User login
The World Health Organization declared COVID-19 a pandemic on March 11, 2020, just 4 months before the start of a new residency cycle. Referred to as “COVID interns,” PGY-1 residents transitioning out of medical school in 2020 faced an unprecedented challenge of doctoring within a confused and ill-prepared health care system, while senior residents scrambled to adjust to their rapidly changing training programs. Each subsequent week brought more sobering news of increasing hospitalizations, intensive care unit admissions, and deaths; hospitals across the country resorted to the redeployment of residents across all specialties to buffer the growing need within their internal medicine and critical care units.1 And while the news and social media blurred into a collage of ventilator shortages, politicization of science, and “#healthcareheroes,” one study showed53.7% of medical interns (N=108) were struggling with mild to extremely severe depression, while 63.9% reported mild to severe anxiety.2
Many shortcomings of our health care system—ill preparedness, racial disparity, health illiteracy—were highlighted during the COVID-19 pandemic, and providers’ mental health was no exception.3 Classic psychosocial risk factors, such as high demands, lack of control, lack of institutional support, and absence of reward defined the workplace, leading Theorell4 to call it “a randomized trial for maximal worsening of the work environment.” Stress and burnout during residency are not novel concepts. A 2002 survey including 415 medical residency programs with a response from more than 4000 residents found depressive symptoms in 35% of respondents, paired with feelings of increased cynicism and decreased humanism despite major curricular reforms and duty hour limitations.5 Unfortunately, the statistics in the coming years hardly budged and, in the wake of the pandemic, culminated to more than 50% to 76% of physicians worldwide reporting burnout in 2020.6-8
As a COVID intern at Brigham and Women’s Hospital (Boston, Massachusetts), I also experienced the demanding workload and witnessed the struggle of my colleagues firsthand. Brigham and Women’s Hospital, similar to many of its peer institutions, implemented frequent mental health check-ins within its curriculum. Known as the Intern Humanistic Curriculum, these check-ins essentially were an echo chamber to unload the psychological burdens of our workdays, and we eagerly shared what made us angry, sad, hopeful, and hopeless. During one such session, I learned about moral injury, a term originating in the military defined as the psychological stress resulting from actions—or the lack of actions—that violates one’s moral or ethical code.9 With the onslaught of patient deaths for which most of us felt unprepared, we had all endured varying degrees of moral injury. Greenberg et al9 described 2 potential outcomes after moral injury: (1) the development of mental health disorders such as depression and posttraumatic stress disorder, or (2) posttraumatic growth, which is the bolstering of psychological resilience. Notably, the outcome is based on the way someone is supported before, during, and after the challenging incident.9
With the aim of psychological growth and developing resilience, residents should prioritize mental health throughout their training. To this end, several resources are readily available, many of which I actively use or frequently revisit, which are reviewed here.
Mindfulness Meditation App
Calm (https://www.calm.com/) is one of several popular mobile applications (apps) that delivers mindfulness mediation—the practice of attending to experiences, thoughts, and emotions without bias or judgment. With more than 100 million downloads, Calm includes meditation tutorials, breathing exercises, nature scenes and sounds, and audio programs taught by mindfulness experts for $69.99 a year or $14.99 a month. Systemic reviews have demonstrated reduced sleep disturbance, decreased ruminative thoughts and emotional reactivity, and increased awareness and acceptance in those practicing mindfulness meditation. Calm users have reported these benefits, with many able to forego the time- and cost-intensive cognitive behavioral therapy that requires highly trained therapists.10-12
Exercise to Relieve Stress
Both aerobic and anaerobic exercises are antidepressive and anxiolytic and also lower one’s overall sensitivity to stress. Whether it is governed by neurotransmitters such as the activation of the opioid systems or the release of endogenous endorphins or time spent focusing on a different task at hand, the benefits of exercise against mental stressors have been extensively studied and established.13 Consider obtaining a new gym membership at the start of residency or joining an intramural team. Both have the added benefit of expanding your social circle.
