Resident perspectives on the impact of program leadership communication on well-being during the COVID-19 pandemic

ABSTRACT

Background

The COVID-19 pandemic introduced a myriad of changes that negatively impacted resident physicians’ well-being. Communication from program leadership may mitigate resident stress during times of crisis, yet literature supporting this premise is scant, and best communication practices remain uncertain. This qualitative study aimed to identify stressors to residents and explore the influence of residency program leadership’s communication on emotional stress during the COVID-19 pandemic.

Methods

Informed by Kotter’s 8-step management model to support resident well-being, this qualitative study used grounded theory methods to interview 25 residents from three training programs (Pediatrics, Internal Medicine, and Medicine-Pediatrics) on a single academic medical campus from May-September 2020. Four investigators coded the data using the constant comparative analysis. Sampling continued until reaching thematic saturation. Codes were built using an iterative approach and organized into themes. Discrepancies were resolved by consensus discussion among investigators.

Results

Residents described increased stress levels, the all-consuming nature of COVID-19, mixed emotions about their role as healthcare providers, new coping mechanisms, and changes to their education and work environment that impacted stress. Communication from leadership to residents during the pandemic varied. Effective communication helped mitigate stress; perceived suboptimal communication exacerbated stress. Who was communicating, methods of communication, and content of communication influenced resident stress.

Conclusions

The COVID-19 pandemic introduced new stressors and challenges to residents. The perception of leadership communication played a critical role in mitigating or exacerbating resident stress. We propose a communication framework (“Who? What? Where? When? How?”) that residency leadership can utilize during times of crisis.

KEYWORDS:

• COVID-19
• resident well-being
• leadership
• communication
• resident stress
• medical training during COVID-19
• crisis management
• residency program leadership‌

Acknowledgements

The authors wish to thank all the residents who participated in this study and provided their insights during the COVID-19 pandemic.

Ethical approval

The study (COMIRB Protocol 20-1212) was determined to be exempt from IRB review by the University of Colorado Institutional Review Board on 5/13/2020. Submission ID is APP001-1.

Author contributions

All authors contributed to the study conception and design. All authors contributed to preparation of interview guide. Data collection via individual interviews was performed by EM, GC, LR, and LBS. Electronic database analysis was performed by LBS. All authors contributed to coding and additional analysis. The first draft of the manuscript was written by EM, GC, and LR. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Consent

Verbal informed consent was obtained prior to interviews of all individual participants included in the study. Individuals involved in the study consented to publication of their data.

Data availability statement

The dataset analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by University of Colorado School of Medicine, Anschutz Medical Campus.

Notes on contributors

Elizabeth A. McGinn

Elizabeth A. McGinn M.D. completed her Pediatrics residency at the University of Colorado. She was a NHLBI R38 recipient for work in pulmonary physiology and has continuing her career at the University of Colorado in the Pediatric Critical Care Medicine Fellowship.

Lynne M. Rosenberg

Lynne M. Rosenberg M.D. completed her Internal Medicine-Pediatrics residency at the University of Colorado. She is currently a chief resident in the Internal Medicine department and will be continuing her career at Denver Health Medical Center as a Toxicology fellow starting July 2024.

Grace S. Chandler

Grace S. Chandler M.D. completed her Pediatrics residency, as well as a chief resident year, at the University of Colorado. She is currently continuing her career at the Northwestern University/Ann & Robert H. Lurie Children's Hospital of Chicago in the Pediatric Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant Fellowship.

L. Barry Seltz

L. Barry Seltz M.D. is an associate program director of the University of Colorado Pediatrics Residency Program and is an associate professor of Pediatric Hospital Medicine.