Key points are not available for this paper at this time.
Among the hugely consequential effects of the coronavirus disease 2019 (COVID-19) pandemic, those impacting the healthcare community have been some of the most disruptive and persistent. Although we are now several years after the early days when frontline workers faced unprecedented physical and emotional challenges, we are still discovering the far-reaching secondary and tertiary consequences of COVID-19 on patients, families, colleagues, and trainees. Johnstone et al. 1 recently reported rates of professional burnout among Canadian urology chief residents who were surveyed in December 2019 and November 2020. The study used a convenience sample of respondents who were attending a mock licensing examination programme, so there was no overlap among the two cohorts, but the respondents were at the same level of training and were surveyed at the same point in the year. Using the Maslach Burnout Inventory (MBI), the authors found substantially, although not statistically, higher rates of professional burnout in the 2020 cohort. Respondents demonstrated increases in the MBI ‘Depersonalisation’ and ‘Emotional Exhaustion’ sub-scores, the latter of which showed statistical significance. Residents who met criteria for burnout also had significantly higher difficulty scheduling personal medical appointments and reported lower rates of having secured post-residency employment. Professional burnout among health professionals has been the focus of a rapidly expanding literature. Initial studies characterising the epidemiology of physician burnout estimated that between one-third and half of practicing physicians met criteria for some degree of work-related burnout. In large-scale, longitudinal surveys comparing burnout among physicians by specialty, urologists and urology trainees were repeatedly shown to experience exceptionally high levels of burnout 2, 3. The so-called ‘happy surgeons’ of the hospital turned out to be decidedly unhappy. Causes of physician burnout, which has been re-characterised as a chronic syndrome of moral injury, are multifactorial, systemic, and influenced by both personal and professional risks. An overarching theme is the loss, both real and perceived, of autonomy and personal control. Among physicians, trainees are particularly vulnerable to forces that threaten autonomy. Residents who have already invested in years of study and whose careers depend on successful completion of specialty training may feel compelled, even obligated, to accept long working hours and sacrifice personal well-being. Recent multinational studies confirming high levels of professional burnout among urology residents may be as much about the impact of training programmes on young physicians as they are about the recognition that such impact can and should be systematically measured. The largest study to date of professional burnout in urology residents reported that 47% of residents met criteria for burnout 4. This study, which analysed AUA Census data collected prior to the pandemic, applied more stringent MBI criteria than the present study by defining burnout as only the ‘high’ levels of Depersonalisation and Emotional Exhaustion, similar to prior large-scale studies of resident burnout 2. This may explain the markedly higher 2019 baseline prevalence of burnout in the Canadian cohort (70%). Consistent with the present findings, 57% of United States residents overall, and significantly more women than men, reported difficulty attending personal health appointments, and nearly two-thirds of residents cited the ability to seek personal healthcare as an unmet need for improved well-being in residency 4. Taken together, these findings suggest that in times of heightened work-related stress and psychological burden, attention to basic needs, including maintaining and sustaining personal health, remains paramount. Anxiety related to securing post-training employment may be similarly contextualised in the perceived loss of control and merits further study. Notably, activities focused on centring and maintaining personal wellness, such as non-medical reading and access to structured mentoring, may strengthen resilience 1. Emerging cross-sectional evidence characterising the effects of the pandemic on training outcomes suggests persistent, long-term challenges. A large United States survey of multispecialty surgical trainees during the initial months of the COVID-19 pandemic reported near-universal adverse consequences on clinical experience and operative volume 5. Screening prevalence of depression and burnout symptoms were as high as 55%, and female sex and lack of programme resources for well-being were identified as significant predictors. A smaller survey of United States and European urology residents similarly identified concerns regarding operative volume during the pandemic 6. Rates of depression and burnout were similar between the groups and not substantially different than pre-pandemic levels. The totality of the evidence in these studies strengthens what we already know: no aspect of the urology community has been untouched by COVID-19. While longer-term comparisons of representative data, such as those systematically collected in national society census programmes, may more precisely quantify the specific additive and cumulative risks to well-being faced by residents during the pandemic, the present study calls for renewed attention to the lived experiences and threats to well-being of urology trainees worldwide. Threats to autonomy and control, from inadequate time to attend personal health appointments 4 to inadequate access to personal protective equipment 5, appear to be pervasive among urology residents in the United States, Canada, and beyond. Shifting from the acknowledgement of prevalence to the engagement of intervention will require a more purposeful and effortful approach. But mirroring the personal and professional sacrifices we have endured during the pandemic, the alternative is unsustainable, inconsistent with our professional obligation, and detrimental to the future of the urological workforce. None declared.
Koo et al. (Tue,) studied this question.