) services are increasingly delivered by phone or video, resulting in more telehealth student rotations. The purpose of this study was to describe genetic counselors' utilization of telehealth for student supervision and to compare how their comfort, preferences, and perception of the difficulty of selected student supervision competencies vary between phone, video, and in-person student supervision. In 2021, patient-facing genetic counselors in North America with ≥1-year GC experience who supervised ≥3 GC students in the last 3 years received an invitation via the American Board of Genetic Counseling or the Association of GC Program Directors listservs to complete a 26-item online questionnaire. There were 132 responses eligible for analysis. Demographics were fairly consistent with the National Society of Genetic Counselors Professional Status Survey. The majority of participants used more than one service delivery model to provide GC services (93%) and supervise students (89%). Six supervisory competencies related to the student-supervisor communication (Eubanks HIggins et al., 2013) were perceived to be most difficult to accomplish by phone and easiest in-person (p < 0.0001). Participants were most comfortable in-person and least comfortable by telephone for both patient care and student supervision (p < 0.001). The majority of participants predicted continued use of telehealth for patient care but preferred in-person service delivery for both patient care (66%) and student supervision (81%). Overall, these findings indicate service delivery model changes in the field have an impact on GC education and suggest that the student-supervisor relationship may be different via telehealth. Furthermore, the stronger preference for in-person patient care and student supervision, despite predicted continued telehealth utilization, points to a need for multifaceted telehealth education initiatives.

Faculty knowledge, actions, and perceptions of sponsorship: an institutional survey study

BACKGROUND

Women and underrepresented in medicine and the health sciences (URiM) faculty face inequities in advancement. Career sponsorship may be a remedy. Few studies have described sponsorship in academic medicine and none across an institution.

OBJECTIVE

To examine faculty awareness, experiences, and perceptions of sponsorship at a large academic health center.

DESIGN

Anonymous online survey.

PARTICIPANTS

Faculty with a ≥50% appointment.

MAIN MEASURES

The survey contained 31 Likert, multiple-choice, yes/no, and open-ended questions about familiarity with the concept of sponsorship; experience of having or being a sponsor; receipt of specific sponsorship activities; sponsorship impact and satisfaction; mentorship and sponsorship co-occurrence; and perception of inequities. Open-ended questions were analyzed using content analysis.

KEY RESULTS

Thirty-one percent of the surveyed faculty (903/2900) responded of whom 53% (477/903) were women and 10% (95/903) were URiM. Familiarity with sponsorship was higher among assistant (91%, 269/894) and associate (182/894; 64%) professors versus full professors (38%, 329/894); women (67%, 319/488) versus men (62%, 169/488); and URiM (77%, 66/517) versus non-URiM faculty (55%, 451/517). A majority had a personal sponsor (528/691; 76%) during their career and were satisfied with their sponsorship (64%, 532/828). However, when responses from faculty of different professorial ranks were stratified by gender and URiM identity, we observed possible cohort effects. Furthermore, 55% (398/718) of respondents perceived that women received less sponsorship than men and 46% (312/672) that URiM faculty received less than their peers. We identified seven qualitative themes: sponsorship importance, growing awareness and change, institutional biases and deficiencies, groups getting less sponsorship, people with sponsorship power, conflation with mentorship, and potential for negative impact.

CONCLUSIONS

A majority of respondents at a large academic health center reported sponsorship familiarity, receipt, and satisfaction. Yet many perceived persistent institutional biases and the need for systematic change to improve sponsorship transparency, equity, and impact.

Intersectionality and COVID-19: Academic Medicine Faculty's Lived Experiences of Well-Being, Workload, and Productivity During the Pandemic

Purpose: The aim of this study was to utilize an intersectional framework to examine academic faculty's lived experiences during COVID-19. Specifically, we set out to: (1) describe the multiple intersectional identities (e.g., gender, race/ethnicity, rank, caregiver status, disability status) represented by the faculty, (2) examine potential disparities in well-being, workload, and productivity linked to these intersectional factors, and (3) identify qualitative themes endorsed by faculty as they relate to lived experiences during COVID-19. Methods: This was a cross-sectional mixed-methods research study. The Center for Women in Medicine and Science (CWIMS) at the University of Minnesota developed and implemented a survey between February-June of 2021 in response to national reports of disparities in the impacts of COVID-19 on faculty with lived experiences from multiple intersections. Results: There were 291 full-time faculty who participated in the study. Quantitative findings indicated that faculty with multiple intersectional identities (e.g., woman+assistant professor+caregiver+underrepresented in medicine) reported greater depression symptoms, work/family conflict, and stress in contrast to faculty with fewer intersectional identities. Furthermore, faculty with more intersectional identities reported higher clinical workloads and service responsibilities and lower productivity with regard to research article submissions, publications, and grant submissions in contrast to faculty with fewer intersectional identities. Qualitative findings supported quantitative findings and broadened understanding of potential underlying reasons. Conclusions: Findings confirm anecdotal evidence that faculty with lived experiences from multiple intersections may be disproportionately experiencing negative outcomes from the pandemic. These findings can inform decisions about how to address these disparities moving into the next several years with regard to promotion and tenure, burnout and well-being, and faculty retention in academic medical settings. Given these findings, it is also important to intentionally plan responses for future public health crises to prevent continued disparities for faculty with multiple intersectional identities.

Exploring dental faculty perceptions of current strategies and barriers to retention

PURPOSE

The aims of the study were to identify perceived strategies for and barriers to faculty retention and examine differences regarding age, gender, and race.

METHODS

Cross-sectional data was captured from the eight author-affiliated dental schools. A Qualtrics survey was emailed to all faculty members at these institutions (1467 possible participants) between November 2021 and February 2022. The survey was formulated from best practices listed in the American Dental Education Association Faculty Diversity Toolkit. It consisted of 18 questions, including demographic information and faculty perceptions of their respective workplaces. These responses were then evaluated with descriptive statistics, Chi-squared analysis, Pearson Correlation, and Fleiss' kappa.

RESULTS

The survey's response rate was 19.2%. There was no significant difference in perceived retention strategies across race, age, gender, practice tenure, practice type, or clinical versus tenure track. The top four barriers identified were inadequate financial compensation, workload, poor work environment, and burnout. There was a significant difference between racial groups and their perceived barrier of support for promotion (p = 0.048). This was more prevalent among clinical faculty (47.7%) than tenure track faculty (16.2%). The work environment was listed as a leading factor for both promoting retention and encouraging the exodus of faculty members.

