Training during a pandemic.

As scientists and physicians, we all went through a period of structured training. But for how many of us did a rapid-onset, global pandemic upend that training? Here we present 11 voices from current trainees, including medical students, graduate students, residents, and fellows, who reflect on how the pandemic altered their research, practice, and learning and, in the process, changed them.

Using nominal group technique among resident physicians to identify key attributes of a burnout prevention program.

PURPOSE: To identify preferred burnout interventions within a resident physician population, utilizing the Nominal Group Technique. The results will be used to design a discrete choice experiment study to inform the development of resident burnout prevention programs. METHODS: Three resident focus groups met (10-14 participants/group) to prioritize a list of 23 factors for burnout prevention programs. The Nominal Group Technique consisted of three steps: an individual, confidential ranking of the 23 factors by importance from 1 to 23, a group discussion of each attribute, including a group review of the rankings, and an opportunity to alter the original ranking across participants. RESULTS: The total number of residents (36) were a representative sample of specialty, year of residency, and sex. There was strong agreement about the most highly rated attributes which grouped naturally into themes of autonomy, meaning, competency and relatedness. There was also disagreement on several of the attributes that is likely due to the differences in residency specialty and subsequently rotation requirements. CONCLUSION: This study identified the need to address multiple organizational factors that may lead to physician burnout. There is a clear need for complex interventions that target systemic and program level factors rather than focus on individual interventions. These results may help residency program directors understand the specific attributes of a burnout prevention program valued by residents. Aligning burnout interventions with resident preferences could improve the efficacy of burnout prevention programs by improving adoption of, and satisfaction with, these programs. Physician burnout is a work-related syndrome characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment [1]. Burnout is present in epidemic proportions and was estimated to occur in over 50 percent of practicing physicians and in up to 89 percent of resident physicians pre-COVID 19. The burnout epidemic is growing; a recent national survey of US physicians reported an 8.9 percent increase in burnout between 2011 and 2014 [2]. Rates of physician burnout have also increased [3] during the COVID-19 pandemic with a new classification of "pandemic burnout" experienced by over 52 percent of healthcare workers as early as June of 2020 [4]. Physician burnout can lead to depression, suicidal ideation, and relationship problems that may progress to substance abuse, increased interpersonal conflicts, broken relationships, low quality of life, major depression, and suicide [5-7]. The estimated rate of physician suicide is 300-400 annually [8-10].

Prevalence of COVID-19 in medical school and residency in Porto Alegre, RS.

OBJECTIVE: A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS: A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS: Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS: Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.

An Initiative to Increase Residency Program Diversity.

A physician workforce that reflects the patient population is associated with improved patient outcomes and promotes health equity. Notwithstanding, racial and ethnic disparities persist within US medical schools, making some individuals underrepresented in medicine (URM). We sought to increase the percentage of URM residents who matched into our pediatric residency programs from a baseline of 5% to 35% to achieve demographic parity with our patients. We developed a multifaceted approach using multiple iterative tests of change, with the primary strategy being increased visibility of URM trainees and faculty to residency applicants. Strategies included applicant interviews with URM faculty, interview dinners with URM residents, visibility at academic conferences for URM trainees, development of targeted marketing materials, and a visiting student program supported by networking with URM residents. The primary outcome measure was the percentage of matched residents in the categorical pediatrics, child neurology, and medical genetics training programs who identified as URM. The percentage of URM residents increased to 16% (6 of 37) in 2018, 26% (11 of 43) in 2019, 19% (8 of 43) in 2020, and 21% (9 of 43) in 2021 (a four-year average of 22% URM residents; P = .0002). This progress toward a more representative residency program was met by challenges, such as pipeline concerns, the minority tax, and recruitment during a pandemic. We were able to implement small, low-resource strategies that had a large cumulative impact and could be implemented in other residency programs. Specific tactics and challenges encountered are discussed in this special article.

How real is a virtual interview? Perspectives of orthopaedic surgery residency directors.

