Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa

Background: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD). Methods: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress and organisational support was determined by calculating the median rank. Results: The majority of the participants were between ages 31­40 (62.6%), male (59.8%), registrars (47.6%), had no comorbidities (73.8%), and had no known mental illness (79.9%). Having a previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02­10.24], p < 0.001), anxiety(OR [95% CI] = 3.9 [1.7­9.0], p = 0.001), stress (OR [95% CI] = 3.8 [1.6­9.2], p = 0.002), and PTSD (OR [95% CI] = 5.4 [2.2­13.5], p < 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at work, and taking the infection home to family. Conclusion: Participants with a history of mental illness were predisposed to developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to appropriate personal protective equipment.

An evaluation of personality traits associated with job satisfaction among South African anaesthetists using the Big Five Inventory

Background: Job satisfaction is a vital contributor to occupational well-being and may be instrumental in mitigating stress and the adverse effects thereof. This is particularly pertinent in anaesthesiology, which is an inherently stressful field. There are myriad factors, including personality traits, shown to influence job satisfaction. Personality testing is conducted in many industries prior to recruitment; however, this is not the case in medicine. Currently the prevailing tool for the aforementioned purpose is the Big Five Inventory based on the well-described Five Factor Model of personality. Methods: A cross-sectional survey was utilised with electronic questionnaires distributed to all 1 509 members of the South African Society of Anaesthesiologists in 2016. Specialists, registrars, diploma-qualified and full-time general practitioner anaesthetists working in both the private and public sectors were included. Results: A response rate of 31% was achieved. Statistical analysis demonstrated that Neuroticism was the strongest and most consistent negative correlate of job satisfaction, while Agreeableness was positively associated with job satisfaction. Encouragingly, a mean of 65.6% was recorded for job satisfaction using a visual analogue scale. Socio-demographic variables positively associated with job satisfaction included increasing age, male gender, private practice and specialist/diploma qualification. Conclusions: Information gleaned from this study may prove useful in vocational counselling with the aim of improving occupational well-being, thereby reducing burnout and maladaptive behaviour among South African anaesthetists

Errors and clinical supervision of intubation attempts by the inexperienced

Background: Tracheal intubation is an essential skill for anaesthetists and other disciplines that require emergency establishment of a secure airway. Early attempts in patients often meet with failure. Existing publications focus mainly on trainees in emergency settings and highlight the role of experience in success; most recommend prior simulation training. Common factors identified as contributing to difficulty have been difficult airways, emergencies and rapid sequence induction. Early intubation skill development in patients with anticipated straightforward airways in a controlled environment has received little attention. Objectives: This qualitative observational study aimed to identify common difficulties associated with a supervised intubation process by inexperienced personnel in the relatively stress-free conditions of elective surgical procedures in the operating theatre. Methods: Following institutional and ethical approval, participants, supervisors, anaesthetic assistants and patients consented to observation and video-recording of supervised intubations in a Durban teaching hospital. Anonymity and confidentiality were assured. Contemporaneous observations were recorded in theatre, and video-recordings were subsequently reviewed for content. Errors, and interactions between supervisor, assistant and participant, and associated outcomes, were identified. Results: Twenty participants (medical interns and medical, paramedical and nursing students) performing 72 intubations were observed. All participants had prior training using manikins or simulators. There were 61 successful intubations and 11 unsuccessful attempts. Factors associated with failure included unfamiliarity with airway, equipment or process. Process errors included inadequate head positioning, laryngoscope handling and tracheal tube manipulation. Anaesthetic assistants contributed to difficulties in some cases. Supervisor support was either verbal, physical or both. Less experienced supervisors tended to intervene earlier. There was a significant trend for success associated with the reported number of prior successful intubations. A successful intubation within the study was, however, no guarantee of subsequent success. Conclusion: Despite prior simulation training, many participants demonstrated lack of familiarity with the airway, intubation process and equipment. While improved simulation training might partly address these issues, supervision of early clinical intubation attempts needs to be redirected from the process of intubation itself to the process of intubation skills acquisition. A first step would be to ensure that all supervisors and assistants are trained for the latter goal, anticipating common errors and providing standardised conditions for success. The use of video-recording of the events is an invaluable aid to observation and interpretation, and is recommended as an adjunct to further studies of mechanical skills transfer