CONCLUSION

Strategies aimed at improving financial compensation, career recognition, and transparency of the promotion process, along with those aimed at improving the work environment were shown to be vital to retaining faculty. Though the low response rate is a study limitation, these findings provide valuable information and a framework for future studies regarding dental faculty recruitment and retention.

Politicization of Medical Care, Burnout, and Professionally Conflicting Emotions Among Physicians During COVID-19

OBJECTIVE

To evaluate the association of politicization of medical care with burnout, professional fulfillment, and professionally conflicting emotions (eg, less empathy, compassion; more anger, frustration, resentment).

PARTICIPANTS AND METHODS

Physicians in select specialties were surveyed between December 2021 and January 2022 using methods similar to our prior studies, with additional assessment of politicization of medical care; moral distress; and having had to compromise professional integrity, workload, and professionally conflicting emotions.

RESULTS

In a sample of 2780 physicians in emergency medicine, critical care, noncritical care hospital medicine, and ambulatory care, stress related to politicization of medical care was reported by 91.8% of physicians. On multivariable analysis, compromised integrity (odds ratio [OR], 3.64; 95% CI, 2.31 to 5.98), moral distress (OR, 2.82; 95% CI, 2.16 to 3.68), and feeling more exhausted taking care of patients with coronavirus disease 2019 (COVID-19) (OR, 3.46; 95% CI, 2.63 to 4.54) were associated with burnout. Compromised integrity, moral distress, and feeling more exhausted taking care of patients with COVID-19 were also statistically significantly associated with lower odds of professional fulfillment and professionally conflicting emotions. Stress related to conversations about non-approved COVID-19 therapies (OR, 1.74; 95% CI, 1.08 to 2.89), patient resistance to mask wearing (OR, 1.84; 95% CI, 1.35 to 2.55), and working more hours due to COVID (OR, 0.66; 95% CI, 0.49 to 0.89) were associated with professionally conflicting emotions.

CONCLUSION

Most physicians experienced intrusion of politics into medical care during the pandemic. These experiences are associated with professionally conflicting emotions, including less compassion and empathy, greater frustration, and resentment. COVID-19-related moral distress and compromised integrity were also associated with less professional fulfillment and greater occupational burnout.

COVID-19 pandemic impacts on mental health, burnout, and longevity in the workplace among healthcare workers: A mixed methods study

To explore the mental health impacts of the COVID-19 pandemic on healthcare workers in Massachusetts and identify potential strategies to maintain the healthcare workforce we conducted a sequential exploratory mixed methods study. Fifty-two individuals completed interviews from April 22nd - September 7th, 2021; 209 individuals completed an online survey from February 17th - March 23rd, 2022. Interviews and surveys asked about the mental health impacts of working in healthcare during the COVID-19 pandemic, burnout, longevity in the workplace, and strategies for reducing attrition. Interview and survey participants were predominantly White (56%; 73%, respectively), female (79%; 81%) and worked as physicians (37%; 34%). Interviewees indicated high stress and anxiety levels due to frequent exposure to patient deaths from COVID-19. Among survey respondents, 55% reported worse mental health than before the pandemic, 29% reported a new/worsening mental health condition for themselves or their family, 59% reported feeling burned out at least weekly, and 37% intended to leave healthcare in less than 5 years. To decrease attrition, respondents suggested higher salaries (91%), flexible schedules (90%), and increased support to care for patients (89%). Healthcare workers' experiences with death, feeling unvalued, and overworked resulted in unprecedented rates of burnout and intention to leave healthcare.

Establishment of a Private Foundation-Academic Partnership to Promote Careers of Early-Stage Investigators Examining the Influence of Sex and Gender on Health and Health Care

Biological sex and gender-based constructs contribute significantly to the diversity of disease outcomes and treatment responses across the life course. To promote research considering sex and gender, the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) launched the Specialized Centers of Research Excellence (SCORE) on sex differences program. The Career Enhancement Core (CEC) of the Johns Hopkins SCORE on Sex and Age Differences in Immunity to Influenza (SADII) partnered with the Foundation for Gender-Specific Medicine, which matched NIH funding to support seed grants. Over 3 years we awarded 12 (10 were women faculty) seed grants to early-stage investigators. One year after the award, the seed grant awardees highlighted their progress, including publications, grant applications, and abstracts. All awardees noted challenges with their progress related to the COVID-19 pandemic and supply chain delays and shared suggestions for improving the programming of the CEC. They also highlighted the multiple ways the awards had helped them gain pilot data toward larger grants, build collaborative relationships, and present at the annual SCORE symposium. We describe a model and evidence supporting a private-academic collaboration to support the careers of early-stage investigators conducting research related to sex and gender.

Work-Life Balance and Academic Productivity Among College of Medicine Faculty During the Evolution of the COVID-19 Pandemic: The New Normal

Background

Work and home stress, productivity, and self-care of academic medicine faculty in Spring 2021 was contrasted to faculty's experience in the Spring of 2020, both of which were relatively compared with the prepandemic period.

Methods

A 93-question survey was sent to academic medicine faculty at an urban public university medical center in March 2020 and again in March 2021. Demographic, family, and academic characteristics, work distribution and productivity before and during the pandemic, perceived stress related to work and home activities, and self-care data compared with the prepandemic period were collected. Differences were assessed using chi-square or Fisher exact tests. Student t-test was used for the difference in mean values, while logistic regression was used to determine predictors of work stress.

Results

Two hundred thirty-one faculty completed the survey in Spring 2020 and 118 faculty responded in Spring 2021. The proportion of faculty reporting increased work and home stress decreased in Spring 2021 compared with Spring 2020. A higher proportion of women compared with men reported increased work stress in both surveys. In Spring 2021, work stress decreased significantly for men but not for women. Home stress decreased significantly for women in Spring 2021 but remained stable for the men faculty. Research productivity increased for both genders in Spring 2021, but a greater percentage of women reported disturbed sleep and diet. There were no differences in home stress levels between genders when caring for young children.

Conclusions

Men faculty are more likely to adapt to the "new normal" by lowering work stressors and increasing productivity, whereas women's continued high work stress and increased productivity may occur at the expense of decreased self-care. The challenges associated with having young children continue to affect the productivity and well-being of all faculty.

