Academia.eduAcademia.edu
ACADEMIA Letters Pandemic Burnout: A Filipino Medical Resident’s Perspective JOHN VINCENT PAGADDU, Cagayan Valley Medical Center COVID-19 (Coronavirus Disease 2019) is a communicable disease caused by a novel coronavirus, SARS-CoV-2.[1] This type of coronavirus is said to be novel since it has not been documented before (not until it was discovered in Wuhan, China on 31 December 2019).[2] After the initial spread of COVID-19 in China, this global health crisis has reached different countries, including the Philippines. Due to rapid progression and rising severity, the World Health Organization (WHO) first declared an outbreak of international concern and pronounced the spread as pandemic on 11 March 2020.[3, 4] Since then, many nations around the globe have implemented several public health strategies and measures to mitigate the impact of COVID19 pandemic. The first case of COVID-19 in the Philippines was confirmed on the 30th of January 2020 in a government hospital in the Philippines as an imported case from Wuhan, China.[5] Since then, the number of cases started to rise and cases of community transmission started to develop in different parts of the country. The impact of COVID-19 crisis in the Philippines has been widespread, sparing no one, rich and poor alike, initially threatening the old and vulnerable. This hit Philippines so bad and has put a huge strain on the healthcare system of the country. Medical doctors who were in residency training have been affected and inflicted in various ways. In Cagayan Valley Medical Center (CVMC), the most memorable day for all the residents from different specialty trainings was the 21st of March 2020 - the date that CVMC declared its first COVID-19 case.[6] At that time, I was a second year internal medicine resident and the Emergency Room (ER) medical resident on-duty. After we were informed about the first COVID-19 case in our institution, I and my co-residents were then called for a meeting and briefing. I was chosen to be part of the first team of healthcare workers that would Academia Letters, December 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: JOHN VINCENT PAGADDU, dospagaddu@gmail.com Citation: Pagaddu, J.V. (2021). Pandemic Burnout: A Filipino Medical Resident’s Perspective. Academia Letters, Article 4285. https://doi.org/10.20935/AL4285. 1 directly manage and care for the COVID-19 patients in our institution. The uncertainty and sudden turns in patient’s conditions were petrifying. With its unpredictable and novel nature, interventions and therapeutic approaches were elusive[7] - a fact that made a lot of medical personnel very much worried. However, medical residents, and medical consultants alike, were left with no choice but to face this battle against COVID-19 with only courage, strength, and hope. The first few days of sleepless COVID ward duties had stricken the temperament of each medical resident. Fortunately, the hospital administrators and the consultants of the Department of Medicine of CVMC implemented stress debriefing and reflection activities every after a tour of duty, which usually lasts for 7days, to ensure emotional and mental stability and resilience of the COVID ward staff. However, a year onwards, the surge of COVID-19 patients resulted in increased demands on the part of the medical residents rotating in the COVID ward. This in turn led to limited clinical exposure to other diseases (apart from COVID-19), reduced skill-based clinical practice, and changes in the structure of the residency program (such as adaptation of virtual platform for conferences, quizzes and case presentations; and modifications in duty schedule). It has been more than a year since COVID-19 pandemic was declared. But until now, publications in the Philippines regarding the impact of COVID-19 pandemic on residents intraining remain limited. In a report by the Philippine Pediatric Society, burnout was one of the common reasons why pediatric residents quit from training during the pandemic period.[8] Burnout is a phenomenon comprised of a triad of “emotional exhaustion,” diminished “personal accomplishment,” and “depersonalization.”[9] Even prior to the emergence of COVID19 crisis, burnout is already a prevalent problem among residents in-training.[10] However, it has been hypothesized that the prevalence of burnout among residents would significantly increase amidst the COVID-19 pandemic. This increase in the prevalence of burnout during pandemic may be attributed to multiple factors. In fact, donning the protective coverall suit is in itself a source of stress for me. Also, the fear of carrying the virus home and subsequently infecting my family is an added source of stress. In a recent evidence, a significant proportion of residents in-training were noted to have a “high risk of burnout” during the pandemic. This was predominantly observed among residents in-training who experienced self-isolation.[11] Furthermore, it was observed that those residents in-training who underwent self-isolation to protect their families were more likely to experience burnout.