Socialize With Others
Social isolation and perceived loneliness are key stressors linked to neuroendocrine disturbances that underlie depression, anxiety, and even schizophrenia.14,15 Throughout residency there will be several social events and opportunities to gather with colleagues—inside or outside of the work environment—and residents should attend as time allows. Even virtual social interactions were found to reduce stress and help in the treatment of social anxiety disorder.14
Communicate About Stressors
Open up to your co-residents, friends, and family about any struggles that may be invisible on the outside. Even attendings can empathize with the struggles of residency, and the mentors in place are actively trained to prioritize resident wellness. If verbal communication is not your strength, try journaling. Writing helps to untangle and better define underlying stressors and is itself meditative.16,17 However, ensure that your journaling is focused on positive emotional responses and aims to determine the positive benefits within any stressful event; those solely expressing negative emotions were found to have higher levels of stress and anxiety afterward than they had before.17
Seek a Mental Health Specialist
As with all other human ailments, severe mental health disorders require specialists and proper medication. Unfortunately, substantial stigma accompanying mental health continues to permeate medicine, creating considerable barriers for residents in need of care.18 A 2016 survey of more than 2000 physicians found that those with mental illnesses did not seek treatment due to limited time, fear of being reported to a medical licensing board, concern over obtaining licensure, and shame or embarrassment at the diagnosis.19 Besides urging residents to seek care, more effort should be invested in addressing the stigma and ensuring confidentiality. In 2021, the internal medicine and medicine-pediatrics residency at the University of Colorado Anschutz Medical Campus (Aurora, Colorado) developed a confidential opt-out, rather than opt-in, mental health program, and appointments were made for all 80 interns in advance. In doing so, they found increased participation and self-reported wellness at a relatively low cost and simple implementation.20 For trainees without such access, online or mobile therapy platforms offering electronic mental health treatment or telepsychiatry also have been employed.21,22 The onus ultimately is still on the individual to seek the care they need. Although only an anecdotal piece of evidence, I have found the prevalence of physicians taking selective serotonin reuptake inhibitors such as escitalopram, sertraline, or fluoxetine to be strikingly common and quite beneficial.
Final Thoughts
Residency remains rife with financial, emotional, and physical stressors; even as the dust settles on the COVID-19 pandemic, the light shed on the importance of trainee mental health must remain illuminated. For the aforementioned resources to have an impact, residents need to be empowered to openly discuss mental health issues and to seek help if necessary. Finally, in 2018, the Journal of Graduate Medical Education published a 10-year prospective cohort study that found that emotional distress during residency persists in professional practice even 10 years after residency and is associated with future burnout.23 Trainees should consider prioritizing their mental health to not only improve their quality of life in the present but also as an investment for their future.
- Spiegelman J, Praiss A, Syeda S, et al. Preparation and redeployment of house staff during a pandemic. Semin Perinatol. 2020;44:151297.
- Debnath PR, Islam MS, Karmakar PK, et al. Mental health concerns, insomnia, and loneliness among intern doctors amidst the COVID-19 pandemic: evidence from a large tertiary care hospital in Bangladesh. Int J Ment Health Addict. 2021:1-21. doi:10.1007/s11469-021-00690-0
- O’Reilly-Shah VN, Gentry KR, Van Cleve W, et al. The COVID-19 pandemic highlights shortcomings in US health care informatics infrastructure: a call to action. Anesth Analg. 2020;131:340-344.
- Theorell T. COVID-19 and working conditions in health care. Psychother Psychosom. 2020;89:193-194.
- Collier VU, McCue JD, Markus A, et al. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002;136:384-390.
- AbuDujain NM, Almuhaideb QA, Alrumaihi NA, et al. The impact of the COVID-19 pandemic on medical interns’ education, training, and mental health: a cross-sectional study. Cureus. 2021;13:E19250.
- Amanullah S, Ramesh Shankar R. The impact of COVID-19 on physician burnout globally: a review. Healthcare (Basel). 2020;8:421.