Influence of years of experience and age on hospital workforce compassion satisfaction, anxiety, depression, stress, and burnout during pandemic: Implications for retention

The hospital workforce is experiencing overwork and burnout in response to COVID-19. It is imperative to identify those experiencing mental duress and determine protective factors to promote mental wellness and workforce retention. Our research aim was to identify the mental wellness and professional quality of life among hospital staff working during a global health pandemic, and to determine if age or years of experience served as protective factors. We electronically surveyed hospital staff in North Dakota during Summer 2021. Participants reported demographic data and completed clinically validated behavioral health screening tools assessing anxiety, depression, perceived stress, and work-related quality of life. The survey was administered to all 47 hospitals in North Dakota and received 771 complete responses. All hospital staff ages 18 and older were invited to participate. Age and years of experience were collected categorically in line with research on the topic. Years of experience had a significant influence (p < 0.05) on compassion satisfaction, burnout, and perceived stress. Compassion satisfaction was lowest for those who had worked 5-10 years, and then began to increase incrementally every 10 years thereafter. Hospital staff with 21-30 years of experience reported the highest mean score for both perceived stress and depression. Age had a significant influence (p < 0.05) on scores for anxiety, depression, compassion satisfaction, burnout, secondary traumatic stress, and perceived stress. Those closest to retirement (the oldest and those with the greatest years of experience) reported higher compassion satisfaction, while the youngest cohorts reported experiencing greater stress and burnout and may subsequently leave the profession. This may impact access to, and quality of, care. This study demonstrates the need to implement interventions with a focus on defending healthcare workers from the psychological effects of their caring profession.

Gender and intention to leave healthcare during the COVID-19 pandemic among U.S. healthcare workers: A cross sectional analysis of the HERO registry

IMPORTANCE

The COVID-19 pandemic stressed the healthcare field, resulting in a worker exodus at the onset and throughout the pandemic and straining healthcare systems. Female healthcare workers face unique challenges that may impact job satisfaction and retention. It is important to understand factors related to healthcare workers' intent to leave their current field.

OBJECTIVE

To test the hypothesis that female healthcare workers were more likely than male counterparts to report intention to leave.

DESIGN

Observational study of healthcare workers enrolled in the Healthcare Worker Exposure Response and Outcomes (HERO) registry. After baseline enrollment, two HERO 'hot topic' survey waves, in May 2021 and December 2021, ascertained intent to leave. Unique participants were included if they responded to at least one of these survey waves.

SETTING

HERO registry, a large national registry that captures healthcare worker and community member experiences during the COVID-19 pandemic.

PARTICIPANTS

Registry participants self-enrolled online and represent a convenience sample predominantly composed of adult healthcare workers.

EXPOSURE(S)

Self-reported gender (male, female).

MAIN OUTCOME

Primary outcome was intention to leave (ITL), defined as having already left, actively making plans, or considering leaving healthcare or changing current healthcare field but with no active plans. Multivariable logistic regression models were performed to examine the odds of intention to leave with adjustment for key covariates.

RESULTS

Among 4165 responses to either May or December surveys, female gender was associated with increased odds of ITL (42.2% males versus 51.4% females reported intent to leave; aOR 1.36 [1.13, 1.63]). Nurses had 74% higher odds of ITL compared to most other health professionals. Among those who expressed ITL, three quarters reported job-related burnout as a contributor, and one third reported experience of moral injury.

CONCLUSIONS AND RELEVANCE

Female healthcare workers had higher odds of intent to leave their healthcare field than males. Additional research is needed to examine the role of family-related stressors.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT04342806.

Where the Sidewalk Ends: Parenting as a trainee during COVID-19

Physicians who are also parents have faced significant difficulties during the COVID-19 pandemic. However, most studies of the physician-parent workforce have focused on the experiences of attending physicians. In this commentary, we highlight the ways that trainee parents have uniquely experienced three major stressors during the pandemic: (1) childcare challenges, (2) scheduling difficulties, and (3) career uncertainties. We discuss potential solutions to mitigate these challenges for the future hematology/oncology workforce. As the pandemic continues, we hope that these steps can improve the ability of trainee parents to care both for their patients and their families.

List-keepers and other carrier bag stories: Academic mothers' (in)visible labor during the COVID-19 pandemic

Beginning in 2020, the COVID-19 pandemic disrupted familiar rhythms of work and life when academic women from the United States sheltered-in-place in their homes. The pandemic brought forth challenges which accentuated that caregiving with little or no support disproportionately affected mothers' abilities to navigate their new lives inside the home, where work and caregiving abruptly collided. This article takes on the (in)visible labor of academic mothers during this time-the labor mothers saw and viscerally experienced, yet that which was often unseen/unexperienced by others. Using Ursula K. Le Guin's Carrier Bag Theory as a conceptual framework, the authors engage with interviews of 54 academic mothers through a feminist-narrative lens. They craft stories of carrying (in)visible labor, isolation, simultaneity, and list-keeping as they navigate the mundaneness of everyday pandemic home/work/life. Through unrelenting responsibilities and expectations, they each find ways to carry it all, as they carry on.

SARS-COV-2 Pandemic: How to Maintain a COVID-free Hospital

The emergence of severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2) and its complications have demonstrated the devastating impact of a new infectious pathogen since the first months of 2020, especially on Health Systems. The work to maintain a COVID-free hospital in terms of reorganization of operational processes and surveillance against SARS-CoV-2 has allowed us to maintain the structure suitable for activities for non-positive patients. The commitment related to this reorganization (not only in terms of costs) is largely satisfied by the responses to the health needs of non-COVID patients. The results obtained during the First Pandemic phase at the Giovanni XXIII Hospital in Monastier di Treviso have allowed the maintenance of the status of a COVID-free hospital. These results are supported by multiple studies in other parts of the world.

Hospice Glassdoor and CAHPS® Scores-Glassdoor Scores and Hospice Financial Characteristics Predict Hospice Consumer Assessment of Healthcare Providers and Systems Scores

BACKGROUND

Recent public data transparency on both decedent caregiver satisfaction and employee satisfaction is impacting the three most essential needs of any hospice, admitting hospice enrollees, attracting hospice professionals and delivering on quality.

AIM

Explore the relationship between Glassdoor hospice employee recommendation data, hospice financial characteristics, and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores among the 50 largest US hospices.

DESIGN

Retrospective data with multivariate regression analysis.

DATA SOURCES

Provider CAHPS hospice survey data from 2019-2020 and Glassdoor employee recommendation data.

RESULTS

Glassdoor Composite and CAHPS Composite were positively correlated (r = .469, p < .01). Glassdoor scores, profit status, and acquisition status predicted Hospice CAHPS scores and explained 44% of the variation in CAHPS Composite. Being a large, for-profit hospice in acquisition status each predicted lower CAHPS scores. Non-profit hospices had significantly higher Glassdoor and CAHPS scores than for-profit hospices. CAHPS Composite and CAHPS Star Rating have potential as global indicators to inform customers of a given hospice's overall quality on the Hospice Compare website of CMS.