OBJECTIVE: As a result of COVID-19 pandemic, the 2021 US residency MATCH was devoid of the traditional in-person interviews. Herein, we assess the impact of Virtual Interviews (VIs) on resident selection, from the perspectives of Orthopedic Surgery (OS) Program Directors (PDs). MATERIALS AND METHODS: A 14-item survey was sent to PDs of ACGME-accredited OS residencies. Questions were designed to assess the pros, cons, and robustness of VIs compared to their antecedent in-person format. RESULTS: Forty-seven PDs responded to our survey. VIs antagonized PDs' ability to assess applicants' fit to program (76.6%), commitment to specialty (64%), and interpersonal skills (68.1%). This led to heavier dependence upon applicants' portfolios (64%). Almost all respondents (97.9%) found VIs to be more cost-efficient, saving a median of $3000 in interview-related expenses. Overall, only 8.5% of PDs were willing to conduct exclusive VIs in future cycles, compared to the majority in favor of dual formats (51.5%) or exclusive in-person interviews (40.4%). CONCLUSIONS: VIs have been an overall success, making most PDs opt for dual interview formats in future cycles. How this technology is further implemented in the future remains to be seen.

Impact of COVID-19 on residency choice: A survey of New York City medical students.

OBJECTIVES: The Coronavirus disease 2019 (COVID-19) pandemic disrupted medical student education, particularly in New York City (NYC). We aimed to assess the impact of the COVID-19 pandemic on medical students' residency choices. METHODS: The authors conducted a cross-sectional survey of medical students in all years of study at four NYC medical schools (Columbia, Cornell, NYU, and SUNY Downstate). The survey was fielded from 19 Aug 2020 to 21 Sep 2020. Survey questions included items assessing COVID-19 impact on residency choices, personal impact of COVID-19, residency/specialty choices, and factors influencing these choices. RESULTS: A total of 2310 students received the survey, with 547 (23.7%) providing partial responses and 212 (9.2%) providing valid responses for our primary analysis. 59.0% of participants thought that COVID-19 influenced their choice of residency/specialty, with 0.9% saying the influence was to a great extent, 22.2% to some extent, and 35.8% very little. On multivariable analysis, factors that were independently associated with COVID-19 impacting residency choice included low debt ($1 to $99,999: adjOR 2.23, 95%CI 1.02-5.03) compared with no debt and Other race/ethnicity (adjOR 0.26, 95%CI 0.10-0.63) compared with White race/ethnicity. On secondary analysis of all participants answering survey items for logistic regression regardless of survey completion, direct personal impact of COVID-19 was significantly associated with COVID-19 impacting specialty choice (adjOR 1.90, 95%CI 1.04-3.52). Moreover, 24 students (11.6%) reported a change in their top residency choice from before to during/after COVID-19, citing concerns about frontline work, work-life balance, and risk of harm. CONCLUSIONS: Our study found that 3 in 5 (59.0%) participants felt that COVID-19 impacted their residency choice, with 11.6% of respondents explicitly changing their top specialty choice. Investigating the impact of the pandemic on medical student residency considerations is crucial to understand how medical career outlooks may change in the future.

Psychological Consequences Among Residents and Fellows During the COVID-19 Pandemic in New York City: Implications for Targeted Interventions.

