Descriptive analysis of interns’ basic psychological needs, burnout and empathy in the COVID-19 pandemic in Ireland

Background The transition from medical student to doctor is recognised as challenging. Interns beginning their first clinical practice during the COVID-19 pandemic faced unprecedented uncertainty with unknown potential consequences for psychological well-being and the ability to practise empathetically. Objectives This study investigated the effect of beginning the practice of medicine during the pandemic on the psychological needs, burnout and empathy of intern doctors. Design A mixed-methods, sequential cross-sectional study design. Participants and setting The national cohort of intern doctors registered to practise in Ireland between July 2020 and June 2021 across six Intern Training Networks was invited to participate in an online survey and semistructured interviews. Results Interns reported slightly lower or comparable rates of burnout and emotional exhaustion compared with prepandemic studies. Frustration of interns’ autonomy was strongly associated with emotional exhaustion. Higher levels of personal accomplishment were described by interns regularly caring for patients with COVID-19, indicating professional reward from clinical responsibility. Interview analysis revealed five themes describing how interns experienced clinical practice; emotional experience, the need for future reflection, resilience strategies, mitigation measures and preservation of empathy. Protective factors against burnout included initial societal support, team cohesiveness and sharing, and the establishment of an overlap period between outgoing and incoming interns. Postponement of reflection and avoidant strategies employed during the crisis are indicators of future needs of this cohort. Conclusions Interns beginning in practice during the pandemic experienced an extremely challenging clinical environment. Our work suggests they met these challenges head-on and retained empathy. Organisational, professional, community and societal responses were critical in supporting them to achieve relatedness and competence satisfaction. Further work is required to better understand autonomy supportive supervision.