CONCLUSIONS

Hospice leaders seeking improvements in CAHPS scores are encouraged to seek feedback on whether their own employees would recommend their hospice to a friend. Communication and responsiveness were the strongest indicators of overall hospice quality. Skelton hospice staffing models must give way to realistic models that value company culture and employee satisfaction. Hospice quality and hospice profits are not necessarily mutually exclusive. Future research should explore the difference in themes emerging from positive and negative online caregiver reviews.

COVID Stressed, but Not due to the Virus

INTRODUCTION

Acute care surgeons can experience posttraumatic stress disorder (PTSD) due to the cumulative stress of practice. This study sought to document the potential impact of the COVID-19 pandemic on PTSD in acute care surgeons and to identify potential contributing factors.

METHODS

The six-item brief version of the PTSD Checklist-Civilian Version (PCL-6), a validated instrument capturing PTSD symptomology, was used to screen Eastern Association for the Surgery of Trauma members. Added questions gauged pandemic effects on professional and hospital systems-level factors. Regression modeling used responses from attending surgeons that fully completed the PCL-6.

RESULTS

Complete responses from 334 of 360 attending surgeons were obtained, with 58 of 334 (17%) screening positive for PTSD symptoms. Factors significantly contributing to both higher PCL-6 scores and meeting criteria for PTSD symptomology included decreasing age, increased administrative duties, reduced research productivity, nonurban practice setting, and loss of annual bonuses. Increasing PCL-6 score was also affected by perceived illness risk and higher odds of PTSD symptomology with elective case cancellation. For most respondents, fear of death and concerns of illness from COVID-19 were not associated with increased odds of PTSD symptomology.

CONCLUSIONS

The prevalence of PTSD symptomology in this sample was similar to previous reports using surgeon samples (15%-22%). In the face of the COVID-19 pandemic, stress was not directly related to infectious concerns but rather to the collateral challenges caused by the pandemic and unrelated demographic factors. Understanding factors increasing stress in acute care surgeons is critical as part of pandemic planning and management to reduce burnout and maintain a healthy workforce.

Influence of the COVID-19 Pandemic on Author Sex and Manuscript Acceptance Rates among Pulmonary and Critical Care Journals

Rationale: The coronavirus disease (COVID-19) pandemic has negatively affected women more than men and may influence the publication of non-COVID-19 research. Objectives: To evaluate whether the COVID-19 pandemic is associated with changes in manuscript acceptance rates among pulmonary/critical care journals and sex-based disparities in these rates. Methods: We analyzed first, senior, and corresponding author sex (female vs. male, identified by matching first names in a validated Genderize database) of manuscripts submitted to four pulmonary/critical care journals between January 1, 2018 and December 31, 2020. We constructed interrupted time series regression models to evaluate whether the proportion of female first and senior authors of non-COVID-19 original research manuscripts changed with the pandemic. Next, we performed multivariable logistic regressions to evaluate the association of author sex with acceptance of original research manuscripts. Results: Among 8,332 original research submissions, women represented 39.9% and 28.3% of first and senior authors, respectively. We found no change in the proportion of female first or senior authors of non-COVID-19 or COVID-19 submitted research manuscripts during the COVID-19 era. Non-COVID-19 manuscripts submitted during the COVID-19 era had reduced odds of acceptance, regardless of author sex (first author adjusted OR [aOR], 0.46 [95% confidence interval (CI), 0.36-0.59]; senior author aOR, 0.46 [95% CI, 0.37-0.57]). Female senior authorship was associated with decreased acceptance of non-COVID-19 research manuscripts (crude rates, 14.4% [male] vs. 13.2% [female]; aOR, 0.84 [95% CI, 0.71-0.99]). Conclusions: Although female author submissions were not disproportionately influenced by COVID-19, we found evidence suggesting sex disparities in manuscript acceptance rates. Journals may need to consider strategies to reduce this disparity, and academic institutions may need to factor our findings, including lower acceptance rates for non-COVID-19 manuscripts, into promotion decisions.

Academic Productivity of Equity-Deserving Physician Scholars During COVID-19: A Scoping Review

PURPOSE

The COVID-19 pandemic presented new barriers and exacerbated existing inequities for physician scholars. While COVID-19's impact on academic productivity among women has received attention, the pandemic may have posed additional challenges for scholars from a wider range of equity-deserving groups, including those who hold multiple equity-deserving identities. To examine this concern, the authors conducted a scoping review of the literature through an intersectionality lens.

METHOD

The authors searched peer-reviewed literature published March 1, 2020, to December 16, 2021, in Ovid MEDLINE, Ovid Embase, and PubMed. The authors excluded studies not written in English and/or outside of academic medicine. From included studies, they extracted data regarding descriptions of how COVID-19 impacted academic productivity of equity-deserving physician scholars, analyses on the pandemic's reported impact on productivity of physician scholars from equity-deserving groups, and strategies provided to reduce the impact of the COVID-19 pandemic on academic productivity of physician scholars from equity-deserving groups.

RESULTS

Of 11,587 unique articles, 44 met inclusion criteria, including 15 nonempirical studies and 29 empirical studies (22 bibliometrics studies, 6 surveys, and 1 qualitative study). All included articles focused on the gendered impact of the pandemic on academic productivity. The majority of their recommendations focused on how to alleviate the burden of the pandemic on women, particularly those in the early stages of their career and/or with children, without consideration of scholars who hold multiple and intersecting identities from a wider range of equity-deserving groups.

CONCLUSIONS

Findings indicate a lack of published literature on the pandemic's impact on physician scholars from equity-deserving groups, including a lack of consideration of physician scholars who experience multiple forms of discrimination. Well-intentioned measures by academic institutions to reduce the impact on scholars may inadvertently risk reproducing and sustaining inequities that equity-deserving scholars faced during the pandemic.

A Mixed-Methods Analysis of Gender and Career Status Differences in the Impact of the COVID-19 Pandemic on Underrepresented Postdoctoral Fellows and Early-Career Faculty

PURPOSE

The lack of racial and ethnic diversity in the biomedical workforce is pronounced and those from underrepresented backgrounds encounter more challenges than their majority counterparts. The extent of the impact of the COVID-19 pandemic on early-career investigators from underrepresented backgrounds is not yet fully understood. To examine the impact of the pandemic on underrepresented early-career biomedical researchers, this study evaluated differences in productivity, research, and psychological well-being by gender and career status.