PURPOSE: To examine the psychological impact of the COVID-19 pandemic on medical trainees (residents and fellows) working at Mount Sinai Hospital (MSH) in New York City (NYC), the initial epicenter of the United States pandemic. METHOD: The authors administered a survey to 991 trainees in frontline specialties working at MSH in NYC between April and May 2020. The instrument assessed symptoms of major depressive disorder, generalized anxiety disorder, COVID-19-related posttraumatic stress disorder, and burnout. Psychiatric screens were aggregated into 1 composite measure, and meeting criteria on any of the 3 scales was considered a positive screen for psychiatric symptoms. The survey also assessed COVID-19-related exposures, worries, coping strategies, and desired interventions. Multivariable logistic regressions were conducted to identify factors associated with psychiatric symptoms and burnout. RESULTS: Of the 560 respondents (56.6% response rate), 29.7% screened positive for psychiatric symptoms and 35.8% screened positive for burnout. History of a mental illness, COVID-19-related duties and personal/career worries, and coping by substance use were associated with increased likelihood of screening positive for psychiatric symptoms. Positive emotion-focused coping and feeling valued by supervisors were associated with decreased likelihood. Internal medicine and surgical specialties, a history of mental illness, increased duty hours, duty-related worries, personal/career worries, coping via self-blame and venting, and coping via substance use were associated with higher odds of burnout. Feeling valued by supervisors was associated with decreased burnout odds. The most common crisis-related needs included access to personal protective equipment, food provisions, and financial support. CONCLUSIONS: Psychological distress and burnout affected approximately one-third of trainees sampled during the height of the pandemic in NYC. As the pandemic surged beyond NYC, these findings suggest that interventions should include addressing basic needs, promoting leadership affirmation, moderating duty hours, supporting trainees financially, and enhancing mental health support.

Impact of COVID-19 on Saudi Neurosurgery Residency: Trainers' and Trainees' Perspectives.

INTRODUCTION: After the official announcement of the coronavirus disease-19 pandemic on March 11, 2020, the disease impacted most aspects of health care delivery, especially postgraduate education and training. METHOD: A cross-sectional, online questionnaire-based assessment was performed. The study participants involved neurosurgery residents and program directors (PDs) across the country between May 16 and May 27, 2020. RESULTS: Approximately 74 of 95 (77.9%) of the residents experienced an impact on their training calendar. Before the pandemic, 51 residents (53.3%) were involved in 2-3 surgeries per week, but during the pandemic, 66 (69.5%) were attending 0-1 case per week. Fifty-three residents (55.8%) agreed that academic sessions were affected despite the helpful effort of online teaching sessions. Thirty-four (35.8%) residents graded their anxiety during coronavirus disease-19 times as high. Ten PDs (58.8%) confirmed spending 3-5 hours per week on educational activities normally, whereas during the pandemic, 15 PDs (88.2%) reduced their educational hours to 0-2 hours per week. CONCLUSION: Our study showed that educational activities significantly decreased and shifted toward virtual teaching methods. Operative volume showed a substantial reduction for both junior and senior residents. Academic and clinical teaching was the main concern for PDs, and they faced challenges interviewing newly matched residents.

Characterizing the social media footprint of general surgery residency programs.

BACKGROUND: The medical community has increasingly embraced social media for a variety of purposes, including trainee education, research dissemination, professional networking, and recruitment of trainees and faculty. Platform choice and usage patterns appear to vary by specialty and purpose, but few studies comprehensively assess programs' social media presence. Prior studies assessed general surgery departments' Twitter use but omitted additional social media platforms and residency-specific accounts. OBJECTIVE: This study sought to broadly characterize the social media footprint of U.S. general surgery residency programs. METHODS: Using a protocolized search of program websites, social media platforms (Twitter, Facebook, Instagram, LinkedIn), and internet search, cross-sectional data on social media usage in March 2020 were collected for programs, their affiliated departments, their program directors (PDs), and their assistant/associate PDs (APDs). RESULTS: 318 general surgery residency programs, 313 PDs, and 296 APDs were identified. 47.2% of programs had surgery-specific accounts on ≥1 platform. 40.2% of PDs and APDs had ≥1 account on Twitter and/or LinkedIn. Program type was associated with social media adoption and Twitter utilization, with lower usage among university-affiliated and independent programs (p<0.01). CONCLUSIONS: Most general surgery residencies, especially non-university-based programs, lacked any department or residency accounts across Twitter, Facebook, and Instagram by March 2020. These findings highlight opportunities for increased social media engagement and act as a pre-pandemic baseline for future investigations of how the shift to virtual trainee education, recruitment, conferences, and clinical care affect social media use.

Diagnostic Performance of COVID-19 Reporting and Data System Classification Across Residents and Radiologists: A Retrospective Study.

