Otolaryngology Resident Wellness, Training, and Education in the Early Phase of the COVID-19 Pandemic

Psychological Impact of the COVID-19 Pandemic on Canadian Surgical Residents: A Province-Wide Study

OBJECTIVES

The objective of this study was to evaluate the psychological impact of the COVID-19 pandemic on surgical residents.

DESIGN

An online survey was distributed evaluating multiple domains: demographics, health and socioeconomic factors, clinical experience, educational experience, and psychological outcomes. The Mayo Clinic Resident Well-Being Index (RWBI) was used as a validated measure of resident mental health.

SETTING AND PARTICIPANTS

Surgical residents from University of British Columbia's surgical residency programs.

RESULTS

A total of 31/86 surgical residents responded to the survey. Of which, 57% and 46% reported feeling burned out or depressed, respectively. Residents who were concerned about personal protective equipment supply and who lived with family members with comorbidities had a higher risk of depression (p = 0.03, p = 0.04). The median Mayo Clinic Resident Well-Being Index was 2.5, higher than the median of 2 observed in the United States national survey of residents.

CONCLUSIONS

The pandemic had a considerable negative impact on the psychological well-being of surgical residents.

Surgical trainee burnout during the COVID-19 pandemic: a systematic review

INTRODUCTION

The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. The aim of this study was to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialties and to identify factors that may modify the risk of burnout.

METHODS

A systematic review was undertaken following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to identify articles related to the keywords "surgeons burnout COVID-19" and "surgical trainees burnout COVID-19". A search was carried out on the PubMed/MEDLINE® and ScienceDirect® databases for articles published from January 2020 to August 2022.

RESULTS

A total of 19 articles met the inclusion criteria, with 3,866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees across the globe during the pandemic was between 9.1% and 95.2%. Burnout rates were higher in general surgery (33.1-95.2%) than in urology (17.6-54.6%), neurosurgery (16.2-44.1%) and orthopaedic surgery (9.1-44.1%). Otolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included being a female trainee, being a more junior trainee and increased working hours.

CONCLUSIONS

There has been a high level of burnout among surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training and the serious consequences of surgeon burnout (both for the individual and for the patients), targetted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed, and must be prioritised by healthcare institutions and training programmes.

Is Virtual Learning Here to Stay? A Multispecialty Survey of Residents, Fellows, and Faculty

The transition to virtual learning during the coronavirus disease 2019 pandemic marks a paradigm shift in graduate medical education (GME). From June to September 2021, we conducted a dual-center, multispecialty survey of residents, fellows, and faculty members to determine overall perceptions about virtual learning and assess its benefits, drawbacks, and future role in GME. We discovered a mainly positive view of virtual education among trainees (138/207, 0.67, 95% CI 0.59-0.73) and faculty (180/278, 0.65, 0.59-0.70). Large group sessions, such as didactic lectures, grand rounds, and national conferences, were ranked best-suited for the virtual environment, whereas small groups and procedural training were the lowest ranked. Major benefits and drawbacks to virtual learning was identified. A hybrid approach, combining in-person and virtual sessions, was the preferred format among trainees (167/207, 0.81, 0.75-0.86) and faculty (229/278, 0.82, 0.77-0.87). Virtual learning offers a valuable educational experience that should be retained in postpandemic GME curriculums.

Burnout Assessment Among Surgeons and Surgical Trainees During the COVID-19 Pandemic: A Systematic Review

BACKGROUND

The objective of the current study was to summarize current research on burnout among surgical trainees and surgeons during the COVID-19 pandemic.

METHODS

PubMed, SCOPUS, Embase, and Psych INFO were systematically searched for studies that evaluated burnout during the COVID-19 pandemic among surgical trainees and surgeons.

RESULTS

A total of 29 articles met inclusion criteria, most of which originated from the United States (n = 18, 62.1%). Rates of burnout ranged from 6.0% to 86.0%. Personal factors responsible for burnout were fear of contracting/transmitting COVID-19 (8 studies, 27.6%), female gender (8, 27.6%), and younger age (5, 17.2%). Professional factors contributing to burnout included increased COVID-19 patient clinical load (6, 20.7%), limited work experience (6, 20.7%), reduction in operative cases (5, 17.2%) and redeployment to COVID-19 wards (4, 13.8%). The COVID-19 pandemic negatively impacted surgical education due to reduced number of operative cases (11, 37.9%), decreased hands-on experience (4, 13.8%), and not being able to complete case requirements (3, 10.34%). The shift of didactics to virtual formats (3, 10.3%), increased use of telemedicine (2, 6.9%), and improved camaraderie among residents (1, 3.4%) were viewed as positive consequences.

CONCLUSION

COVID-19 related burnout was reported in as many as 1 in 2 surgical trainees and attending surgeons. Intrinsic- (i.e., gender, age), family- (i.e., family/being married/having children or being single/not having children), as well as work-related extrinsic- (i.e., work-force deployment, risk of infection/spread, changes in educational format) factors were strongly associated with risk of burnout. These factors should be considered when designing interventions to ameliorate burnout among surgical trainees and surgeons.

Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review

OBJECTIVE

Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout.

DESIGN

PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021.

PARTICIPANTS

Surgical Trainees and Practicing Surgeons.

RESULTS

We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons.

CONCLUSION

Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout.

Assessment of Sleep Features, Mental Health Outcomes, and Alcohol and Tobacco Consumption in Residents and Fellows in Otolaryngology Before and During the COVID-19 Pandemic

Importance

The workload of many residents and fellows in otolaryngology-head and neck surgery has particularly increased during the COVID-19 pandemic; however, outcomes associated with mental health status and sleep remain unclear.

Objective

To assess the sleep, mental status, and alcohol and tobacco consumption habits of residents and fellows before the COVID-19 pandemic (before March 10, 2020) and during the pandemic period (after March 10, 2020).

Design, Setting, and Participants

This cohort study included residents and fellows of 6 university hospitals of European regions with a high prevalence of COVID-19 cases. Survey development, data collection, and analyses were performed from March 10, 2020, to June 30, 2021.

Main Outcomes and Measures

Residents and fellows were invited to respond to a survey assessing management of treatment in patients with COVID-19 and related work features; stress and mental health status (Beck Depression Inventory); sleep features (Insomnia Severity Index); and alcohol and tobacco consumption.

Results

Of 220 potential participants, 128 residents and fellows (58.2%) completed the evaluations. No demographic data on mean (SD) age and sex or gender were collected. The prepandemic mean (SD) score of the Beck Depression Inventory (3.1 [2.8]) significantly increased after the start of the pandemic (mean [SD] score, 4.2 [4.1]; difference, -1.1; 95% CI, -1.96 to -0.24; d = 0.31), and the prepandemic mean (SD) score of the Insomnia Severity Index (4.9 [4.1) significantly increased after the start of the pandemic (mean [SD] score, 6.0 [4.9]; difference, 1.1; 95% CI, 0.00-2.2; d = 0.25). Insomnia concerned 46% of participants (51 of 112), and depression concerned 47% of participants (55 of 116) during the pandemic. The mean (SD) prepandemic alcohol consumption (1.7 [2.3] IU per week) significantly increased after the start of the pandemic (mean [SD], 2.9 [4.0] IU per week; difference, 1.2; 95% CI, 0.40-2.00; d = 0.37). Residents and fellows who were mobilized in COVID-19 units reported significant increases of workload (r = 0.2; 95% CI, 0.1-0.3), stress level (r = 0.2; 95% CI, 0.1-0.3), and alcohol consumption (for 5-10 IU per week: mean [SD] prepandemic, 11 [8] IU per week vs postpandemic, 20 [16] IU per week; d = 0.37) and a worsening of sleep status (for moderate insomnia: mean [SD] prepandemic Insomnia Severity Index, 4 [3] vs postpandemic, 15 [12]; d = 0.25). There was a significant association between alcohol consumption and the Beck Depression Inventory score (r = 0.4; 95% CI, 0.2-0.6). The mean (SD) consumption of tobacco decreased from 2.1 (1.3) to 0.9 (1.5) (difference, -1.20; 95% CI, -1.50 to -0.85; d = 0.85).

Conclusions and Relevance

Results of this cohort study suggest that the workload of residents and fellows increased during the pandemic, which may be associated with a worsening of mental health and sleep status and an increase of alcohol consumption.

Fellows’ Perspective of Educational Changes in Medical Sports Medicine During the COVID-19 Pandemic

Background

As a result of the coronavirus disease 2019 (COVID-19) pandemic, graduate medical education, along with most of daily life, was disrupted. The goal of this study was to explore the experiences of fellows in primary care/medical sports medicine (MSM) and view the changes made to training programs through their eyes.

Methodology

A questionnaire was developed to collect qualitative and quantitative data regarding the fellow’s experiences in training from March to June 2020. Fellows on the American Medical Society for Sports Medicine list of current Sports Medicine Fellows in the United States and Canada were invited to participate. Of the 329 invited, 90 (27.4%) fellows returned questionnaires.

Results

MSM fellows highlighted positive adaptations as well as losses to their educational programs related to the pandemic. The biggest gain reported was additional learning time, and the greatest loss was to sports and event coverage. Most fellows reported attending collaborative sessions, and they noted an increase in didactics compared to pre-pandemic levels. The largest losses were noted in event coverage and training room exposures, with smaller declines in ultrasounds, procedures, and research experiences. They also described challenges, including changing clinical roles, managing social isolation and boredom, and balancing work and family responsibilities.

Conclusions

Fellows identified gains, losses, and challenges due to pandemic-related changes to their fellowship programs. Fellowship directors and educators in different fields can use this understanding of the fellows’ experiences to build on current resources, further develop collaborative efforts, create new educational opportunities, and provide additional support for fellow learning.

