COVID-19 has heightened tensions between and exposed threats to core values of emergency medicine.

BACKGROUND: Professional culture is a powerful influence in emergency departments, but incompletely understood. Disasters magnify cultural realities, and as such the COVID-19 pandemic offered a unique opportunity to better understand emergency medicine (EM) values, practices, and beliefs. METHODS: We conducted a collaborative ethnography at a tertiary care center during the acute phase of the response to the threat of COVID-19 (March-May 2020). Collaborative ethnography is a method that partners directly with communities during design, data gathering, and analysis to study culture. An ED-based research team gathered data including field notes from 300 h of participant observation and informal interviews, 42 semi-structured interviews, and 57 departmental documents. Data were deductively coded using a previously generated framework for understanding EM culture. RESULTS: Each of seven core values from the original framework were identified in the dataset and further contextualized understanding of EM culture. COVID-19 exacerbated pre-existing tensions and threats to the core values of EM. For example, the desire to provide patient-centered care was impeded by strict visitor restrictions; the ability to treat life-threatening illness was impaired by new resuscitation room layouts and infection control procedures; and subtle changes in protocols had downstream impact on flow and the ability to balance needs and resources at a system level. The cultural values related to teams were protective and strengthened during this time. The pandemic exposed problems with the status quo, underscored inherent tensions between ED values, and highlighted threats to self-identity. CONCLUSION: COVID-19 has highlighted and compounded existing tensions and threats to the core values of EM, underscoring a critical mismatch between values and practice. Realignment of the realities of ED work with staff values is urgently needed.

RéSUMé: CONTEXTE: La culture professionnelle est une influence puissante dans les services d'urgence, mais elle est incomplètement comprise. Les catastrophes amplifient les réalités culturelles et, à ce titre, la pandémie de COVID-19 a offert une occasion unique de mieux comprendre les valeurs, les pratiques et les croyances de la médecine d'urgence (MU). MéTHODES: Nous avons mené une ethnographie collaborative dans un centre de soins tertiaires pendant la phase aiguë de la réponse à la menace du COVID-19 (mars-mai 2020). L'ethnographie collaborative est une méthode qui s'associe directement aux communautés pendant la conception, la collecte de données et l'analyse pour étudier la culture. Une équipe de recherche basée à l'urgence a recueilli des données, y compris des notes de terrain tirées de 300 heures d'observation des participants et d'entrevues informelles, de 42 entrevues semi-structurées et de 57 documents ministériels. Les données ont été codées de manière déductive à l'aide d'un cadre précédemment créé pour comprendre la culture de la MU. RéSULTATS: Chacune des sept valeurs fondamentales du cadre original a été identifiée dans l'ensemble de données et a permis de mieux comprendre la culture de la MU. COVID-19 a exacerbé les tensions préexistantes et les menaces qui pèsent sur les valeurs fondamentales de la MU. Par exemple, le désir de fournir des soins centrés sur le patient a été entravé par des restrictions strictes concernant les visiteurs ; la capacité de traiter des maladies potentiellement mortelles a été compromise par les nouvelles dispositions des salles de réanimation et des procédures de contrôle des infections ; et des changements subtils dans les protocoles ont eu un impact en aval sur le flux et la capacité à équilibrer les besoins et les ressources au niveau du système. Les valeurs culturelles liées aux équipes étaient protectrices et renforcées pendant cette période. La pandémie a mis en évidence les problèmes liés au statu quo, souligné les tensions inhérentes entre les valeurs des services d'urgence et mis en évidence les menaces pour l'identité personnelle. CONCLUSION: COVID-19 a mis en évidence et aggravé les tensions et les menaces existantes pour les valeurs fondamentales de la MU, soulignant un décalage critique entre les valeurs et la pratique. Il est urgent de réaligner les réalités du travail dans les services d'urgence sur les valeurs du personnel.

Emergency medicine physician burnout and wellness in Canada before COVID19: A national survey.

INTRODUCTION: Emergency medicine (EM) is a high-risk specialty for burnout. COVID-19 has had and will continue to have important consequences on wellness and burnout for EM physicians in Canada. Baseline data are crucial to monitor the health of EM physicians in Canada, and evaluate any interventions designed to help during and after COVID-19. OBJECTIVES: To describe the rates of burnout, depression, and suicidality in practicing EM physicians in Canada, just before the COVID-19 pandemic. METHODS: A modified snowball method was used for survey distribution. Participants completed the Maslach Burnout Inventory - Health Services Tool (MBI-HSS), a screening measure for depression (PHQ-9), and a question regarding if the physician had ever or in the past 12 months contemplated suicide. RESULTS: A total of 384 respondent surveys were included in the final analysis: 86.1% (329/382) met at least one of the criteria for burnout, 58% (217/374) scored minimal to none on the PHQ-9 screening tool for depression, 14.3% (53/371) had contemplated suicide during their staff career in EM, and of those, 5.9% (22/371) had actively considered suicide in the past year. CONCLUSION: Canadian EM physicians just before the COVID-19 pandemic had an alarming number of respondents meet the threshold for burnout, confirming EM as a high-risk specialty. This important baseline information can be used to monitor the physical and mental risks to EM physicians during and after COVID-19, and evaluate support for mental health and wellness, which is urgently needed now and post pandemic.