OBJECTIVE: The aim of the study was to evaluate the interobserver agreement and diagnostic accuracy of COVID-19 Reporting and Data System (CO-RADS), in patients suspected COVID-19 pneumonia. METHODS: Two hundred nine nonenhanced chest computed tomography images of patients with clinically suspected COVID-19 pneumonia were included. The images were evaluated by 2 groups of observers, consisting of 2 residents-radiologists, using CO-RADS. Reverse transcriptase-polymerase chain reaction (PCR) was used as a reference standard for diagnosis in this study. Sensitivity, specificity, area under receiver operating characteristic curve (AUC), and intraobserver/interobserver agreement were calculated. RESULTS: COVID-19 Reporting and Data System was able to distinguish patients with positive PCR results from those with negative PCR results with AUC of 0.796 in the group of residents and AUC of 0.810 in the group of radiologists. There was moderate interobserver agreement between residents and radiologist with κ values of 0.54 and 0.57. CONCLUSIONS: The diagnostic performance of CO-RADS for predicting COVID-19 pneumonia showed moderate interobserver agreement between residents and radiologists.

Plastic Surgery amidst the Pandemic: The New York University Experience at the Epicenter of the COVID-19 Crisis.

SUMMARY: The coronavirus disease of 2019 pandemic became a global threat in a matter of weeks, with its future implications yet to be defined. New York City was swiftly declared the epicenter of the pandemic in the United States as case numbers grew exponentially in a matter of days, quickly threatening to overwhelm the capacity of the health care system. This burgeoning crisis led practitioners across specialties to adapt and mobilize rapidly. Plastic surgeons and trainees within the New York University Langone Health system faced uncertainty in terms of future practice, in addition to immediate and long-term effects on undergraduate and graduate medical education. The administration remained vigilant and adaptive, enacting departmental policies prioritizing safety and productivity, with early deployment of faculty for clinical support at the front lines. The authors anticipate that this pandemic will have far-reaching effects on the future of plastic surgery education, trends in the pursuit of elective surgical procedures, and considerable consequences for certain research endeavors. Undoubtedly, there will be substantial impact on the physical and mental well-being of health care practitioners across specialties. Coordinated efforts and clear lines of communication between the Department of Plastic Surgery and its faculty and trainees allowed a concerted effort toward the immediate challenge of tempering the spread of coronavirus disease of 2019 and preserving structure and throughput for education and research. Adaptation and creativity have ultimately allowed for early rebooting of in-person clinical and surgical practice. The authors present their coordinated efforts and lessons gleaned from their experience to inform their community's preparedness as this formidable challenge evolves.

Impact of the Coronavirus Disease 2019 Pandemic on Cardiac Surgical Education in North America.

OBJECTIVE: We report the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiac surgery trainee education in North America. METHODS: A survey was sent to participating academic adult cardiac surgery centers in North America. Data regarding the effect of COVID-19 on cardiac surgery training were analyzed. RESULTS: Responses were received from 53 academic institutions with diverse geographic distribution. Cardiac surgery trainee re-deployment to alternative clinical duties peaked at the height of the pandemic. We stratified institutions based on high (n = 20) and low burden (n = 33) of patients hospitalized with COVID-19. The majority of institutions have converted didactics (high burden 90% vs low burden 73%) and interviews for jobs/fellowships (high burden 75% vs low burden 73%) from in-person to virtual. Institutions were mixed in preference for administration of the licensing examination, with the most common preference for examinations to be held remotely on normal timeline (high burden 45% vs low burden 30%) or in person with more than 3-month delay (high burden 20% vs low burden 33%). Despite the challenges experienced during the COVID-19 pandemic on trainee clinical experience, re-deployment, and decreased operative volume, institutions expected their trainees to graduate on schedule (high burden 95% vs low burden 91%). CONCLUSIONS: Our study demonstrates that actions taken during the COVID-19 pandemic has led to disruptions in cardiac surgery training with transition of didactics and interviews virtually and re-deployment to alternative duties. Despite this, institutions remain optimistic that their trainees will graduate on schedule.