Psychological Issues and Alcohol Consumption in Resident and Fellow Physicians in Otolaryngology Before and During the COVID-19 Pandemic

Abstract

To the Editor We were pleased to read the recent article by Chebib et al. 1 The effects of COVID-19 on resident physician training are not yet fully understood and present a wide range of effects, from issues in educational objectives to mental distress. There is some evidence pointing out that younger and less experienced health professionals, such as resident physicians, are more prone to suffer mental distress when facing unforeseen situations, such as the COVID-19 pandemic. 2 Some studies have shown high rates of depression, anxiety, and sleep disturbances in health care professionals and the general population owing to the pandemic, 3 but it is important to keep in mind that those responses may be expected reactions to external stressors, more than a disease state, especially when those data were obtained early in the pandemic course. However, beyond this discussion, the changes in routines for handling the pandemic-such as reallocation of residents and attendings to COVID-19 units, cancellation of elective surgeries, constant use of protective personal equipment, acquisition of new learning curve for treating those patientsare stressors that may lead to harmful behaviors as coping strategies. These include increased consumption of alcohol and drugs. In fact, being a resident seems to be a risk factor for substance misuse, 4 as well as having a heavy workload. 1 Both substance misuse and mental distress in health care workers are associated with suboptimal patient care.The increase in workload during the pandemic reported by Chebib et al 1 also should be an alarming sign of a poor experience for resident physicians in terms of learning. This rise probably was not owing to their usual otolaryngology-head and neck surgery activities, and recent evidence has shown that increased workload is associated with impaired learning in resident physicians, 5 independent of the training area.This evidence should foster discussions about improving supervision for redeployed residents, extending temporarily the duration of residency training programs (considering that some hands-on activities and training objectives could not be reached during the pandemic) and providing psychological/ psychiatric support for health care workers, mainly for resident physicians. The supervisors, but also colleagues, should be aware of subtle warning signs of mental distress, such as avoidance behavior, "forgetting" about discussions of ses, missing meetings recurrently, and alcohol or other substance abuse.

The first wave of COVID-19 and mental distress of physician residents in Brazil: a comparison between two cohorts

“…Longitudinal studies with healthcare workers during this pandemic have shown enduring rates of mental distress [ 4 , 15 – 17 ], although others found a reduction in these frequencies [ 18 ]. We highlight that the consequences related to psychological distress are vast, including increased rates of absenteeism [ 19 ], alcohol misuse, and medical errors [ 20 ], likewise may be related to an unsatisfactory learning experience [ 6 ], which is a keystone in residency training.…”

“…In the direction of narrow mental distress, psychological and psychiatric assistance should be made available for residents, as well as specific training to improve resilience and incentives towards a healthy lifestyle, including physical exercises [ 19 ]. Additionally, colleagues and staff should be aware of warning signs, such as avoidance behavior, unexplained absenteeism and alcohol abuse [ 20 ]. The training opportunities missed due to the redeployment of residents and faculty members should be addressed by policymakers and supervisors in order to guarantee the proper formation of specialists (profile and number of patients managed by residents, hands-on abilities, professional experience and soft skills).…”