- Lebares CC, Guvva EV, Ascher NL, et al. Burnout and stress among US surgery residents: psychological distress and resilience. J Am Coll Surg. 2018;226:80-90.
- Greenberg N, Docherty M, Gnanapragasam S, et al. Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ. 2020;368:m1211.
- Gal E, Stefan S, Cristea IA. The efficacy of mindfulness meditation apps in enhancing users’ well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. J Affect Disord. 2021;279:131-142.
- Huberty J, Green J, Glissmann C, et al. Efficacy of the mindfulness meditation mobile app “Calm” to reduce stress among college students: randomized controlled trial. JMIR Mhealth Uhealth. 2019;7:E14273.
- Huberty J, Puzia ME, Larkey L, et al. Can a meditation app help my sleep? a cross-sectional survey of Calm users. PLoS One. 2021;16:E0257518.
- Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev. 2001;21:33-61.
- Kampmann IL, Emmelkamp PM, Hartanto D, et al. Exposure to virtual social interactions in the treatment of social anxiety disorder: a randomized controlled trial. Behav Res Ther. 2016;77:147-156.
- Mumtaz F, Khan MI, Zubair M, et al. Neurobiology and consequences of social isolation stress in animal model-A comprehensive review. Biomed Pharmacother. 2018;105:1205-1222.
- Khanna P, Singh K. Stress management training and gratitude journaling in the classroom: an initial investigation in Indian context. Curr Psychol. 2021;40:5737-5748.
- Ullrich PM, Lutgendorf SK. Journaling about stressful events: effects of cognitive processing and emotional expression. Ann Behav Med. 2002;24:244-250.
- Outhoff K. Depression in doctors: a bitter pill to swallow. S Afr Fam Pract. 2019;61(suppl 1):S11-S14.
- Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51-57.
- Major A, Williams JG, McGuire WC, et al. Removing barriers: a confidential opt-out mental health pilot program for internal medicine interns. Acad Med. 2021;96:686-689.
- Greenhalgh T, Wherton J. Telepsychiatry: learning from the pandemic. Br J Psychiatry. 2022;220:1-5.
- Timakum T, Xie Q, Song M. Analysis of E-mental health research: mapping the relationship between information technology and mental healthcare. BMC Psychiatry. 2022;22:57.
- Raimo J, LaVine S, Spielmann K, et al. The correlation of stress in residency with future stress and burnout: a 10-year prospective cohort study. J Grad Med Educ. 2018;10:524-531.
The World Health Organization declared COVID-19 a pandemic on March 11, 2020, just 4 months before the start of a new residency cycle. Referred to as “COVID interns,” PGY-1 residents transitioning out of medical school in 2020 faced an unprecedented challenge of doctoring within a confused and ill-prepared health care system, while senior residents scrambled to adjust to their rapidly changing training programs. Each subsequent week brought more sobering news of increasing hospitalizations, intensive care unit admissions, and deaths; hospitals across the country resorted to the redeployment of residents across all specialties to buffer the growing need within their internal medicine and critical care units.1 And while the news and social media blurred into a collage of ventilator shortages, politicization of science, and “#healthcareheroes,” one study showed53.7% of medical interns (N=108) were struggling with mild to extremely severe depression, while 63.9% reported mild to severe anxiety.2
Many shortcomings of our health care system—ill preparedness, racial disparity, health illiteracy—were highlighted during the COVID-19 pandemic, and providers’ mental health was no exception.3 Classic psychosocial risk factors, such as high demands, lack of control, lack of institutional support, and absence of reward defined the workplace, leading Theorell4 to call it “a randomized trial for maximal worsening of the work environment.” Stress and burnout during residency are not novel concepts. A 2002 survey including 415 medical residency programs with a response from more than 4000 residents found depressive symptoms in 35% of respondents, paired with feelings of increased cynicism and decreased humanism despite major curricular reforms and duty hour limitations.5 Unfortunately, the statistics in the coming years hardly budged and, in the wake of the pandemic, culminated to more than 50% to 76% of physicians worldwide reporting burnout in 2020.6-8
As a COVID intern at Brigham and Women’s Hospital (Boston, Massachusetts), I also experienced the demanding workload and witnessed the struggle of my colleagues firsthand. Brigham and Women’s Hospital, similar to many of its peer institutions, implemented frequent mental health check-ins within its curriculum. Known as the Intern Humanistic Curriculum, these check-ins essentially were an echo chamber to unload the psychological burdens of our workdays, and we eagerly shared what made us angry, sad, hopeful, and hopeless. During one such session, I learned about moral injury, a term originating in the military defined as the psychological stress resulting from actions—or the lack of actions—that violates one’s moral or ethical code.9 With the onslaught of patient deaths for which most of us felt unprepared, we had all endured varying degrees of moral injury. Greenberg et al9 described 2 potential outcomes after moral injury: (1) the development of mental health disorders such as depression and posttraumatic stress disorder, or (2) posttraumatic growth, which is the bolstering of psychological resilience. Notably, the outcome is based on the way someone is supported before, during, and after the challenging incident.9
