Effects of COVID-19 on Residents and Early Career Surgeons

In December 2019, COVID-19 was first documented in Wuhan, China. By January 2020, the World Health Organization declared the outbreak a public health emergency of international concern, followed by an unprecedented spread of this virus akin to the 1918 flu pandemic. As of May 2022, more than 517 million people had been infected and more than 6.2 million people worldwide had died from the virus—nearly 1 million in the US alone.

Unprecedented Stressor

From the nidus of the pandemic, the US healthcare system has been prodigiously stressed, with a ripple effect not just on patients, but also on providers. Recognizing this incredible and unique stress on surgeons, and particularly surgical trainees and early career surgeons, the Resident and Associate Society of the American College of Surgeons (RAS-ACS) wanted to better understand its constituents’ experiences to determine how to support them best during this crisis.

As context, the RAS-ACS provides surgical trainees and early practice surgeons with opportunities for participation in ACS affairs, fosters leadership skills in academic surgery, and offers a platform for young surgeons and trainees to voice their opinions and concerns to the College leadership. RAS-ACS is the home of Resident Members and Associate Fellows, whereas the Young Fellows Association (YFA) represents ACS Fellows age 45 and younger.

In response to the COVID-19 pandemic, RAS-ACS formed a COVID-19 Resident Taskforce in May 2020 to analyze the effects of the pandemic on RAS and YFA members. The taskforce disseminated an anonymous, online survey to the RAS and YFA listservs in July 2020. A total of 1,160 individuals (40% [465] residents and 60% [695] early career surgeons) responded, and the results were remarkable. Respondents provided a sobering depiction of how COVID-19 had negatively affected their clinical and personal experiences and revealed a striking lack of access to personal protective equipment (PPE).*

A multivariable, stepwise logistic regression model identified that individuals who reported high depression and burnout symptoms were more likely to be women, less likely to report availability of wellness resources, more likely to report taking care of known COVID-positive patients, and less likely to report access to adequate PPE. The results of this survey inspired a discussion with the ACS leadership and led to an official College statement regarding the necessity to prioritize and preserve access to PPE for surgical residents.

The reality is that COVID-19 remains an ongoing phenomenon, with an average of nearly 60,000 people diagnosed and 400 deaths per week in the US. Hence, the virus places an ongoing demand on the healthcare system and continues to affect surgeons and surgical trainees.

Survey Design and Purposes

To assess how the pandemic continues to affect RAS-ACS members, the Executive Committee and Committee Chair disseminated a follow-up survey in March 2022. The anonymous, online survey—identical to the 2020 survey but with a few additions—was disseminated through the RAS listserv (see Table 1). A five-point Likert scale was used to quantify the effect of the pandemic on these experiences.

The degree of depression and burnout among residents and early career surgeons was assessed using the Patient Health Questionnaire (PHQ-9), which screens for depression using nine questions, and the modified, abbreviated Maslach Burnout Inventory-Human Services Survey for Medical Personnel (aMBI), which examines emotional exhaustion and depersonalization. An invitation to participate in the study by completing the anonymous, online survey was disseminated in July 2020.

Over a 2-week period, an initial survey was disseminated, followed by two reminders for individuals who had not initially replied. Recipients were notified that completing the survey was considered consent to share their anonymous responses. The study design was previously submitted to the American Institutes for Research Institutional Review Board and received exempt status. The survey data were aggregated on a secure spreadsheet for ACS administrative use only.

Overall, 847 individuals responded (361 resident members, 486 Associate Fellows); 37% were ages 31–35, with 36–40 year olds representing the second largest group (29%) followed by 26–30 year olds (6%). Women accounted for 40% of the respondents, and most participants identified as Caucasian (51%). Sixty-six percent reported working at a university-affiliated institution, with the largest representation coming from southern locations (20%). International members accounted for 36% of responses.

Most participants reported practicing or training in general surgery (53%), with a small percentage (0.5%−10%) representing surgical subspecialities. We saw a relatively even response of trainees across postgraduate years, with interns being the least represented group (9% of trainee respondents). Most respondents (78%) came from medium to large programs—that is, four or more graduating chiefs per year.

The Results

Several themes emerged from the 2022 survey results and will be examined by each of the five RAS-ACS committees through their unique perspectives. In the following pages:

• The Communications Committee describes how the COVID-19 pandemic has affected resident wellness—from burnout and depression to fear of contracting the virus—and outlines residents’ concerns related to educational opportunities
• The Advocacy and Issues Committee provides perspective on the crucial role of advocacy measures during the COVID-19 pandemic as they pertain to surgical trainees and physician wellness 
• The Associate Fellows Committee explores how the COVID-19 pandemic continues to affect early practice surgeons, specifically with respect to operative volume, compensation, career opportunities, and wellness 
• The Education Committee considers how the COVID-19 pandemic radically changed the training and surgical education format and how some of these modifications have become enduring alterations 
• The Membership Committee examines how COVID-19 has affected residents’ ability to engage in professional societies and how this dilemma affects residents professionally and personally 

These articles depict the issues facing surgical residents and early practice surgeons as the COVID-19 pandemic continues to strain our healthcare system and its providers.

In addition, members of the ACS Medical Student Task Force describe how COVID-19 has increased their exposure to surgery and surgical mentors through virtual learning, but decreased peer-to-peer interaction and in-person experiences.

*Coleman JR, Abdelsattar JM, Glocker RJ. COVID-19 pandemic and the lived experience of surgical residents, fellows, and early-career surgeons in the American College of Surgeons. J Am Coll Surg. 2021;232(2):119-135.

Dr. Julia Coleman is a surgical critical care fellow, The Ohio State University, Columbus, and Vice-Chair, RAS Executive Committee.