METHOD

This was a cross-sectional analysis of preintervention data, collected in September-October 2020, from 220 participants enrolled in the Building Up a Diverse Biomedical Research Workforce study. Participants were from 25 academic medical centers in the United States and were underrepresented early-career researchers. The primary outcomes were agreement on a 5-point Likert scale with pandemic impact statements (e.g., "The COVID-19 pandemic has impacted my ability to conduct research"). Thematic analysis was conducted on responses to 2 open-ended questions assessing the pandemic's impact.

RESULTS

Most participants were female (79.9%), of non-Hispanic/Latinx/Spanish origin Black/African American (33.2%) or Hispanic/Latinx/Spanish origin (34.1%), and early-career faculty (53.4%). Over half of participants agreed or strongly agreed that the COVID-19 pandemic impacted their ability to work (55.7%) and conduct research (70.7%). Themes from qualitative analysis suggested lower research productivity, concerns about the academic job market and funding, and psychological distress due to the pandemic. Women were more likely to attribute lost productivity and psychological distress to homeschooling and childcare responsibilities. Postdoctoral fellows were concerned about more competition for fewer academic positions.

CONCLUSIONS

In this study of early-career underrepresented biomedical researchers, the impact of the COVID-19 pandemic was widely felt by participants, varying by gender and career status. For those postdoctoral fellows and early-career faculty who are underrepresented, it is critical for institutions to offer flexibility in their positions.

Use of provider-to-provider telemedicine in Kenya during the COVID-19 pandemic

Introduction

According to the World Health Organization (WHO), about 90 percent of countries continue to report COVID-related disruptions to their health systems. The use of telemedicine has been especially common among high-income countries to safely deliver and access health services where enabling infrastructure like broadband connectivity is more widely available than low- and middle-income countries (LMICs). The Addis Clinic implements a provider-to-provider (P2P) asynchronous telemedicine model in Kenya. We sought to examine the use of the P2P telemedicine platform during the second year of COVID-19.

Methods

To assess sustainability, we compared the data for two 12-month calendar periods (period A = year 2020, and period B = year 2021). To examine performance, we compared the data for two different 12-month periods (period C = pandemic period of February 2021 to January 2022, and period D = baseline period of February 2019 to January 2020).

Results

Sustainability of the P2P telemedicine platform was maintained during the pandemic with increased activity levels from 2,604 cases in 2020 to 3,525 cases in 2021. There was an average of 82 specialists and 5.9 coordinators during 2020, and an average of 81 specialists and 6.0 coordinators during 2021. During 2020, there were 444 cases per coordinator, and 587 cases per coordinator in 2021(P = 0.078). During 2020, there were 32 cases per specialist, and 43 cases per specialist in 2021(P = 0.068). Performance decreased with 99 percent of cases flagged as "answered" during the baseline period (period D), and 75 percent of cases flagged as "answered" during the pandemic period (period C).

Conclusion

Results suggest that despite a decline in certain sustainability and performance indicators, The Addis Clinic was able to sustain a very high level of activity during the second year of the pandemic, as shown by the continued use of the system. Furthermore, despite some of the infrastructure challenges present in LMICs, the P2P telemedicine platform was a viable option for receiving clinical recommendations from medical experts located remotely. As health systems in LMICs grapple with the effects of the pandemic, it is worthwhile to consider the use of telemedicine to deliver essential health services.

Medical School Faculty and Staff Well-being in Fall 2020 during the COVID-19 Pandemic

The COVID-19 pandemic increased stress and worry among faculty and staff members at universities across the US. To assess the well-being of university faculty and staff, a survey was administered at a medical school in the state of Hawai'i during early fall 2020. The purpose of the exploratory study was to assess and gauge faculty and staff members' well-being regarding the school's response to COVID-19. Participants in this study represented a convenience sample of compensated teaching, research, and administrative faculty and staff members. A total of 80 faculty and 73 staff members participated. Overall, faculty and staff reported relatively low levels of worries and stress. Staff members reported greater levels of worry and stress than faculty members in 8 of the 11 questions. Statistical differences were detected in 3 questions, with staff reporting higher levels of worry and stress in their health and well-being of themselves (P < .001), paying bills (P < .001), and losing their jobs (P < .001). Both faculty and staff reported good overall satisfaction on the timeliness and clarity of messages that they received, support from leadership and the school, and support to adjust to changes in response to COVID-19. For both faculty and staff, the greatest worry or concern for the open-ended question on worry and stress was related to financial and economic issues. Data from this survey and can contribute to an understanding of medical school employee well-being during a major operational disruption and may help develop policies and programs to assist employees in different employment categories during future disruptions.

Workforce Experiences of a Rapidly Established SARS-CoV-2 Asymptomatic Testing Service in a Higher Education Setting: A Qualitative Study

The aim of the study was to explore workforce experiences of the rapid implementation of a SARS-CoV-2 asymptomatic testing service (ATS) in a higher education setting during the COVID-19 pandemic. The setting was a multi-campus university in the UK, which hosted a testing service for employees and students over two years. Qualitative semi-structured videoconference interviews were conducted. We contacted 58 participants and 25 were interviewed (43% response rate). Data were analysed thematically. The analysis produced four overarching themes: (1) feelings relating to their involvement in the service, (2) perceptions of teamwork, (3) perceptions of ATS leadership, (4) valuing the opportunity for career development. Agile and inclusive leadership style created psychological safety and team cohesion, which facilitated participants in the implementation of a rapid mitigation service, at pace and scale. Specific features of the ATS (shared vision, collaboration, networking, skills acquisition) instilled self-confidence, value and belonging, meaningfully impacting on professional development and career opportunities. This is the first qualitative study to explore the experiences of university employees engaged in the rapid deployment of a service as part of a pandemic outbreak and mitigation strategy within a higher education setting. Despite pressures and challenges of the task, professional growth and advancement were universal. This has implications for workforce engagement and creating workplaces across the sector that are well-prepared to respond to future pandemics and other disruptive events.

A global overview of healthcare workers' turnover intention amid COVID-19 pandemic: a systematic review with future directions

BACKGROUND

Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic.

METHODS

A mixed studies systematic review was conducted. The PubMed, Embase, Scopus, CINAHL, Web of Science and PsycINFO databases were searched from January 2020 to March 2022. The Joanna Briggs Institute's Critical Appraisal Tools and the Mixed Methods Appraisal Tool version 2018 were applied by two independent researchers to critically appraise the methodological quality. Findings were synthesised using a convergent integrated approach and categorised thematically.

RESULTS

Forty-three studies, including 39 quantitative, two qualitative and two mixed methods studies were included in this review. Eighteen were conducted in the Middle East, ten in the Americas, nine in the Asia-Pacific region and six in Europe. Nurses (n = 35) were included in the majority of the studies, while physicians (n = 13), allied health workers (n = 11) and healthcare administrative or management staff (n = 7) were included in a smaller proportion. Five themes emerged from the data synthesis: (1) fear of COVID-19 exposure, (2) psychological responses to stress, (3) socio-demographic characteristics, (4) adverse working conditions, and (5) organisational support.