With the aim of psychological growth and developing resilience, residents should prioritize mental health throughout their training. To this end, several resources are readily available, many of which I actively use or frequently revisit, which are reviewed here.
Mindfulness Meditation App
Calm (https://www.calm.com/) is one of several popular mobile applications (apps) that delivers mindfulness mediation—the practice of attending to experiences, thoughts, and emotions without bias or judgment. With more than 100 million downloads, Calm includes meditation tutorials, breathing exercises, nature scenes and sounds, and audio programs taught by mindfulness experts for $69.99 a year or $14.99 a month. Systemic reviews have demonstrated reduced sleep disturbance, decreased ruminative thoughts and emotional reactivity, and increased awareness and acceptance in those practicing mindfulness meditation. Calm users have reported these benefits, with many able to forego the time- and cost-intensive cognitive behavioral therapy that requires highly trained therapists.10-12
Exercise to Relieve Stress
Both aerobic and anaerobic exercises are antidepressive and anxiolytic and also lower one’s overall sensitivity to stress. Whether it is governed by neurotransmitters such as the activation of the opioid systems or the release of endogenous endorphins or time spent focusing on a different task at hand, the benefits of exercise against mental stressors have been extensively studied and established.13 Consider obtaining a new gym membership at the start of residency or joining an intramural team. Both have the added benefit of expanding your social circle.
Socialize With Others
Social isolation and perceived loneliness are key stressors linked to neuroendocrine disturbances that underlie depression, anxiety, and even schizophrenia.14,15 Throughout residency there will be several social events and opportunities to gather with colleagues—inside or outside of the work environment—and residents should attend as time allows. Even virtual social interactions were found to reduce stress and help in the treatment of social anxiety disorder.14
Communicate About Stressors
Open up to your co-residents, friends, and family about any struggles that may be invisible on the outside. Even attendings can empathize with the struggles of residency, and the mentors in place are actively trained to prioritize resident wellness. If verbal communication is not your strength, try journaling. Writing helps to untangle and better define underlying stressors and is itself meditative.16,17 However, ensure that your journaling is focused on positive emotional responses and aims to determine the positive benefits within any stressful event; those solely expressing negative emotions were found to have higher levels of stress and anxiety afterward than they had before.17
Seek a Mental Health Specialist
As with all other human ailments, severe mental health disorders require specialists and proper medication. Unfortunately, substantial stigma accompanying mental health continues to permeate medicine, creating considerable barriers for residents in need of care.18 A 2016 survey of more than 2000 physicians found that those with mental illnesses did not seek treatment due to limited time, fear of being reported to a medical licensing board, concern over obtaining licensure, and shame or embarrassment at the diagnosis.19 Besides urging residents to seek care, more effort should be invested in addressing the stigma and ensuring confidentiality. In 2021, the internal medicine and medicine-pediatrics residency at the University of Colorado Anschutz Medical Campus (Aurora, Colorado) developed a confidential opt-out, rather than opt-in, mental health program, and appointments were made for all 80 interns in advance. In doing so, they found increased participation and self-reported wellness at a relatively low cost and simple implementation.20 For trainees without such access, online or mobile therapy platforms offering electronic mental health treatment or telepsychiatry also have been employed.21,22 The onus ultimately is still on the individual to seek the care they need. Although only an anecdotal piece of evidence, I have found the prevalence of physicians taking selective serotonin reuptake inhibitors such as escitalopram, sertraline, or fluoxetine to be strikingly common and quite beneficial.