[11] Recognizing burnout is relevant and important. This is such because burnout does not only have a negative implication on the medical trainees but also it may lead to serious harm on patients.[12] This context has prompted our institution and the medical training core to develop strategies and programs. One strategy is the formation of four teams, which take Academia Letters, December 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: JOHN VINCENT PAGADDU, dospagaddu@gmail.com Citation: Pagaddu, J.V. (2021). Pandemic Burnout: A Filipino Medical Resident’s Perspective. Academia Letters, Article 4285. https://doi.org/10.20935/AL4285. 2 turns in going into COVID ward duty. Each team, which is composed of residents in-training, consultants, nurses, and other allied health professionals, is tasked to go into a 7-day straight duty. This is followed by a 2-week quarantine, then a 1 week family time. This strategy has helped maintain the well-being and coping of the medical residents in-training intact. Medical residents in-training play a vital role in the direct care of COVID-19 patients. During this COVID-19 tragedy, burnout has been a pressing concern, and has even reached an epidemic proportion. If this will not be addressed, this may result in devastating consequences. As such, it is of extreme importance to understand the nature of burnout and develop collaborative strategies to prevent future catastrophes. Academia Letters, December 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: JOHN VINCENT PAGADDU, dospagaddu@gmail.com Citation: Pagaddu, J.V. (2021). Pandemic Burnout: A Filipino Medical Resident’s Perspective. Academia Letters, Article 4285. https://doi.org/10.20935/AL4285. 3 References [1] who.int [homepage on the internet] World Health Organization (WHO) (2021). Coronavirus Overview. WHO [online]. [2] ecdc.europa.edu [homepage on the internet]. Europe: European Center Centre for Disease Prevention and Control [uppdated 2021; cited 2021 Oct 27]. Available from https://www. ecdc.europa.eu/en/covid-19/questions-answers/questions-answers-medical-info [3] who.int [homepage on the internet] World Health Organization [Updated 2021; cited 2021 Oct 27]. Available from: https://www.who.int/publications/m/item/covid-19-public-healthemergency-of-international-concern-(pheic)-global-research-and-innovation-forum [4] who.int. [homepage on the internet] World Health Organization [Updated 2021; cited 2021 Oct 27]. Available from: https://www.who.int/director-general/speeches/detail/whodirector-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020 [5] doh.gov [homepage on the internet]. Philippines: Department of Health (DOH) [Updated 2020; cited 2021 Oct 27). Available from: https://doh.gov.ph/doh-press-release/ doh-confirms-first-2019-nCoV-case-in-the-country [6] Inquirer.net [homepage on the internet]. Philippine Daily Inquirer [Updated 2021; cited 2021 Oct 27] Available from: https://newsinfo.inquirer.net/1246116/fireman-is-cagayans1st-covid-19-patient [7] TAPinto.net [homepage on the internet]. TAP IP LLC [updated 2021; cited 2021 Oct 27] Available from: https://www.tapinto.net/articles/a-hopeful-treatment-is-covid-19-s-silverlining-12 [8] Philippine Pediatric Society (PPS). PEDIATRIC RESIDENCY TRAINING DURING THE PANDEMIC [monograph on the internet]. PPS; no date [cited 2021 October 27] Available from: https://pps.org.ph/wp-content/uploads/2020/09/Pediatric-Residency-TrainingDuring-the-Pandemic.pdf [9] Maslach C. Burnout: a multidimensional perspective. In: Schaufeli W. B., Maslach C., Marek T., editors. Professional Burnout: Recent Developments in Theory and Research. Washington, DC: Taylor & Francis; 1993 [10] Wood, E., Ange, B., & Wyatt, T. Residents’ burnout in COVID 19 pandemic environment. Canadian medical education journal 2021; 12(1), e182–e183. Available from: https://doi. Academia Letters, December 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: JOHN VINCENT PAGADDU, dospagaddu@gmail.com Citation: Pagaddu, J.V. (2021). Pandemic Burnout: A Filipino Medical Resident’s Perspective. Academia Letters, Article 4285. https://doi.org/10.20935/AL4285. 4 org/10.36834/cmej.70709 [11] Farsi, A, Alomar, S., Kadi, M., Farsi, S., Algethamy, H., Reda, B., et al. Self-isolation during the COVID-19 pandemic is associated with increased risk of burnout among physician trainees: A cross sectional study. World Family Medicine 2021; 19(1): 112-125 Available from: http://mejfm.com/February%202021/Covid%20burnout.htm [12] Joseph, R. Getting to the guts of physician burnout: A resident’s perspective [monograph on the internet]. Medical Economics; 2018 [cited 2021 Oct 27] Available from: https:// www.medicaleconomics.com/view/getting-guts-physician-burnout-residents-perspective Academia Letters, December 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0 Corresponding Author: JOHN VINCENT PAGADDU, dospagaddu@gmail.com Citation: Pagaddu, J.V. (2021). Pandemic Burnout: A Filipino Medical Resident’s Perspective. Academia Letters, Article 4285. https://doi.org/10.20935/AL4285. 5