Wellness in Residency during COVID Era: a trainee perspective

Wellness in Residency during COVID Era: a trainee perspective

Author: Graziella Rangel Paniz, MD, Internal Medicine PGY3, University of New Mexico School of Medicine
Faculty Mentor: Eileen Barrett, MD, MPH, Associate Professor, Department of Internal Medicine, University of New Mexico School of Medicine

“I can’t!” she cried. “I can’t anymore. All of them are dying, and I am not good enough to make it stop!”  I was off that warm June afternoon, enjoying all the sunlight Albuquerque can provide and reloading my vitamin D stores when my phone rang; one of my best friends was calling me, and her tone immediately alerted me something was not right. 

We were in the middle of the first wave of COVID-19 cases and knew little about this new virus and how it behaved. We did know that patients would develop severe hypoxic respiratory failure, and we could not do much when they “crashed.” Several residents, including me, were deployed to the ICUs to help with the surge and face this new pandemic without enough information on treating infections – after all, it was new for everyone. I remember being scared. Actually, I remember being terrified with the idea of being face to face with COVID for the first time. 

As residents, our educational, clinical, and teaching responsibilities put us in a higher physical and mental health risk category than our peers outside medicine. Pandemic challenges make it even harder: electives are cancelled to redeploy residents to the frontlines, work hours are longer, hospital shifts feel endless wearing PPE, and teaching becomes sparse due to the increased workload and stress levels. This is all in addition to the feelings of powerlessness and grief from seeing patients deteriorate, the uncertainty of what’s coming (Are the new cases going down?), and the lack of definitive guidelines (How should we treat them? Hydroxychloroquine? Azithromycin? Ivermectin? Will we ever have treatments that are effective?). There are also personal stressors that I often don’t talk about at work. As an international graduate, I haven’t seen my family for almost 2 years, don’t believe I’ll see them anytime soon, and am concerned for their safety and ability to get the vaccine. There are also uncertainties surrounding visas and job searches. These are realities for many, many of us. How do we fix this mess? Is it fixable? How can we make it more manageable?

It’s difficult to talk about wellness when illness is all we hear about. The concept of wellness in residency programs is not new, but it was reinvented after the COVID-19 pandemic arrived. A surgery program in Canada, for example, improved their residents’ wellness by targeting 3 main domains1: 

● Efficiency of practice (limited exposure to patients to one provider, frequent education about COVID19 updates and policies)
● Culture of wellness (promotion of self-care and education about signs of burnout) 
● Personal resilience endorsement (weekly mandatory individual meetings with all the residents to promote not only discussions around surgical care during the pandemic, but also around physical, emotional, and social challenges they could potentially be facing at that time)

Many of these measures were adopted in several programs in the United States, aiming to prevent burnout, depression, and anxiety among trainees.

My residency program at the University of New Mexico (UNM) included mental health check-ins. Here at UNM, all incoming interns were scheduled for free, confidential, Zoom-based mental health check-ins with a mental health provider through the organization’s Employee Assistance Program. After a pilot with interns, these were also scheduled for all our internal medicine residents. These sessions were 15-30-minute periods where the counselor and resident could talk generally about stress management and how things were going. Anyone wishing to schedule additional appointments could do so, and anyone who wished not to participate could just cancel the appointment. Everyone was scheduled so no one would feel stigmatized for speaking with the counselor, and because these were check-ins and not therapy, participants will not have to report these when applying for a license. Internal data which has not been approved for public dissemination shows the program has been successful so far.

When I heard those words from my best friend, I knew deep inside she was verbalizing how all young physicians in training were feeling when the pandemic hit: tired, powerless, hopeless, and lonely. And getting through it was not easy – and it still isn’t. I still struggle to find a balance between life as a doctor and life as a “regular person.” Decompressing when you can’t travel, you can’t gather with your friends, and going to the movies sounds almost impossible. I was lucky to live in a state where the sun shines 300 days of the year and is full of natural beauties. I reconnected with myself and put together my thoughts (and my energy!) through nature, but obviously, what worked for me, does not necessarily work for everyone, including my dear friend. 

While there is no one-size-fits-all solution, I believe that offering residents a neutral environment to talk, vent, and debrief is a great step towards normalizing self-care and removing the stigma that we erroneously carry that doctors cannot get sick. Mental health check-ins are an optimal tool implemented by my program and should be kept post-COVID. My friend needed help and was brave enough to ask for it and had good resources available – but how many residents are still suffering with COVID (and non-COVID) burnout and depression out there? Prioritizing mental health among trainees is essential and crucial for good practice. This is a lesson we should learn from this pandemic; we must take care of ourselves to be able to take care of others. 

Reference:

1) Lie JJ, Huynh C, Scott TM, Karimuddin AA. Optimizing Resident Wellness During a Pandemic: University of British Columbia's General Surgery Program's COVID-19 Experience [published online ahead of print, 2020 Jul 19]. J Surg Educ. 2020;S1931-7204(20)30251-8. doi:10.1016/j.jsurg.2020.07.017