Final Thoughts
Residency remains rife with financial, emotional, and physical stressors; even as the dust settles on the COVID-19 pandemic, the light shed on the importance of trainee mental health must remain illuminated. For the aforementioned resources to have an impact, residents need to be empowered to openly discuss mental health issues and to seek help if necessary. Finally, in 2018, the Journal of Graduate Medical Education published a 10-year prospective cohort study that found that emotional distress during residency persists in professional practice even 10 years after residency and is associated with future burnout.23 Trainees should consider prioritizing their mental health to not only improve their quality of life in the present but also as an investment for their future.
The World Health Organization declared COVID-19 a pandemic on March 11, 2020, just 4 months before the start of a new residency cycle. Referred to as “COVID interns,” PGY-1 residents transitioning out of medical school in 2020 faced an unprecedented challenge of doctoring within a confused and ill-prepared health care system, while senior residents scrambled to adjust to their rapidly changing training programs. Each subsequent week brought more sobering news of increasing hospitalizations, intensive care unit admissions, and deaths; hospitals across the country resorted to the redeployment of residents across all specialties to buffer the growing need within their internal medicine and critical care units.1 And while the news and social media blurred into a collage of ventilator shortages, politicization of science, and “#healthcareheroes,” one study showed53.7% of medical interns (N=108) were struggling with mild to extremely severe depression, while 63.9% reported mild to severe anxiety.2
Many shortcomings of our health care system—ill preparedness, racial disparity, health illiteracy—were highlighted during the COVID-19 pandemic, and providers’ mental health was no exception.3 Classic psychosocial risk factors, such as high demands, lack of control, lack of institutional support, and absence of reward defined the workplace, leading Theorell4 to call it “a randomized trial for maximal worsening of the work environment.” Stress and burnout during residency are not novel concepts. A 2002 survey including 415 medical residency programs with a response from more than 4000 residents found depressive symptoms in 35% of respondents, paired with feelings of increased cynicism and decreased humanism despite major curricular reforms and duty hour limitations.5 Unfortunately, the statistics in the coming years hardly budged and, in the wake of the pandemic, culminated to more than 50% to 76% of physicians worldwide reporting burnout in 2020.6-8
As a COVID intern at Brigham and Women’s Hospital (Boston, Massachusetts), I also experienced the demanding workload and witnessed the struggle of my colleagues firsthand. Brigham and Women’s Hospital, similar to many of its peer institutions, implemented frequent mental health check-ins within its curriculum. Known as the Intern Humanistic Curriculum, these check-ins essentially were an echo chamber to unload the psychological burdens of our workdays, and we eagerly shared what made us angry, sad, hopeful, and hopeless. During one such session, I learned about moral injury, a term originating in the military defined as the psychological stress resulting from actions—or the lack of actions—that violates one’s moral or ethical code.9 With the onslaught of patient deaths for which most of us felt unprepared, we had all endured varying degrees of moral injury. Greenberg et al9 described 2 potential outcomes after moral injury: (1) the development of mental health disorders such as depression and posttraumatic stress disorder, or (2) posttraumatic growth, which is the bolstering of psychological resilience. Notably, the outcome is based on the way someone is supported before, during, and after the challenging incident.9
With the aim of psychological growth and developing resilience, residents should prioritize mental health throughout their training. To this end, several resources are readily available, many of which I actively use or frequently revisit, which are reviewed here.
