Medical residents face notorious stress. A pandemic just piles on, studies say

Health care workers have been suffering from mental health issues since the start of the coronavirus pandemic. Some are forced to work without proper protection, while most have to deal with deaths, unpaid overtime and worry for loved ones.

Now, a new study shows that Chinese doctors in training are also feeling the blunt force of the pandemic, with feelings of depression, anxiety and fears of workplace violence increasing dramatically from before the coronavirus hit to during its peak.

The study was published last week in the journal JAMA Network Open and was led by researchers from the University of Michigan, Ann Arbor, and the Shanghai Jiao Tong University School of Medicine.

“It’s easy to forget that they face many of the same additional stresses as the rest of us ⁠— concerns about elderly or at-risk family, loss of childcare ⁠— while simultaneously managing an increased clinical workload, and all while placing themselves and their families at greater risk of infection,” Dr. Elena Frank, study co-author and study director at the University of Michigan’s Sen Lab, said in a news release. “The potential mental health consequences of confronting such enormous pressures cannot be overlooked.”

American medical workers have had to make drastic changes in their lives to accommodate their role as healthcare providers.

Lisa Neuburger, a 37-year-old nurse in Minnesota, had to move out of her parents’ home and into a camper, McClatchy News reported. She made the decision after a coronavirus patient’s ventilator tube detached, possibly exposing her to fluid from the person’s lungs.

“I couldn’t sleep that night,” Neuburger told the Associated Press. “I thought, ‘If I brought this home to my mom, she’s probably going to die, and it’s probably going to be my fault.’ So I had to find a different way.”

Rosem Morton, a nurse in Maryland “feverishly” checked the number of cases in her state and hospital at the beginning of the pandemic, but “after six weeks, I just feel defeated,” she wrote in National Geographic

Residents face notorious work conditions

Without added pressure from a pandemic, post-graduate “trainee work hour” regulations in the U.S. call for a maxium of 80 hours per week over a four-week period, according to the Accreditation Council for Graduate Medical Education.

But now all hospitals are facing increased demand, meaning many healthcare workers are working unpaid overtime, or without hazard pay.

Some residents have said they are expected to handle coronavirus duties while their attendings⁠ — medical supervisors ⁠— can choose to float to non-COVID services, Forbes reported.

“Our medical educational practices are medieval,” one doctor wrote in an opinion piece for Medscape in 2018, The Intercept said. “This training has rendered a corpus of burned-out physicians who are far from the healers — technically and spiritually — that you’d want caring for your family.”

Often called “interns,” residents have an M.D. degree, but are training to become licensed doctors with a specialty, such as pediatrics or emergency medicine.

They often lack time for leisure activities, are sleep deprived, have to study while they treat patients, have to sort financial issues such as growing student loans and deal with ⁠— for the first time⁠ — emotional drainage from sick and dying patients, research says.

Over time, this can lead to burnout which includes distress, depression, anxiety, substance abuse and in some cases suicidal thoughts or actions, a 2018 review in the Journal of Family Medicine and Disease Prevention says.

“If not managed appropriately, burnout can result in a lowered quality of life, negative impacts on patient care, and in extreme cases, professional impairment,” the review said.

What did the study find?

The researchers asked 385 first-year medical residents in Shanghai beginning their work at 12 hospitals to track their moods on a smartphone app every day, and answer questions about their mental health and any experience with workplace violence, according to the study.

The students began recording their responses in October, which researchers used to compare with those from January and February when the pandemic reached its peak in China, according to the study.

Scores for depression “increased statistically significantly” by about 61%, and those for anxiety rose by about 64%.

Fear of workplace violence nearly doubled, and about 50% of residents reported observing violence from patients or their families, compared to about 22% from before the pandemic, the study shows.

The researchers say the findings “show in stark terms the potential mental toll of a frontline healthcare worker in the time of COVID-19,” the release said.

A separate non peer-reviewed study showed the toll American medical residents feel is similar to those of residents in China, according to the paper published in April in medRxiv.

Both groups included thousands of first-year medical residents at different hospitals and showed that depression increased from about 6.5% before their residency began, to about 35% at least once during their first year.

The preprint researchers said the similarities between American and Chinese residents suggest “a need for system reform,” worldwide.

Medical schools in the U.S. offered early graduations for fourth-year medical students⁠ — one level before residency⁠ — so they can help overwhelmed hospitals dealing with COVID-19.

“Recruiting fourth-year medical students to work in hospitals hard hit by COVID-19 may be necessary. Nevertheless, it’s troubling that students who don’t yet have the skills or experience to thrive in the hospital environment are being moved to the frontlines at the peak of a pandemic instead of in July, when the first wave will have crested across most, if not all, of the United States,” Anna Goshua, a second-year student at Stanford University School of Medicine, wrote for Stat. “If medical students are called to combat COVID-19 in hospitals, protecting them needs to be a priority.”

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