567 - Finding the resident voice amidst stressors associated with the COVID-19 pandemic.

Poster Number: 567
Publication Number: 567.116

Elizabeth McGinn, University of Colorado - Pediatrics, Denver, CO, United States; Grace S. Chandler, University of Colorado School of Medicine, denver, CO, United States; Lynne Rosenberg, Children's Hospital Colorado, Denver, CO, United States; Barry Seltz, University of Colorado School of Medicine, Denver, CO, United States

Background: The COVID-19 pandemic has threatened resident mental health and exacerbated emotional stress. Previous studies have shown effective residency leadership has been associated with lower resident burnout rates. An earlier survey at our institution showed an inverse association between resident stress and perceived leadership response effectiveness during the pandemic. However, optimal communication strategies from residency leadership during times of crisis have not been thoroughly explored.

Objective: To describe residents' emotional stressors and explore the impact of program leadership communication on stress during the COVID-19 pandemic.

Design/Methods: Informed by the crisis and emergency risk communication model as a conceptual framework, our qualitative study used grounded theory methodology to interview 25 pediatric (n=9), medicine-pediatric (n=12), and internal medicine (n=4) residents from a single institution between May-September 2020. Four coders, in mixed pairs, analyzed the data with the constant comparative method. Codes were inductively built using an iterative approach and organized into categories describing themes. Sampling continued until reaching thematic saturation. Discrepancies were resolved by consensus.

Results: Data analysis yielded six themes (Table 1). Residents described increased stress attributed to COVID-19 and noted a sense of the pandemic’s omnipresence that permeated all domains of their lives. In the clinical setting, uncertain best practices, personal protective equipment availability, and missed learning due to changes in patient volume/illness types and cancelled electives increased resident stress. Residents described their role as healthcare providers with mixed feelings of pride, guilt, and vulnerability. Some residents worried about personal safety; many feared exposure and infecting others. Restrictions to visiting loved ones led to feelings of social isolation. Program leadership communication varied, both mitigating and exacerbating resident stress. Rapidly changing information, inconsistent messaging, and high email volume increased stress. Residents valued communication from the program director, numerical patient trends reports, and Town Hall meetings. Effective communication was characterized by timeliness, transparency, leadership availability, openness to feedback, and bidirectional discussions.Conclusion(s): The resident perspective offered a deeper understanding of the unique stressors associated with training during COVID-19. Our study provides insight into key communication strategies for program leadership that can likely be applied in any crisis.
Table 1. Representative resident quotes demonstrating six themes identified during qualitative analysis.