Mindfulness Meditation App
Calm (https://www.calm.com/) is one of several popular mobile applications (apps) that delivers mindfulness mediation—the practice of attending to experiences, thoughts, and emotions without bias or judgment. With more than 100 million downloads, Calm includes meditation tutorials, breathing exercises, nature scenes and sounds, and audio programs taught by mindfulness experts for $69.99 a year or $14.99 a month. Systemic reviews have demonstrated reduced sleep disturbance, decreased ruminative thoughts and emotional reactivity, and increased awareness and acceptance in those practicing mindfulness meditation. Calm users have reported these benefits, with many able to forego the time- and cost-intensive cognitive behavioral therapy that requires highly trained therapists.10-12
Exercise to Relieve Stress
Both aerobic and anaerobic exercises are antidepressive and anxiolytic and also lower one’s overall sensitivity to stress. Whether it is governed by neurotransmitters such as the activation of the opioid systems or the release of endogenous endorphins or time spent focusing on a different task at hand, the benefits of exercise against mental stressors have been extensively studied and established.13 Consider obtaining a new gym membership at the start of residency or joining an intramural team. Both have the added benefit of expanding your social circle.
Socialize With Others
Social isolation and perceived loneliness are key stressors linked to neuroendocrine disturbances that underlie depression, anxiety, and even schizophrenia.14,15 Throughout residency there will be several social events and opportunities to gather with colleagues—inside or outside of the work environment—and residents should attend as time allows. Even virtual social interactions were found to reduce stress and help in the treatment of social anxiety disorder.14
Communicate About Stressors
Open up to your co-residents, friends, and family about any struggles that may be invisible on the outside. Even attendings can empathize with the struggles of residency, and the mentors in place are actively trained to prioritize resident wellness. If verbal communication is not your strength, try journaling. Writing helps to untangle and better define underlying stressors and is itself meditative.16,17 However, ensure that your journaling is focused on positive emotional responses and aims to determine the positive benefits within any stressful event; those solely expressing negative emotions were found to have higher levels of stress and anxiety afterward than they had before.17
Seek a Mental Health Specialist
As with all other human ailments, severe mental health disorders require specialists and proper medication. Unfortunately, substantial stigma accompanying mental health continues to permeate medicine, creating considerable barriers for residents in need of care.18 A 2016 survey of more than 2000 physicians found that those with mental illnesses did not seek treatment due to limited time, fear of being reported to a medical licensing board, concern over obtaining licensure, and shame or embarrassment at the diagnosis.19 Besides urging residents to seek care, more effort should be invested in addressing the stigma and ensuring confidentiality. In 2021, the internal medicine and medicine-pediatrics residency at the University of Colorado Anschutz Medical Campus (Aurora, Colorado) developed a confidential opt-out, rather than opt-in, mental health program, and appointments were made for all 80 interns in advance. In doing so, they found increased participation and self-reported wellness at a relatively low cost and simple implementation.20 For trainees without such access, online or mobile therapy platforms offering electronic mental health treatment or telepsychiatry also have been employed.21,22 The onus ultimately is still on the individual to seek the care they need. Although only an anecdotal piece of evidence, I have found the prevalence of physicians taking selective serotonin reuptake inhibitors such as escitalopram, sertraline, or fluoxetine to be strikingly common and quite beneficial.
Final Thoughts
Residency remains rife with financial, emotional, and physical stressors; even as the dust settles on the COVID-19 pandemic, the light shed on the importance of trainee mental health must remain illuminated. For the aforementioned resources to have an impact, residents need to be empowered to openly discuss mental health issues and to seek help if necessary. Finally, in 2018, the Journal of Graduate Medical Education published a 10-year prospective cohort study that found that emotional distress during residency persists in professional practice even 10 years after residency and is associated with future burnout.23 Trainees should consider prioritizing their mental health to not only improve their quality of life in the present but also as an investment for their future.
