key: cord-0895603-g8xchawb
authors: Algattas, Hanna; Roy, Souvik; Agarwal, Nitin; Maroon, Joseph
title: COVID-19 Impact in Neurosurgery Residency: Grit in the Face of Pandemic
date: 2021-04-21
journal: World Neurosurg
DOI: 10.1016/j.wneu.2021.04.057
sha: 3718ef223b5d26f514dd3665e108bb1502282fa0
doc_id: 895603
cord_uid: g8xchawb

Introduction The Coronavirus-19 (COVID) pandemic presented a significant challenge to healthcare providers. Neurosurgeons work with critically ill patients who were at particularly high risk for COVID and the pandemic produced ever-shifting circumstances to allow this continued care. This study explores the psychological impact of the pandemic on neurosurgical residents at a single institution. Methods Residents completed the Perceived Stress Scale (PSS) and the Inventory of Depressive Symptomology 30 (IDS-30) two validated surveys prior to and during the pandemic. PSS scores may range from 0 to 40 with higher scores indicative of increased stress. IDS-30 ranges from 0 to 84 with higher scores indicating more severe levels of depression. Survey results were compared collectively amongst residents and statistically analyzed. Results The surveys had 19 out of 28 total responders (68%). Mean score on the PSS was 16.1 pre-pandemic and 14.7 during the pandemic (p>0.05). The mean score on the IDS-30 was 14.7 pre-pandemic and 12.0 during the pandemic (p> 0.05). Matching the survey questionnaire results by each resident revealed an average decrease of 2.3 and 2.4 for the PSS and IDS-30, respectively. Conclusion There were no significant changes in perceived stress or depressive symptoms during the pandemic. Resilience and perseverance are commonly sought traits amongst neurosurgical residents and are components stressed during their training. Neurosurgical residents prove unwavering while caring for patients during the COVID pandemic.

The Coronavirus-19 (COVID) pandemic presented a significant challenge to healthcare 3 providers. Neurosurgeons work with critically ill patients who were at particularly high risk for 4 COVID and the pandemic produced ever-shifting circumstances to allow this continued care. 5 This study explores the psychological impact of the pandemic on neurosurgical residents at a 6 single institution. 

The surveys had 19 out of 28 total responders (68%). Mean score on the PSS was 16.1 pre-15 pandemic and 14.7 during the pandemic (p>0.05). The mean score on the IDS-30 was 14.7 pre-16 pandemic and 12.0 during the pandemic (p> 0.05). Matching the survey questionnaire results by 17 each resident revealed an average decrease of 2.3 and 2.4 for the PSS and IDS-30, respectively.

There were no significant changes in perceived stress or depressive symptoms during the 20 pandemic. Resilience and perseverance are commonly sought traits amongst neurosurgical 21 residents and are components stressed during their training. Neurosurgical residents prove 22 unwavering while caring for patients during the COVID pandemic. The current pandemic caused by the novel coronavirus, severe acute respiratory 3 syndrome coronavirus 2 (SARS-CoV2) presents a significant change and challenge to our 4 society. 1 Additionally, the novelty of the pandemic has presented several challenges in clinical 5 management. 2,3 Furthermore, the transmissibility has presented a threat to the safety of 6 physicians and other healthcare providers. Hospitals have adapted their practices to deal with 7 these challenges. Particularly challenging has been identifying an equitable way to allocate 8 healthcare resources. Physicians are one such resource and balancing both exposure risk and 9 clinical need has forced many institutions to make changes in scheduling and placement.

At academic centers, a large portion of the workforce consists of resident physicians.

Pandemic-related changes affect both clinical duties and resident education. The field of 12 neurosurgery is particularly susceptible to stress given it has fewer residents with large case 13 volumes which often require intensive and higher-level patient care. Managing, these ever-14 changing factors in the midst of the pandemic certainly proves challenging. 4,5 However, as a 15 field, resilience and perseverance are commonly sought traits amongst neurosurgical residents as 16 these qualities are crucial to long term success within the profession. Lack of composure, 17 emotional volatility, and sensitivity to criticism were all negative selection factors in personality 18 assessment tools provided to incoming neurosurgical applicants. 6 As a quaternary care center 19 and a busy neurosurgical service, the University of Pittsburgh's Medical Center (UPMC) became 20 one of the centers for management of the pandemic's public health crisis in Allegheny County.

In response to these challenges, the University of Pittsburgh Department of Neurosurgery 22 initiated a unique approach to both patient and resident management described by Fernandes- Table 2 . residents as a group are often known for their resilience and grit. So much so that these assessing 20 for these qualities is a crucial part of the applicant interview process. Within the concept of 21 resident wellbeing, burnout is a topic of concern and discussion. However, Shakir et al. found a 22 burnout rate of 36.5% among neurosurgery residents. 5 This is actually lower than the prevalence 23 of burnout of all physicians combined at 54.4% 10 and the prevalence of burnout among all 24 surgical specialties at around 40% 11 . This evidence may indicate that, for unknown reasons, 25 neurosurgical residents and providers may be more resilient to burnout than other specialties. implemented an approach to maximize patient safety and physician experience during the 21 pandemic which may have also played a role in producing the results seen. 7 However, an 22 alternative explanation could be that the period of time between the two survey points is not 23 sufficiently long enough to capture a psychological or emotional variation.

This study is limited by the lack of statistical significance of the noted decrease in stress 25 levels through the survey. This is likely due to the small sample size inherent to a single 26 neurosurgical residency program causing the design to be insufficiently powered. However, it is 27 also important to note that the studies did not find any statistically significant increase in stress 28 levels in response to the cohort being placed in an inherently stressful situation. This may be 29 remedied by mandated participation and tighter control of the duration of each time point.

However, this change would negatively affect voluntary participation and may be impractical.

Another important consideration was the timing of the surveys. While the coronavirus was not 2 officially declared a pandemic in the US until March 13 th , 2020 there were cases present in the 3 US in the months preceding, which may have biased the pre-pandemic survey points with added 4 stress. Additionally, these findings may not be generalizable to residents of other specialties and 5 subspecialties given differences in exposure to coronavirus, work hours, and predominant 6 mode/location of work. 

the International CSG. The species Severe acute respiratory syndrome-related