COVID-19 increased anxiety, burnout among endoscopy trainees
Click Here to Manage Email Alerts
Two studies focused on the impact COVID-19 on endoscopy trainees, showing increased anxiety and burnout, and offered ways for trainees to continue their education until training is resumed.
“The COVID-19 pandemic has had a profound adverse effect on endoscopy volumes and drastically changed endoscopic training processes worldwide,” Katarzyna M. Pawlak, MD, PhD, from the Hospital of the Ministry of Interior and Administration, Szczecin in Poland told Healio Gastroenterology. “The main concerns raised by trainees were in regard to competency development and the need to potentially prolong training to achieve endoscopic competence. Trainees expressed symptoms of anxiety and burnout and cited [personal protective equipment] PPE shortages and a lack of mental and emotional support as key issues impacting training.”
Increased anxiety
In a study published in Gastrointestinal Endoscopy, researchers conducted an international survey of 770 trainees from 63 countries over 3 weeks. The percentage reduction in monthly procedure volume before and during COVID-19 served as the primary outcome. Other outcomes included potential variation of COVID-19’s affect between different continents and rates and predictors of anxiety and burnout among trainees.
Pawlak and colleagues found 93.8% of trainees reported a decrease in endoscopy case volume. There were 71.9% trainees who said they were concerned the pandemic could prolong training. Investigators noted 52.4% of trainees reported anxiety and 18.8% reported burnout. Anxiety independently correlated with female gender (OR: 2.15; P < .001), adequacy of PPE (OR: 1.75; P = .005), lack of institutional support for emotional health (OR: 1.67; P = .008) and concerns regarding prolongation of training (OR: 1.60; P = .013). In addition, 68.9% of trainees said the existing national guidelines should be altered to support adequate endoscopy training during COVID-19.
“Program directors should also be encouraged to proactively and recurrently engage with trainees to discuss their learning gaps and career development and devise individualized curricula to support their learning needs,” Pawlak said. “Trainee education can be maximized during the pandemic through the use of evidence-based interventions that do not rely on patient care, such as simulation-based training; high-quality endoscopy education resources curated by major gastrointestinal societies... Furthermore, with decreased procedures, endoscopic performance should be assessed by validated performance tools to allow for the identification of learning gaps, and to tailor endoscopic education to meet the same.”
Road to a ‘restart’
In Gastroenterology, Rajesh N. Keswani MD MS, from Northwestern Medicine Digestive Health Center in Chicago and colleagues suggested during the recovery process after the pandemic, trainees make weekly “schedules” of educational opportunities and set individual goals. Attending physicians must implement new training methods for the trainees.
“The central theme of trainee education during the pandemic is focusing on evolution rather than reaction,” Keswani told Healio Gastroenterology. “We want to avoid simply reacting to external circumstances, as this often leads to patiently waiting until things ‘return to normal’ – when we can simply learn in the traditional apprentice-based model. Instead, we need to use this as an opportunity to evolve where we augment this traditional training model with newer concepts including video-based education, distance learning and simulation. In that way, the changes that we adopt will be long-lasting and durably improve training.”
Due to the increase in patients with COVID-19 many trainees have been deployed to hospital units dedicated to treat infected patients, according to Keswani and colleagues. They said endoscopy training must be transformed to embrace the technology-driven future to help trainees continue their education. GI societies now offer virtual educational programs to GI and endoscopy trainees. Twitter offers trainees education through structured conversations that occur weekly on @MondayNightIBD, @GIJournal, and #ScopingSundays.
Trainees can also participate in webinars offered by GI societies and the industry. The authors noted training programs should implement video recording capabilities to offer endoscopy procedure videos for trainees to review cases remotely and discuss.
“Discussions around restarting gastroenterology training are in full swing and are slowly being enacted around the world,” the authors wrote. “While the ideal strategies are quite varied and will constantly evolve, there is some consensus that local disease prevalence, availability of personnel, access to PPE and testing, and monitoring for resurgence will be critical factors guiding implementation.”
As endoscopies are resumed, trainees will need to be trained in infection control and proper use of PPE. They will need to continue to practice social distancing during training activities. There should be emphasis placed on filling patient care slots to maximize training opportunities and to offer necessary patient care. Trainees may need to reduce vacation time, but they should also be mindful of their well-being.
Collapse
Keswani RN, et al. Gastroenterology. 2020;doi: 10.1053/j.gastro.2020.05.012.
Pawlak KM, et al. Gastrointest Endo. 2020; doi: 10.1016/j.gie.2020.06.010.
Read more about
Click Here to Manage Email Alerts