IMPACT OF COVID-19 PANDEMIC ON HOUSE-STAFF

ABSTRACT

SESSION TITLE Late-breaking Abstracts SESSION TYPE Original Investigations PRESENTED ON October 18-21, 2020 PURPOSE: On April 7, 2020, 597 people died from COVID-19 in NYC. That was the peak of a pandemic which has caused nearly twenty-thousand confirmed deaths in the city since March 11, 2020. Internal Medicine residents took care of these patients. Traditionally communication skills and nuances necessary for breaking bad news and complex goals of care discussions are refined over years of practice, not weeks. Poor coping skills with patient death in large numbers can lead to burnout and compassion-fatigue. This study aims to examine the impact that the COVID-19 pandemic has had on house-staff, their communication skills and perceived abilities to cope with patient death. METHODS: An IRB approved (#20-03637) anonymous REDCap survey was shared by email to all Mount Sinai Morningside and West Internal Medicine house-staff who had worked from March to June 2020. Respondents answered open and closed ended questions plus Bugen’s “Coping with Death Survey” (CDS) which uses Likert-scale questions to produce scores from 30 to 210. Scores below 105 indicate inadequate coping and scores above 157 suggest optimal coping. RESULTS: There was a total of forty-eight respondents (n=94 surveyed) of whom thirty-two answered every question. Their mean age was 29.5 (n=48, SD 2.53). 47.9% (n=23) had worked as doctors for three years, 47.9% (n=23) had worked as doctors outside of the U.S., and 56.3% (n=27) were interns. Before the pandemic, house-staff discussed goals of care, broke bad news, and encountered patient death “less than once a week” (44.2%, n=19), (58.1%, n=25), (93%, n=40) respectively. During the pandemic they discussed goals of care “every day” (48.8%, n=21). They broke bad news and encountered patient death “every other day” (46.5%, n=20) and (39.5%, n=17) respectively. Levels of comfort and fluency with these conversations improved from before (Mean 52.05, SD 24.01) and during (Mean=76.7, SD 14.89) the pandemic (t=6.7301, p=0.0001, n=40). 92.3% (n=36) of respondents feel more comfortable treating dying patients but 51.3% (n=20) of them remember a “particularly bad experience at work”. Three people (7.7%) have changed their career plans. Respondents’ (n=32) overall CDS score mean was 131.5 (SD 20.07). Those with less than two years’ experience working as doctors (n=16, Mean 124.44, SD 18.20) compared to those with more experience (n=16, Mean=138.56, SD 19.88) had a significantly lower mean CDS score (t= 2.0965, p= 0.0446). CONCLUSIONS: More than half of residents remember traumatic encounters during this period of high patient death. While their levels of comfort caring for and communicating with these patients improved during this time, their ability to cope with death remains suboptimal, particularly amongst the junior house-staff. CLINICAL IMPLICATIONS Internal Medicine residency programs should implement breaking bad news workshops and educate house-staff on resilience in times of crisis. DISCLOSURES No relevant relationships by Raymonde Jean, source=Web Response No relevant relationships by Katherine Mark, source=Web Response No relevant relationships by Georgina Osorio, source=Web Response No relevant relationships by Patrick Tobin-Schnittger, source=Web Response