CONCLUSIONS

A wide range of factors influence healthcare workers' turnover intention in times of pandemic. Future research should be more focused on specific factors, such as working conditions or burnout, and specific vulnerable groups, including migrant healthcare workers and healthcare profession minorities, to aid policymakers in adopting strategies to support and incentivise them to retain them in their healthcare jobs.

Building capacity for integrated knowledge translation: a description of what we can learn from trainees’ experiences during the COVID-19 pandemic

The use of collaborative health research approaches, such as integrated knowledge translation (IKT), was challenged during the COVID-19 pandemic due to physical distancing measures and transition to virtual platforms. As IKT trainees (i.e. graduate students, postdoctoral scholars) within the Integrated Knowledge Translation Research Network (IKTRN), we experienced several changes and adaptations to our daily routine, work and research environments due to the rapid transition to virtual platforms. While there was an increased capacity to communicate at local, national and international levels, gaps in equitable access to training and partnership opportunities at universities and organizations have emerged. This essay explores the experiences and reflections of 16 IKTRN trainees during the first 2 years of the COVID-19 pandemic at the micro (individual), meso (organizational) and macro (system) levels. The micro level, or individual experiences, focuses on topics of self-care (taking care of oneself for physical and mental well-being), maintaining research activities and productivity, and leisure (social engagement and taking time for oneself), while conducting IKT research during the pandemic. At the meso level, the role of programmes and organizations explores whether and how institutions were able to adapt and continue research and/or partnerships during the pandemic. At the macro level, we discuss implications for policies to support IKT trainees and research, during and beyond emergency situations. Themes were identified that intersected across all levels, which included (i) equitable access to training and partnerships; (ii) capacity for reflexivity; (iii) embracing changing opportunities; and (iv) strengthening collaborative relationships. These intersecting themes represent ways of encouraging sustainable and equitable improvements towards establishing and maintaining collaborative health research approaches. This essay is a summary of our collective experiences and aims to provide suggestions on how organizations and universities can support future trainees conducting collaborative research. Thus, we hope to inform more equitable and sustainable collaborative health research approaches and training in the post-pandemic era.

Changes in Anxiety Level and Personal Protective Equipment Use Among Healthcare Workers Exposed to COVID-19

BACKGROUND

The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19).

METHODS

An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated.

RESULTS

The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available. Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score.

CONCLUSION

Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.

Work-Life Balance and Productivity Among Academic Faculty During the COVID-19 Pandemic: A Latent Class Analysis

Background: For faculty in academic health sciences, the balance between research, education, and patient care has been impeded by the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify personal and professional characteristics of faculty to understand the impact of the pandemic on faculty and consequent policy implications. Methods: A 93-question survey was sent to faculty at a large urban public university and medical center. Demographic, family, and academic characteristics, work distribution and productivity before and during the pandemic, stress, and self-care data information were collected. Latent class analysis (LCA) was performed to identify classes of faculty sharing similar characteristics. Comparisons between latent classes were performed using analysis of variance and chi-square analyses. Results: Of 497 respondents, 60% were women. Four latent classes of faculty emerged based on six significant indicator variables. Class 1 individuals were more likely women, assistant professors, nontenured with high work and home stress; Class 2 faculty were more likely associate professors, women, tenured, who reported high home and work stress; Class 3 faculty were more likely men, professors, tenured with moderate work, but low home stress; and Class 4 faculty were more likely adjunct professors, nontenured, and had low home and work stress. Class 2 reported significantly increased administrative and clinical duties, decreased scholarly productivity, and deferred self-care. Conclusions: The pandemic has not affected faculty equally. Early and mid-career individuals were impacted negatively from increased workloads, stress, and decreased self-care. Academic leaders need to acknowledge these differences and be inclusive of faculty with different experiences when adjusting workplace or promotion policies.

Researching the researchers: psychological distress and psychosocial stressors according to career stage in mental health researchers

Background

Although there are many benefits associated with working in academia, this career path often involves structural and organisational stressors that can be detrimental to wellbeing and increase susceptibility to psychological distress and mental ill health. This exploratory study examines experiences of work-related psychosocial stressors, psychological distress, and mental health diagnoses among mental health researchers.

Methods

This international cross-sectional study involved 207 mental health researchers who were post-graduate students or employed in research institutes or university settings. Work-related psychosocial stressors were measured by the Copenhagen Psychosocial Questionnaire III (COPSOQ III). Psychological distress was assessed using the Depression-Anxiety-Stress Scale-21 (DASS-21). Thoughts of suicide was assessed using an adaptation of the Patient Health Questionnaire-9 (PHQ-9). History of mental health diagnoses was assessed through a custom questionnaire. Pearson’s chi-square test of independence was used to compare mental health diagnoses and suicidal ideation across career stages. The association between work-related psychosocial stressors and psychological distress was conducted using multivariate linear regression controlling for key demographic, employment-related and mental health factors.

Results

Differences in ‘demands at work’ and the ‘work-life balance’ domain were lowest among support staff (p = 0.01). Overall, 13.4% of respondents met the threshold for severe psychological distress, which was significantly higher in students compared to participants from other career stages (p = 0.01). Among the subgroup of participants who responded to the question on mental health diagnoses and suicidal ideation (n = 152), 54% reported a life-time mental health diagnosis and 23.7% reported suicidal ideation since their academic career commencement. After controlling for key covariates, the association between the ‘interpersonal relations and leadership’ domain and psychological distress was attenuated by the mental health covariates included in model 3 (β = −0.23, p = 0.07). The association between the remaining work-related psychosocial stressors and psychological distress remained significant.

Conclusions

Despite working in the same environment, research support staff report experiencing significantly less psychosocial stressors compared to postgraduate students, early-middle career researchers and senior researchers. Future research that targets key modifiable stressors associated with psychological distress including work organization and job content, and work-life balance could improve the overall mental health and wellbeing of mental health researchers.

