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      Impact of COVID-19 on residency choice: A survey of New York City medical students

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          Abstract

          Objectives

          The Coronavirus disease 2019 (COVID-19) pandemic disrupted medical student education, particularly in New York City (NYC). We aimed to assess the impact of the COVID-19 pandemic on medical students’ residency choices.

          Methods

          The authors conducted a cross-sectional survey of medical students in all years of study at four NYC medical schools (Columbia, Cornell, NYU, and SUNY Downstate). The survey was fielded from 19 Aug 2020 to 21 Sep 2020. Survey questions included items assessing COVID-19 impact on residency choices, personal impact of COVID-19, residency/specialty choices, and factors influencing these choices.

          Results

          A total of 2310 students received the survey, with 547 (23.7%) providing partial responses and 212 (9.2%) providing valid responses for our primary analysis. 59.0% of participants thought that COVID-19 influenced their choice of residency/specialty, with 0.9% saying the influence was to a great extent, 22.2% to some extent, and 35.8% very little. On multivariable analysis, factors that were independently associated with COVID-19 impacting residency choice included low debt ($1 to $99,999: adjOR 2.23, 95%CI 1.02–5.03) compared with no debt and Other race/ethnicity ( adjOR 0.26, 95%CI 0.10–0.63) compared with White race/ethnicity. On secondary analysis of all participants answering survey items for logistic regression regardless of survey completion, direct personal impact of COVID-19 was significantly associated with COVID-19 impacting specialty choice ( adjOR 1.90, 95%CI 1.04–3.52). Moreover, 24 students (11.6%) reported a change in their top residency choice from before to during/after COVID-19, citing concerns about frontline work, work-life balance, and risk of harm.

          Conclusions

          Our study found that 3 in 5 (59.0%) participants felt that COVID-19 impacted their residency choice, with 11.6% of respondents explicitly changing their top specialty choice. Investigating the impact of the pandemic on medical student residency considerations is crucial to understand how medical career outlooks may change in the future.

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          Clinical Characteristics of Covid-19 in New York City

          Parag Goyal, Justin J Choi, Laura C Pinheiro … (2020)
          To the Editor: The world is in the midst of the coronavirus disease 2019 (Covid-19) pandemic, 1,2 and New York City has emerged as an epicenter. Here, we characterize the first 393 consecutive patients with Covid-19 who were admitted to two hospitals in New York City. This retrospective case series includes adults 18 years of age or older with confirmed Covid-19 who were consecutively admitted between March 3 (date of the first positive case) and March 27, 2020, at an 862-bed quaternary referral center and an affiliated 180-bed nonteaching community hospital in Manhattan. Both hospitals adopted an early-intubation strategy with limited use of high-flow nasal cannulae during this period. Cases were confirmed through reverse-transcriptase–polymerase-chain-reaction assays performed on nasopharyngeal swab specimens. Data were manually abstracted from electronic health records with the use of a quality-controlled protocol and structured abstraction tool (details are provided in the Methods section in the Supplementary Appendix, available with the full text of this letter at NEJM.org). Among the 393 patients, the median age was 62.2 years, 60.6% were male, and 35.8% had obesity (Table 1). The most common presenting symptoms were cough (79.4%), fever (77.1%), dyspnea (56.5%), myalgias (23.8%), diarrhea (23.7%), and nausea and vomiting (19.1%) (Table S1 in the Supplementary Appendix). Most of the patients (90.0%) had lymphopenia, 27% had thrombocytopenia, and many had elevated liver-function values and inflammatory markers. Between March 3 and April 10, respiratory failure leading to invasive mechanical ventilation developed in 130 patients (33.1%); to date, only 43 of these patients (33.1%) have been extubated. In total, 40 of the patients (10.2%) have died, and 260 (66.2%) have been discharged from the hospital; outcome data are incomplete for the remaining 93 patients (23.7%). Patients who received invasive mechanical ventilation were more likely to be male, to have obesity, and to have elevated liver-function values and inflammatory markers (ferritin, d-dimer, C-reactive protein, and procalcitonin) than were patients who did not receive invasive mechanical ventilation. Of the patients who received invasive mechanical ventilation, 40 (30.8%) did not need supplemental oxygen during the first 3 hours after presenting to the emergency department. Patients who received invasive mechanical ventilation were more likely to need vasopressor support (95.4% vs. 1.5%) and to have other complications, including atrial arrhythmias (17.7% vs. 1.9%) and new renal replacement therapy (13.3% vs. 0.4%). Among these 393 patients with Covid-19 who were hospitalized in two New York City hospitals, the manifestations of the disease at presentation were generally similar to those in a large case series from China 1 ; however, gastrointestinal symptoms appeared to be more common than in China (where these symptoms occurred in 4 to 5% of patients). This difference could reflect geographic variation or differential reporting. Obesity was common and may be a risk factor for respiratory failure leading to invasive mechanical ventilation. 3 The percentage of patients in our case series who received invasive mechanical ventilation was more than 10 times as high as that in China; potential contributors include the more severe disease in our cohort (since testing and hospitalization in the United States is largely limited to patients with more severe disease) and the early-intubation strategy used in our hospitals. Regardless, the high demand for invasive mechanical ventilation has the potential to overwhelm hospital resources. Deterioration occurred in many patients whose condition had previously been stable; almost a third of patients who received invasive mechanical ventilation did not need supplemental oxygen at presentation. The observations that the patients who received invasive mechanical ventilation almost universally received vasopressor support and that many also received new renal replacement therapy suggest that there is also a need to strengthen stockpiles and supply chains for these resources.
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            The Psychological and Mental Impact of Coronavirus Disease 2019 (COVID-19) on Medical Staff and General Public – A Systematic Review and Meta-analysis