- Spiegelman J, Praiss A, Syeda S, et al. Preparation and redeployment of house staff during a pandemic. Semin Perinatol. 2020;44:151297.
- Debnath PR, Islam MS, Karmakar PK, et al. Mental health concerns, insomnia, and loneliness among intern doctors amidst the COVID-19 pandemic: evidence from a large tertiary care hospital in Bangladesh. Int J Ment Health Addict. 2021:1-21. doi:10.1007/s11469-021-00690-0
- O’Reilly-Shah VN, Gentry KR, Van Cleve W, et al. The COVID-19 pandemic highlights shortcomings in US health care informatics infrastructure: a call to action. Anesth Analg. 2020;131:340-344.
- Theorell T. COVID-19 and working conditions in health care. Psychother Psychosom. 2020;89:193-194.
- Collier VU, McCue JD, Markus A, et al. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002;136:384-390.
- AbuDujain NM, Almuhaideb QA, Alrumaihi NA, et al. The impact of the COVID-19 pandemic on medical interns’ education, training, and mental health: a cross-sectional study. Cureus. 2021;13:E19250.
- Amanullah S, Ramesh Shankar R. The impact of COVID-19 on physician burnout globally: a review. Healthcare (Basel). 2020;8:421.
- Lebares CC, Guvva EV, Ascher NL, et al. Burnout and stress among US surgery residents: psychological distress and resilience. J Am Coll Surg. 2018;226:80-90.
- Greenberg N, Docherty M, Gnanapragasam S, et al. Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ. 2020;368:m1211.
- Gal E, Stefan S, Cristea IA. The efficacy of mindfulness meditation apps in enhancing users’ well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. J Affect Disord. 2021;279:131-142.
- Huberty J, Green J, Glissmann C, et al. Efficacy of the mindfulness meditation mobile app “Calm” to reduce stress among college students: randomized controlled trial. JMIR Mhealth Uhealth. 2019;7:E14273.
- Huberty J, Puzia ME, Larkey L, et al. Can a meditation app help my sleep? a cross-sectional survey of Calm users. PLoS One. 2021;16:E0257518.
- Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev. 2001;21:33-61.
- Kampmann IL, Emmelkamp PM, Hartanto D, et al. Exposure to virtual social interactions in the treatment of social anxiety disorder: a randomized controlled trial. Behav Res Ther. 2016;77:147-156.
- Mumtaz F, Khan MI, Zubair M, et al. Neurobiology and consequences of social isolation stress in animal model-A comprehensive review. Biomed Pharmacother. 2018;105:1205-1222.
- Khanna P, Singh K. Stress management training and gratitude journaling in the classroom: an initial investigation in Indian context. Curr Psychol. 2021;40:5737-5748.
- Ullrich PM, Lutgendorf SK. Journaling about stressful events: effects of cognitive processing and emotional expression. Ann Behav Med. 2002;24:244-250.
- Outhoff K. Depression in doctors: a bitter pill to swallow. S Afr Fam Pract. 2019;61(suppl 1):S11-S14.
- Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51-57.
- Major A, Williams JG, McGuire WC, et al. Removing barriers: a confidential opt-out mental health pilot program for internal medicine interns. Acad Med. 2021;96:686-689.
- Greenhalgh T, Wherton J. Telepsychiatry: learning from the pandemic. Br J Psychiatry. 2022;220:1-5.
- Timakum T, Xie Q, Song M. Analysis of E-mental health research: mapping the relationship between information technology and mental healthcare. BMC Psychiatry. 2022;22:57.
- Raimo J, LaVine S, Spielmann K, et al. The correlation of stress in residency with future stress and burnout: a 10-year prospective cohort study. J Grad Med Educ. 2018;10:524-531.
