Trial under fire: one New York City anaesthesiology residency programme's redesign for the COVID-19 surge

Abstract

significant associations with psychological distress were found for the presence of multiple co-morbidities in staff, direct involvement in COVID-19 patient care, receiving a quarantine order, and redeployment outside normal professional boundaries (Table 1). Insomnia, based on the first item of the GHQ-12, was reported by 45 participants (16.7%). Redeployment to work outside areas of usual clinical practice was reported by 41.9% of participants. The majority (59.3%) perceived their workload to be similar to pre-pandemic levels. Just 12.2% of participants had family, friends, or colleagues diagnosed with COVID-19. Formal PPE training was received by 256 (94.8%) participants with 149 (55.2%) being confident in correct usage and their ability to protect from infection. Situations where recommended PPE was unavailable were encountered by 46 (17.0%). Risks of getting infected (83.6%) and infecting family members (78.0%) were the top two concerns (Supplementary Appendix 2). This study shows significant psychological distress amongst anaesthesiologists and nurses working in ICUs in the context of the COVID-19 pandemic. While lower than reported in the outbreak epicentre in China, which reported depression in 50.4% and anxiety in 44.6% of healthcare workers, we found a twofold higher prevalence of anxiety and up to threefold higher prevalence of depression than reported amongst general healthcare workers in Singapore and Italy during this pandemic. 3,4,7 Many would regard even pre-pandemic work in such high-acuity environments as stressful and emotionally exhausting, thus potentially accounting for the differences compared with general healthcare workers. Indeed, pre-pandemic studies of occupational stress identified similar levels of anxiety and stress (29.0e35.7%) in ICU physicians and nurses using the GHQ-12. 5,8 Thus, the contention that COVID-19 has provoked all the elements of psychological distress in respondents still requires testing. Our study has limitations. Socioeconomic status, which may influence outcomes and intervention planning, was not assessed. Neither a pre-crisis baseline nor follow-up to assess the temporal changes in psychological distress was available. Being a single-centre snapshot, further studies in other populations are necessary for generalisability. Lastly, clinical interviews by a psychiatrist would have been ideal. Nonetheless, we identified risk factors for psychological distress that may be useful for identifying at-risk individuals, and respondent concerns of the infection risk, adequacy of PPE, and redeployment outside normal professional boundaries are still issues that need to be addressed. The psychological distress prevalent amongst providing anaesthesia and intensive care providers during this pandemic necessitates policies for screening of at-risk individuals and adoption of early psychological support interventions for affected staff. 9,10

Impact of the COVID-19 pandemic on anaesthesia trainees and their training

“…Internationally, anaesthesia departments have recognised these stressors and responded. 17 Training on stress recognition, peer support, and access to resources is variably implemented but universally understood. 18 In Durban, the mental health burden was recognised early, and counselling sessions both in groups and individually were offered by the psychology department.…”

The impact of the COVID‐19 pandemic on the education and wellness of U.S. Pediatric Anesthesiology Fellows

“…In March 2020, an unprecedented global pandemic due to coronavirus disease 2019 (COVID‐19) or the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) resulted in state‐wide shutdowns of elective surgical activities that extended for several months throughout the United States 1 . A number of teaching hospitals canceled or postponed elective surgeries to accommodate potential (and in some places, actual) surges of COVID‐19 patients, 2,3 as well as to prevent undue exposure to perioperative personnel and preserve personal protective equipment (PPE) 1 . As a result of the ongoing pandemic, graduate medical education program directors had to quickly adapt to new and frequently changing rules implemented by their respective hospitals, graduate medical education accrediting organizations, and regional government.…”

“…As a result of the ongoing pandemic, graduate medical education program directors had to quickly adapt to new and frequently changing rules implemented by their respective hospitals, graduate medical education accrediting organizations, and regional government. This resulted in a comprehensive and rapid shift of educational culture, including everything from altered work schedules to newly virtual (or canceled) didactic lectures and unanticipated clinical rotations 2,3 . Educational leaders found themselves fraught with daily, complex dilemmas, and novel educational paradigms and constructs.…”

“…Trainees faced considerable uncertainty regarding training, board certification, the job market, and more. For trainees in adult hospitals, many scheduled clinical activities were replaced by COVID‐19‐related activities, 2,3 and this group of trainees in some ways obtained an enhanced educational experience compared to their initial expectations. However, because of the relative paucity of cases in the pediatric setting, many pediatric anesthesiology fellows (anesthesiologists who are completing additional subspecialty training for one year in the field of pediatric anesthesiology) suddenly found themselves with the prospect of a limited augmentation of their educational experience.…”

The ‘third wave’: impending cognitive and functional decline in COVID-19 survivors

“…Critically ill patients exceeded the capacity of intensive care units (ICUs), operating rooms (ORs) were converted to makeshift ICUs, and temporary satellite hospitals were erected to divert care for non-critically ill patients. 2 With the introduction of social distancing, contact tracing, mandatory masks and similar public health measures, New York City and the surrounding area were ultimately able to "flatten the curve" 3 . Months later, as other US cities and states began to relax their stay-at-home restrictions and people across the US optimistically prepared to resume their former lives, cases began to rise again at an alarming rate, especially in Southern and Western states 4 .…”