            Min Luo, Lixia Guo, Mingzhou Yu … (2020)
            Highlights • We included 62 studies from 17 countries assessing psychological distress of COVID-19 • We found a high psychological burden among medical staff and the general public • However, the psychological distress was significantly higher among patients • We identified risk factors of psychological burdens to identify high-risk people • Professional medical services should be allocated to high-risk population • More self-help materials should be made available for people with milder impact
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              “We Signed Up for This!” — Student and Trainee Responses to the Covid-19 Pandemic

              Thomas H Gallagher, Anneliese M Schleyer (2020)
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                Author and article information

                Contributors
                Kate E. Lee:
                ORCID: https://orcid.org/0000-0002-0171-7121
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Francesca Lim: Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – review & editing
                Elisabeth R. Silver:
                ORCID: https://orcid.org/0000-0002-4779-0949
                Role: Data curationRole: MethodologyRole: VisualizationRole: Writing – review & editing
                Adam S. Faye: Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Chin Hur: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Chang-Qing Gao: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 6 October 2021
                Publication date Collection: 2021
                Publication date PMC-release: 6 October 2021
                Volume: 16
                Issue: 10
                Electronic Location Identifier: e0258088
                Affiliations
                [1 ] Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
                [2 ] Department of Medicine, Division of General Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, United States of America
                [3 ] Department of Psychological Sciences, Rice University, Houston, TX, United States of America
                [4 ] Division of Gastroenterology & Hepatology, New York University Langone Health, New York, NY, United States of America
                Central South University, Xiang Ya Hospital, CHINA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors are co-last authors on this work.

                Author information
                https://orcid.org/0000-0002-0171-7121
                https://orcid.org/0000-0002-4779-0949
                Article
                Publisher ID: PONE-D-20-37819
                DOI: 10.1371/journal.pone.0258088
                PMC ID: 8494369
                PubMed ID: 34614004
                SO-VID: 875e72ba-0db8-4d9d-92a9-604a504cb807
                Copyright © © 2021 Lee et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 1 December 2020
                Date accepted : 17 September 2021
                Page count
                Figures: 1, Tables: 3, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000062, National Institute of Diabetes and Digestive and Kidney Diseases;
                Award ID: T32DK083256-12S1
                Award Recipient :
                ORCID: https://orcid.org/0000-0002-0171-7121
                This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases in the form of a grant awarded to KEL (T32DK083256-12S1).
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: Covid 19
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Pandemics
                Subject: Social Sciences
                Subject: Sociology
                Subject: Education
                Subject: Medical Education
                Subject: Medicine and Health Sciences
                Subject: Medical Humanities
                Subject: Medical Education
                Subject: Medicine and Health Sciences
                Subject: Pediatrics
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Survey Research
                Subject: Surveys
                Subject: People and places
                Subject: Geographical locations
                Subject: North America
                Subject: United States
                Subject: New York
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Pediatric Surgery
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Custom metadata
                Data Availability Data cannot be shared publicly because of potential to identify individual medical students by their survey responses including demographic information, school, and career goals. The survey was administered confidentially and the authors will respect the privacy of respondents. Data are available from the Columbia Institutional Review Board Ethics Committee (contact via irboffice@ 123456columbia.edu , 212-305-5883) for researchers who meet the criteria for access to confidential data.
                Outbreaks COVID-19

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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