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      Being an Obstetrics and Gynaecology Resident during the COVID-19: Impact of the Pandemic on the residency training program

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          Abstract

          Objective

          to evaluate the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy.

          Study design

          This was a cross-sectional survey study aimed to assess the impact of the COVID-19 pandemic on the obstetrics and gynecology residency training program in Italy. An online survey with 45 questions was sent and completed anonymously by residents after accepting an informed consent. The invitation to the online survey was sent to all the Italian residents in obstetrics and gynecology. Those on maternity leave at the time of the study were excluded. Residents were asked about their routinely activity before the COVID-19 pandemic, and to report the reduction in their clinical practice. They were also asked about psychological impact of COVID-19 on their clinical practice.

          Results

          933 Italian residents in obstetrics and gynecology, were invited for this survey study. Four-hundred and seventy-six (51%) completed the survey and were included in the study. Three-hundred and eighty-seven (81.3%) were female, and 89 (18.7%) were male. Residents age ranged from 25 to 42. In 71,8% (342/476) of the cases residents work in a COVID-19 reference Hospitals. One-hundred and eighty-four out of 76 residents (38.6%) were tested on RT-PCR assay of nasal and pharyngeal swab specimens, and of them 12/184 (6.5%) were positive to SARS-COV-2. Regarding the use of personal protective equipment (PPE), 267 (56.1%) reported to receive adequate device, and 379 (79.6%) felt to be well informed about prevention and management protocols. Three-hundred and thirty-one residents (69.5%) reported to have managed COVID-19 positive patients. For 54,7% of respondent residents, training activity in general decreased significantly during the COVID-19 epidemic. A one-third reduction was reported in 31,4% of the cases, whereas a total suspension of the training in 9,9% of the cases. In 89,3% of cases the reduction was caused by the reorganization of work. Anxiety about the professional future was reported in 84% of the residents, and 59% of them had the perception that their training was irreversibly compromised.

          Conclusions

          Among Italian residents in obstetrics and gynecology, COVID-19 pandemic was associated with a significant training impairment.

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          Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

          Cuiyan Wang, Riyu Pan, Xiaoyang Wan … (2020)
          Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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            Coronaviruses: An Overview of Their Replication and Pathogenesis

            Anthony R. Fehr, Stanley Perlman (2015)
            Coronaviruses (CoVs), enveloped positive-sense RNA viruses, are characterized by club-like spikes that project from their surface, an unusually large RNA genome, and a unique replication strategy. Coronaviruses cause a variety of diseases in mammals and birds ranging from enteritis in cows and pigs and upper respiratory disease in chickens to potentially lethal human respiratory infections. Here we provide a brief introduction to coronaviruses discussing their replication and pathogenicity, and current prevention and treatment strategies. We also discuss the outbreaks of the highly pathogenic Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and the recently identified Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV).
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              Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore

              Benjamin Tan, Nicholas W.S. Chew, Grace K.H. Lee … (2020)
              Background: In response to the coronavirus 2019 (COVID-19) pandemic, Singapore raised its Disease Outbreak Response System Condition alert to “orange,” the second highest level. Between 19 February and 13 March 2020, confirmed cases rose from 84 to 200 (34.2 per 1 000 000 population), with an increase in patients in critical condition from 4 to 11 (5.5%) and no reported deaths in Singapore (1). Understanding the psychological impact of the COVID-19 outbreak among health care workers is crucial in guiding policies and interventions to maintain their psychological well-being. Objective: We examined the psychological distress, depression, anxiety, and stress experienced by health care workers in Singapore in the midst of the outbreak, and compared these between medically and non–medically trained hospital personnel. Methods and Findings: From 19 February to 13 March 2020, health care workers from 2 major tertiary institutions in Singapore who were caring for patients with COVID-19 were invited to participate with a self-administered questionnaire. In addition to information on demographic characteristics and medical history (Table 1), the questionnaire included the validated Depression, Anxiety, and Stress Scales (DASS-21) and the Impact of Events Scale–Revised (IES-R) instrument (2, 3). Health care workers included “medical” (physicians, nurses) and “nonmedical” personnel (allied health professionals, pharmacists, technicians, administrators, clerical staff, and maintenance workers). The primary outcome was the prevalence of depression, stress, anxiety, and posttraumatic stress disorder (PTSD) among all health care workers (Table 2). Secondary outcomes were comparison of the prevalence of depression, anxiety, stress, and PTSD, and mean DASS-21 and IES-R scores between medical and nonmedical health care workers. The Pearson χ2 test and Student t test were used to compare categorical and continuous outcomes, respectively, between the 2 groups. Multivariable regression was used to adjust for the a priori defined confounders of age, sex, ethnicity, marital status, presence of comorbid conditions, and survey completion date. Table 1. Participant Characteristics at Baseline Table 2. Prevalence of Depression, Anxiety, Stress, and PTSD and Mean DASS-21 and IES-R Scores in Medical and Nonmedical Health Care Personnel (N = 470) Of 500 invited health care workers, 470 (94%) participated in the study; baseline characteristics are shown in Table 1. Sixty-eight (14.5%) participants screened positive for anxiety, 42 (8.9%) for depression, 31 (6.6%) for stress, and 36 (7.7%) for clinical concern of PTSD. The prevalence of anxiety was higher among nonmedical health care workers than medical personnel (20.7% versus 10.8%; adjusted prevalence ratio, 1.85 [95% CI, 1.15 to 2.99]; P = 0.011), after adjustment for age, sex, ethnicity, marital status, survey completion date, and presence of comorbid conditions. Similarly, higher mean DASS-21 anxiety and stress subscale scores and higher IES-R total and subscale scores were observed in nonmedical health care workers (Table 2). Discussion: Overall mean DASS-21 and IES-R scores among health care workers were lower than those in the published literature from previous disease outbreaks, such as the severe acute respiratory syndrome (SARS). A previous study in Singapore found higher IES scores among physicians and nurses during the SARS outbreak, and an almost 3 times higher prevalence of PTSD, than those in our study (4). This could be attributed to increased mental preparedness and stringent infection control measures after Singapore's SARS experience. Of note, nonmedical health care workers had higher prevalence of anxiety even after adjustment for possible confounders. Our findings are consistent with those of a recent COVID-19 study demonstrating that frontline nurses had significantly lower vicarious traumatization scores than non–frontline nurses and the general public (5). Reasons for this may include reduced accessibility to formal psychological support, less first-hand medical information on the outbreak, less intensive training on personal protective equipment and infection control measures. As the pandemic continues, important clinical and policy strategies are needed to support health care workers. Our study identified a vulnerable group susceptible to psychological distress. Educational interventions should target nonmedical health care workers to ensure understanding and use of infectious control measures. Psychological support could include counseling services and development of support systems among colleagues. Our study has limitations. First, data obtained from self-reported questionnaires were not verified with medical records. Second, the study did not assess socioeconomic status, which may be helpful in evaluating associations of outcomes and tailoring specific interventions. Finally, the study was performed early in the outbreak and only in Singapore, which may limit the generalizability of the findings. Follow-up studies could help assess for progression or even a potential rebound effect of psychological manifestations once the imminent threat of COVID-19 subsides. In conclusion, our study highlights that nonmedical health care personnel are at highest risk for psychological distress during the COVID-19 outbreak. Early psychological interventions targeting this vulnerable group may be beneficial.
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                Author and article information

                Contributors
                Anna Rita Palumbo
                Journal
                Journal ID (nlm-ta): Eur J Obstet Gynecol Reprod Biol
                Journal ID (iso-abbrev): Eur. J. Obstet. Gynecol. Reprod. Biol
                Title: European Journal of Obstetrics, Gynecology, and Reproductive Biology
                Publisher: Elsevier B.V.
                ISSN (Print): 0301-2115
                ISSN (Electronic): 1872-7654
                Publication date PMC-release: 1 August 2020
                Publication date (Electronic): 1 August 2020
                Affiliations
                [a ]Department of Clinical and Experimental Medicine, Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Catanzaro, Italy
                [b ]Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
                Author notes
                [* ]Corresponding author at: viale Pio X, 88100, Catanzaro, Italy. a.palumbo34@ 123456gmail.com
                Article
                Publisher ID: S0301-2115(20)30498-X
                DOI: 10.1016/j.ejogrb.2020.07.057
                PMC ID: 7395645
                PubMed ID: 32771888
                SO-VID: d3bab4cc-afaa-4757-88e5-e3f45a874679
                Copyright © © 2020 Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 18 May 2020
                Date revision received : 27 July 2020
                Date accepted : 29 July 2020
                Categories
                Subject: Article

                Keywords: coronavirus,training,european,impact,obstetrics,gynecology
                Data availability:
                Keywords: coronavirus, training, european, impact, obstetrics, gynecology

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