Work-life balance among health administration faculty before and during the COVID-19 pandemic

This current study examines measures of work-life balance among health administration faculty prior to and during the COVID-19 pandemic. A repeated cross-sectional design is used to analyze data collected from a national survey in 2018 and 2021. Changes in six different outcome measures of work-life balance were examined using multivariable logistic regression, controlling for health administration faculty characteristics. Compared to 2018 respondents, faculty respondents in 2021 were more likely to report that family and personal matters were interfering with their ability to do their job (OR = 1.93, p=0.001). Females more frequently reported that their career had suffered because of personal issues/obligations (OR = 1.82, p=0.003) but were less likely to report having enough time to get their teaching (OR = 0.68, p=0.026). Respondents with children 18 years or younger reported higher rates of regularly having to miss a meeting or event at home (OR = 1.88, p<0.001) and an event at work (OR = 3.74, p<0.001). These faculty also more frequently reported that family or personal matters were interfering with their ability to do their job (OR = 3.04, p<0.001) and that their career suffered because of personal issues/obligations (OR = 2.09, p=0.001). Given the implications of work-life conflicts to organizational outcomes, academic leaders and university decision-makers should consider adopting strategies to mitigate the effects of these disruptions to the work-life equilibrium of academics.

The Stress and Resilience Town Hall: A systems response to support the health workforce during COVID-19 and beyond

OBJECTIVE

The COVID-19 pandemic is a traumatic stressor resulting in anxiety, depression, post-traumatic stress, and burnout among healthcare workers. We describe an intervention to support the health workforce and summarize results from its 40-week implementation in a large, tri-state health system during the COVID-19 pandemic.

METHOD

We conducted 121 virtual and interactive Stress and Resilience Town Halls attended by 3555 healthcare workers. Town hall participants generated 1627 stressors and resilience strategies that we coded and analyzed using rigorous qualitative methods (Kappa = 0.85).

RESULTS

We identify six types of stressors and eight types of resilience strategies reported by healthcare workers, how these changed over time, and how town halls were responsive to emerging health workforce needs. We show that town halls dedicated to groups working together yielded 84% higher mean attendance and more sharing of stressors and resilience strategies than those offered generally across the health system, and that specific stressors and strategies are reported consistently while others vary markedly over time.

CONCLUSIONS

The virtual and interactive Stress and Resilience Town Hall is an accessible, scalable, and sustainable intervention to build mutual support, wellness, and resilience among healthcare workers and within hospitals and health systems responding to emerging crises, pandemics, and disasters.

First year impacts of the COVID-19 pandemic on pediatric physiatrists

PURPOSE

The objective of this study was to determine how the COVID-19 pandemic impacted the work and compensation of pediatric physiatrists during the first year of the pandemic.

METHODS

Pediatric physiatrists were surveyed in the spring of 2021 about how the first year of the COVID-19 pandemic impacted their practices as a part of a larger survey examining pediatric rehabilitation medicine practices. The COVID-19 specific questions covered three topic areas: 1) personal experiences with COVID-19; 2) occupational workflow changes due to COVID-19, including telehealth; and 3) employment consequences of the COVID-19 pandemic.

RESULTS

Thirteen of 259 pediatric physiatrists reported having a COVID-19 infection, of whom none required hospitalization. Nearly all (96.5%) of pediatric physiatrists reported using telehealth during the pandemic compared to 14% prior to the pandemic. They reported numerous changes to their clinical operations, and 50% reported not having adequate personal protective equipment available for themselves or their staff all of the time. Fifteen pediatric physiatrists (5.9%) reported being furloughed, and three reported job loss during the first year of the pandemic.

CONCLUSION

While only a small percentage of pediatric physiatrists contracted COVID-19 during the first year of the pandemic, nearly all experienced workflow changes.

Disproportionate Negative Career Impact of the COVID-19 Pandemic on Female Pediatric Cardiologists in the Northeast United States

The COVID-19 pandemic has had a dramatic impact on practicing physicians, with effects in clinical practice, academic pursuits, research endeavors, and personal lives. Women in medicine have been uniquely impacted. We examined the impact of the pandemic on the careers of pediatric cardiologists in the Northeast with an anonymous online survey. Participants reported demographic data, information on work hours, administrative burden, career satisfaction, academic productivity, and burnout. We approached 490 cardiologists and received 127 completed surveys (response rate 26%; 49% female). Among all respondents, 72% reported increased burnout, 43% reported decreased career satisfaction, and 57% reported decreased academic productivity. In multivariable ordinal regression analysis, when compared to male physicians, females were 2.4 times more likely to report decreased overall career satisfaction (p = 0.027), 2.6 times more likely to report decreased academic productivity (p = 0.028), and 2.6 times more likely to report increased feelings of burnout "to a large degree" (p = 0.022). Among all respondents, decreased career satisfaction was independently associated with increased household responsibility (OR = 4.4, p = 0.001). Increased administrative burden was independently associated with decreased academic productivity (OR = 2.6, p = 0.038). Open-ended responses highlighted loss of community due to remote work and blurring of the boundaries between work and home. Conversely, respondents appreciated flexibility to work remotely. In conclusion, the majority of pediatric cardiologists in the Northeast experienced negative career impacts due to the COVID-19 pandemic. Important gender differences emerged, with female physicians disproportionately reporting increased burnout, decreased career satisfaction, and decreased academic productivity.

"I may be essential but someone has to look after my kids": women physicians and COVID-19

Objectives

This paper analyzes results from focus groups held with women physicians in British Columbia which explored questions around how gender norms and roles influenced their experiences during COVID-19.

Methods

Four virtual focus groups were organized between July and September 2020. Participants (n = 27) were voluntarily recruited. Data were analyzed using applied thematic analysis.

Results

In addition to the COVID-19-related changes experienced across the profession, women physicians faced distinct challenges related to an increase in unpaid care responsibilities, and often felt excluded from, and occasionally dismissed by, leadership. Women leaders often felt their contributions were unrecognized and undervalued. Participants drew strength from other women leaders, peer networks, and professional support, but these strategies were limited by unpaid care and emotional labour demands, which were identified as increasing risk of burnout.

Discussion

Even though women physicians hold a degree of relative privilege, unpaid care work and gender norms contribute to distinct secondary effects of COVID-19. Women physicians link these to pre-pandemic assumptions (within families and communities) that women would absorb care deficits at their own cost. Health system leadership continues to reflect a masculine normative experience wherein the personal and professional are separated, and which devalues the emotional labour often associated with feminine leadership. The strategies participants employed to address negative impacts, while demonstrating resourcefulness and peer support, reflect individualistic responses to social-structural challenges. There is a need for greater recognition of women’s contributions at home and work, increased representation in decision-making, and practical supports such as childcare and counselling.

COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers

OBJECTIVE

To evaluate relationships between coronavirus disease 2019 (COVID-19)-related stress and work intentions in a sample of US health care workers.

PATIENTS AND METHODS

Between July 1 and December 31, 2020, health care workers were surveyed for fear of viral exposure or transmission, COVID-19-related anxiety or depression, work overload, burnout, and intentions to reduce hours or leave their jobs.