COVID-19 and rhinological surgery

The Coronavirus-19 (COVID-19) pandemic has caused disruptions in the normal patient care workflow, necessitating adaptations within the healthcare profession. The objective of this article is to outline some of these adaptations and considerations necessitated by COVID-19 within the subspeciality of rhinology and endoscopic skull base surgery.

Otolaryngology in the face of A pandemic

Although infrequent, pandemics are serious public health concerns with unpredictable courses. The COVID-19 pandemic began over 2 years ago and is far from over. This pandemic has spread rapidly throughout the world and led to several million deaths, making it commonly compared to the deadly Spanish influenza pandemic. Policy and safety measures are constantly being adapted to reduce transmission rates. The pandemic places stress on all healthcare workers, but especially otolaryngology providers due to their direct contact with airway connected cavities. This puts them at high risk for infection and has impacted inpatient and outpatient otolaryngology care, as well as education, research, and mental health.

Burnout and well-being in otolaryngology trainees: A systematic review

Objective

To comprehensively review the recent published literature to characterize current trends of burnout and well-being among otolaryngology trainees.

Methods

Study design: systematic review and meta-analysis. A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well-being, as well as the general topic of well-being among surgical residents was completed. All included studies were summarized qualitatively. For the quantitative analysis, only articles reporting a Maslach burnout inventory (MBI), modified MBI or Mini-Z- Burnout assessment were included.

Results

Twenty-five articles were included in the qualitative summary and nine articles in the quantitative analysis. In the qualitative summary, trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists. Total hours worked per week and female gender were associated with worsened well-being. Residency program strategies to improve trainee well-being include program-sponsored wellness activities, dedicated wellness champions, and assistance with clerical burden. Implementation of protected nonclinical time has been shown to decrease burnout and increase well-being among trainees. Moreover, formal trainee mentorship programs have also been shown to reduce trainee burnout and stress. In the quantitative analysis, rates of trainee burnout ranged from 29.7% to 86% with an overall trend towards reduced rates of burnout from 2006 to 2021. Utilizing a weighted average, the overall burnout among otolaryngology residents was 58.6%.

Conclusions

Rates of burnout remain high among otolaryngology trainees. Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well-being.

N95 vs Half-face Respirator Wear in Surgical Trainees: Physiologic and Psychological Effects of Prolonged Use

Objectives

As specialists of the upper airway, otolaryngologists are at high risk for COVID-19 transmission. N95 and half-face respirator (HFR) masks are commonly worn, each with advantages in functionality and comfort. In this study, physiologic and psychological parameters of prolonged N95 vs HFR wear were compared.

Study Design

Prospective crossover cohort study.

Setting

Single academic tertiary care hospital.

Methods

A prospective crossover cohort study was performed. Healthy otolaryngology trainees and medical students (N = 23) participated and wore N95 and HFR masks continuously for 3 hours each on separate days. Various measures were analyzed: vitals, spirometry variables, scores on the State-Trait Anxiety Inventory and HIT-6 (Headache Impact Test-6), distress, and "difficulty being understood."

Results

The average age was 26.3 years (SD, 3.42). There were no significant differences in vital signs and spirometry variables between N95 and HFR wear. N95 wear was associated with decreases in oxygen saturation of approximately 1.09% more than with HFRs (95% CI, 0.105-2.077). State-Trait Anxiety Inventory scores increased more with HFR wear when compared with mean changes with N95 wear (95% CI, 1.350-8.741). There were no significant differences in HIT-6 scores or distress levels between masks. The proportions of participants reporting difficulty being understood was significantly higher with HFRs.

Conclusions

Oxygen saturation decreases with prolonged N95 wear, but anxiety and difficulty being understood are greater with HFR wear. Although HFRs have less resistance to gas exchange, N95 respirators may produce less anxiety and distress in clinical situations. Further studies are warranted to evaluate the clinical significance of these differences.

Level of Evidence

2.

The effects of COVID-19 on physician’s burnout: a systematic review

Background: To suggest measures to prevent burnout of physicians during the coronavirus disease 2019 (COVID-19) pandemic, we conducted a systematic review of research on physician burnout due to COVID-19.Methods: Three foreign databases were used: MEDLINE, Embase, and the Cochrane Library. A search was performed using the following search terms: COVID-19, coronavirus, NCOV, physicians, doctors, residents, and burnout. Four rounds of review were performed to enhance the consistency of quality assessment. The Joanna Briggs Institute checklist for analytical cross-sectional studies was used to assess the quality of the eligible studies.Results: A total of 465 studies were identified, of which 32 were selected. The quality assessment determined that 19 studies met the Joanna Briggs Institute criteria and had a low risk of bias. The most common tool used to measure physician burnout in the 32 studies was the Maslach Burnout Inventory.Conclusion: This study systematically evaluated the literature on physician burnout. However, the generalizability of our findings to Korean physicians may be limited. The composition of the medical personnel in Korea, such as open doctors, volunteer doctors, medical professors, and public health doctors, differs significantly from that of other countries. Nevertheless, evaluating the current status of physician burnout due to COVID-19 globally may hold meaningful implications for policymaking.