key: cord-0737364-4hzhaxs8
authors: Szigiato, Andrei-Alexandru; Palakkamanil, Mathew; Aubin, Marie-Josee; Ziai, Setareh
title: The Canadian Ophthalmology Resident Experience during the COVID-19 Pandemic
date: 2020-10-26
journal: Can J Ophthalmol
DOI: 10.1016/j.jcjo.2020.10.015
sha: a554e9a41ed70cc309128cb759124c302a739d2a
doc_id: 737364
cord_uid: 4hzhaxs8

nan

The ongoing worldwide pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has greatly impacted our lives. At the time of writing this report, there have been 18,166,298 confirmed cases and 690,953 deaths worldwide due to SARS-CoV-2, with 118,966 cases and 8,995 deaths in Canada. 1 During the height of the pandemic in Canada, from March to June 2020, the federal government initiated policies and procedures to limit the spread of SARS-CoV-2, such as restricting travel, encouraging the use of face masks in public areas, and providing financial benefits for those unable to work. 2 Only persons providing essential services (ie healthcare workers, police, firefighters) continued to actively work in the field, often in challenging conditions, and at risk to themselves and their families.

Resident physicians specializing in ophthalmology were among the healthcare workers on the front-lines, but with a shift in practice patterns due to a reduction in ambulatory clinics, the shutdown of elective surgeries, and the transitioning from in-person group teaching to online formats. To our knowledge, there has not been a formal assessment of the impact of the pandemic on ophthalmology residents. The purpose of this study was to provide an overview of this impact on ophthalmology residents across Canada, from the resident perspective.

A cross-sectional survey study was conducted. All ophthalmology residents in Canada (n=217) were emailed a short, anonymous survey (Google Forms), from May 6 to June 13, 2020.

The survey was created to assess the ophthalmology resident experience during the COVID-19 pandemic. Themes included the availability/use of personal protective equipment (PPE), testing for the SARS-CoV-2 virus amongst residents, status of medical and surgical rotations, stressors related to the pandemic, coping strategies, and attitudes of residents regarding COVD-19. This survey was reviewed by two academic ophthalmologists and two senior ophthalmology residents. In our literature review, there were no similar, validated studies on this subject matter.

Survey data was exported to Microsoft Excel 2013 (Redmond, Wash). All descriptive statistics were performed using Microsoft Excel.

Of 217 residents, 102 (47.0%) responded to the survey, representing residents from all 15 residency programs in Canada. Residents from all 5 years of training were equally represented.

There was a greater proportion of residents from larger programs (>20 residents) who responded (>20 residents 37.3%, 11-15 residents 28.4%). Table 1 summarizes the survey findings.

There were 32 residents (31.4%) who were tested for SARS-CoV-2 during the 4 months of the study, out of which only 1 tested positive (1.0%). There were 20 residents (19.6%) who examined patients confirmed positive for SARS-CoV-2. Outbreaks of SARS-CoV-2 that resulted in other positive cases or preventative quarantines were present in the departments of 27 residents (26.5%). A small proportion of residents (4.9%) were assigned to work in a COVID unit for up to 1 month.

Most residents (93.0%) felt they had adequate access to personal protective equipment (PPE).

When examining symptomatic patients, residents either used gloves, gown, eye protection and a surgical mask (42.2%) or gloves, gown, eye protection and an N95 mask (42.2%).

As of June 2020, most residents (51.0%) returned to their scheduled rotations, working at reduced volumes. At the time of survey completion, 65% of residents on surgical rotations had not operated in the previous two weeks.

The majority of residents were worried about being infected by SARS-CoV-2 (58% agree/strongly agree). Residents were also concerned about spreading the virus to patients (74% agree/strongly agree), or family and friends (86% agree/strongly agree). Residents felt isolated due to social distancing measures (53% agree/strongly agree). Most residents had increased anxiety compared to before the pandemic (70% agree/strongly agree).

Furthermore, residents were concerned about their surgical skills deteriorating due to the shutdowns (55% agree/strongly agree) but were less worried about losing clinical skills (43% agree/strongly agree). Most residents (51%) stated they did not have access to a surgical simulator or wet-lab to maintain their skills in the operating room. Senior residents were concerned about finding jobs and fellowships due to COVID-19 (62% agree/strongly agree).

The majority of residents felt that they would receive sufficient training to become a competent ophthalmologist by the end of their residency (83% agree/strongly agree).

Residents had mostly positive coping strategies for their stress during the pandemic, including speaking regularly with family and close friends (69%), cooking (65%), exercising (60%) and spending time outside (54%). Negative coping strategies included increased alcohol intake (15%), use of sleeping aids (5%), and use of other substances (1%).

This survey revealed that a small proportion of residents were physically affected by SARS-CoV-2. A small proportion of residents were tested (31%) and only 1% of residents surveyed were confirmed positive for COVID-19. Reasons for this may be related to adequate availability/use of PPE as well as a low rate of examining COVID-19 positive/symptomatic patients. Despite the low prevalence of infection amongst residents, levels of anxiety were higher compared to before the pandemic. This is likely multi-factorial, and included anxiety related to contracting the virus, spreading it to family/friends, isolation due to social distancing, and increased burden of working with PPE. Senior residents were the most affected by the pandemic, due to reduction in surgical exposure caused by shutdowns in elective surgery, the travel restrictions for international fellowships, job stress, and the postponed Royal College examinations. Importantly, most residents stated they did not have adequate availability of surgical simulation or access to a wet-lab to maintain their surgical skills. We recommend that this should be rapidly explored further by individual programs and rectified given the indeterminate timeline of the pandemic.

Thankfully, despite the added stressors and changes brought by the pandemic, there was guarded optimism amongst residents, with the feeling that they would have adequate training and be competent ophthalmologists by the end of their residency.

The 47.0% response rate, while high for national resident surveys, 3, 4 represents half of all residents, which limits generalizability of the results. As with most survey studies, information is subject to recall bias. There was more representation from larger programs in cities which had a larger prevalence of COVID-19. 

COVID-19 Dashboard by the Center for Systems Science and Engineering

COVID-19: A timeline of Canada's first-wave response

Resident wellness in US ophthalmic graduate medical education the resident perspective

Assessment of phonomicrosurgical training in otolaryngology residencies: a resident survey

We want to thank Dr. Majd Mustafa and Dr. Irfan Kherani for their help with survey review and distribution.The Canadian Ophthalmology Resident Experience during COVID-19Page 6 of 11