RESULTS

Among 20,665 respondents at 124 institutions (median organizational response rate, 34%), intention to reduce hours was highest among nurses (33.7%; n=776), physicians (31.4%; n=2914), and advanced practice providers (APPs; 28.9%; n=608) while lowest among clerical staff (13.6%; n=242) and administrators (6.8%; n=50; all P<.001). Burnout (odds ratio [OR], 2.15; 95% CI, 1.93 to 2.38), fear of exposure, COVID-19-related anxiety/depression, and workload were independently related to intent to reduce work hours within 12 months (all P<.01). Intention to leave one's practice within 2 years was highest among nurses (40.0%; n=921), APPs (33.0%; n=694), other clinical staff (29.4%; n=718), and physicians (23.8%; n=2204) while lowest among administrators (12.6%; n=93; all P<.001). Burnout (OR, 2.57; 95% CI, 2.29 to 2.88), fear of exposure, COVID-19-related anxiety/depression, and workload were predictors of intent to leave. Feeling valued by one's organization was protective of reducing hours (OR, 0.65; 95% CI, 0.59 to 0.72) and intending to leave (OR, 0.40; 95% CI, 0.36 to 0.45; all P<.01).

CONCLUSION

Approximately 1 in 3 physicians, APPs, and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether. Reducing burnout and improving a sense of feeling valued may allow health care organizations to better maintain their workforces postpandemic.

Society for Maternal-Fetal Medicine Special Statement: COVID-19 research in pregnancy: progress and potential

The COVID-19 global pandemic has broad implications for obstetrical care and perinatal outcomes. As we approach the 2-year mark into an unprecedented international pandemic, this review presents the progress and opportunities for research related to COVID-19 and pregnancy. Research is the basis for evidence-based clinical guidelines, and we aim to provide the structure and guidance for framing COVID-19-related obstetrical research. This structure will pertain not only to this pandemic but future ones as well.

The Silent Pandemic: The Psychological Burden on Frontline Healthcare Workers during COVID-19

This narrative review explores the full scope of harmful psychological effects of the COVID-19 (Coronavirus Disease of 2019) pandemic on FLHCWs (Frontline healthcare workers). Additionally, we highlight the risk factors for worse outcomes. A literature review identified 24 relevant papers included in this synthesis. The majority of studies reported a high number of mental health conditions in HCWs (Healthcare workers) overall. Working in the frontline setting was repeatedly identified as an independent risk factor for poorer mental health. Additional risk factors, such as gender, occupational pressure, and low level of support from hospital administration, family, and the community, were also commonly identified. In the past, defined interventions have been shown to mitigate the psychological impact of high-stress situations on frontline workers. This review is aimed at identifying individuals at higher risk to help effectively target preventative measures in future stress situations in our healthcare system.

Editorial: Applications of Cognitive and Behavioral Therapy in Response to COVID-19

The corona virus (COVID-19) continues to have a devastating health, economic, and social impact on our local and international communities. Cognitive and Behavioral Therapies (CBTs), as a family of therapies that posit cognitive, behavioral, emotional, and interpersonal change processes in the understanding and successful treatment of mental health disorders, have risen to the challenge. This special issue represents contributions from CBT experts on the impact on psychopathology, new assessment methods, adaptations of integrated behavioral health, telehealth, psychology training, and discusses a public health framework. The issue includes a series of articles offering guidance for the clinician on interventions for those impacted by trauma, CBT for youth and families, and telehealth for psychotic spectrum disorders and group therapy for social anxiety.

When COVID-19 Strikes Your Hospital

Kadri and colleagues presented findings from a nationally representative cohort of 144 116 hospitalized patients cared for in 558 hospitals to understand the effect of COVID-19 surges on patient outcomes. The editorialist discusses the findings and outlines potential strategies to prevent the deleterious effects of future surges on patients and staff.

Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee

The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled.

The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study

BACKGROUND

Since the COVID-19 pandemic onset, telemedicine has increased exponentially across numerous outpatient departments and specialties. Qualitative studies examining clinician telemedicine perspectives during the pandemic identified challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients. However, these studies only included a relatively small number of physicians or were limited to a single specialty, and few assessed perspectives on integrating trainees into workflows, an important area to address to support the clinical learning environment. As telemedicine use continues, it is necessary to understand a range of clinician perspectives.

OBJECTIVE

This study aims to survey pediatric and adult medicine clinicians at the University of Chicago Medical Center to understand their telemedicine benefits and barriers, workflow impacts, and training and support needs.

METHODS

In July 2020, we conducted an observational cross-sectional study of University of Chicago Medical Center faculty and advanced practice providers in the Department of Medicine (DOM) and Department of Pediatrics (DOP).

RESULTS

The overall response rate was 39% (200/517; DOM: 135/325, 42%; DOP: 65/192, 34%); most respondents were physicians (DOM: 100/135, 74%; DOP: 51/65, 79%). One-third took longer to prepare for (65/200, 33%) and conduct (62/200, 32%) video visits compared to in-person visits. Male clinicians reported conducting a higher percentage of telemedicine visits by video than their female counterparts (P=.02), with no differences in the number of half-days per week providing direct outpatient care or supervising trainees. Further, clinicians who conducted a higher percentage of their telemedicine by video were less likely to feel overwhelmed (P=.02), with no difference in reported burnout. Female clinicians were "more overwhelmed" with video visits compared to males (41/130, 32% vs 12/64, 19%; P=.05). Clinicians 50 years or older were "less overwhelmed" than those younger than 50 years (30/85, 35% vs 23/113, 20%; P=.02). Those who received more video visit training modalities (eg, a document and webinar on technical issues) were less likely to feel overwhelmed by the conversion to video visits (P=.007) or burnt out (P=.009). In addition, those reporting a higher ability to technically navigate a video visit were also less likely to feel overwhelmed by video visits (P=.02) or burnt out (P=.001). The top telemedicine barriers were patient-related: lack of technology access, lack of skill, and reluctance. Training needs to be focused on integrating learners into workflows. Open-ended responses highlighted a need for increased support staff. Overall, more than half "enjoyed conducting video visits" (119/200, 60%) and wanted to continue using video visits in the future (150/200, 75%).

CONCLUSIONS

Despite positive telemedicine experiences, more support to facilitate video visits for patients and clinicians is needed. Further, clinicians need additional training on trainee education and integration into workflows. Further work is needed to better understand why gender and age differences exist. In conclusion, interventions to address clinician and patient barriers, and enhance clinician training are needed to support telemedicine's durability.