- Spiegelman J, Praiss A, Syeda S, et al. Preparation and redeployment of house staff during a pandemic. Semin Perinatol. 2020;44:151297.
- Debnath PR, Islam MS, Karmakar PK, et al. Mental health concerns, insomnia, and loneliness among intern doctors amidst the COVID-19 pandemic: evidence from a large tertiary care hospital in Bangladesh. Int J Ment Health Addict. 2021:1-21. doi:10.1007/s11469-021-00690-0
- O’Reilly-Shah VN, Gentry KR, Van Cleve W, et al. The COVID-19 pandemic highlights shortcomings in US health care informatics infrastructure: a call to action. Anesth Analg. 2020;131:340-344.
- Theorell T. COVID-19 and working conditions in health care. Psychother Psychosom. 2020;89:193-194.
- Collier VU, McCue JD, Markus A, et al. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002;136:384-390.
- AbuDujain NM, Almuhaideb QA, Alrumaihi NA, et al. The impact of the COVID-19 pandemic on medical interns’ education, training, and mental health: a cross-sectional study. Cureus. 2021;13:E19250.
- Amanullah S, Ramesh Shankar R. The impact of COVID-19 on physician burnout globally: a review. Healthcare (Basel). 2020;8:421.
- Lebares CC, Guvva EV, Ascher NL, et al. Burnout and stress among US surgery residents: psychological distress and resilience. J Am Coll Surg. 2018;226:80-90.
- Greenberg N, Docherty M, Gnanapragasam S, et al. Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ. 2020;368:m1211.
- Gal E, Stefan S, Cristea IA. The efficacy of mindfulness meditation apps in enhancing users’ well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. J Affect Disord. 2021;279:131-142.
- Huberty J, Green J, Glissmann C, et al. Efficacy of the mindfulness meditation mobile app “Calm” to reduce stress among college students: randomized controlled trial. JMIR Mhealth Uhealth. 2019;7:E14273.
- Huberty J, Puzia ME, Larkey L, et al. Can a meditation app help my sleep? a cross-sectional survey of Calm users. PLoS One. 2021;16:E0257518.
- Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev. 2001;21:33-61.
- Kampmann IL, Emmelkamp PM, Hartanto D, et al. Exposure to virtual social interactions in the treatment of social anxiety disorder: a randomized controlled trial. Behav Res Ther. 2016;77:147-156.
- Mumtaz F, Khan MI, Zubair M, et al. Neurobiology and consequences of social isolation stress in animal model-A comprehensive review. Biomed Pharmacother. 2018;105:1205-1222.
- Khanna P, Singh K. Stress management training and gratitude journaling in the classroom: an initial investigation in Indian context. Curr Psychol. 2021;40:5737-5748.
- Ullrich PM, Lutgendorf SK. Journaling about stressful events: effects of cognitive processing and emotional expression. Ann Behav Med. 2002;24:244-250.
- Outhoff K. Depression in doctors: a bitter pill to swallow. S Afr Fam Pract. 2019;61(suppl 1):S11-S14.
- Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51-57.
- Major A, Williams JG, McGuire WC, et al. Removing barriers: a confidential opt-out mental health pilot program for internal medicine interns. Acad Med. 2021;96:686-689.
- Greenhalgh T, Wherton J. Telepsychiatry: learning from the pandemic. Br J Psychiatry. 2022;220:1-5.
- Timakum T, Xie Q, Song M. Analysis of E-mental health research: mapping the relationship between information technology and mental healthcare. BMC Psychiatry. 2022;22:57.
- Raimo J, LaVine S, Spielmann K, et al. The correlation of stress in residency with future stress and burnout: a 10-year prospective cohort study. J Grad Med Educ. 2018;10:524-531.
Resident Pearl
- Although institution-sponsored wellness programs exist to promote the mental health of trainees, rates of anxiety and depression remain high among residents, which was further highlighted during the COVID-19 pandemic. Instead of passively engaging with wellness messages, residents must actively prioritize their own mental health to avoid stress and burnout.
