Dra. Constanza Leal, Universidad de Chile, Country Ambassador Chile WYF-ISPRM
In March 2020, the first case of SARS-CoV2 infection was detected in Chile. This meant that by the end of March, quarantines, curfews, and online work and learning rapidly became the tendency. As Physical Medicine and Rehabilitation residents, our educational programs were also affected; ambulatory rehabilitation was cancelled and most clinical rotations too. Our hospital and program directors were concerned that residents could get infected or be virus carriers, so those from specialties not related to acute attention of Covid-19 patients were sent home; still there was no clarity regarding what our future activities would be. When the situation became more critical across the country (around June-July 2020) hospitals where at maximum capacity and the call for support became essential, that’s when all residents where needed in the emergency units and for the direct care of Covid-19 patients. It was winter and we were completing three months of quarantine in the metropolitan region, where most of the PM&R programs are executed and residents live, many of them far from their families.
It was evident that the situation was becoming more stressful, but as we weren’t having direct contact with our colleagues; we couldn’t tell how deep the problem was affecting our every day activities. I decided to make a mental health survey to put in evidence how quarantines, PM&R program modifications, online education, hospital shifts and the virus itself were affecting the residents. By the end of July all 58 residents from the four programs of PM&R held in Chile were invited to answer an online anonymous survey. The following results were from 47 answers: 14 from first year, 14 from second year and 19 from third and final year residents.
When asked, “On a scale from 1 to 10, how much has the pandemic affected your mental health?” (1 being “not at all” and 10 “extremely”) the median was 7 (IQR 5-9), mode was 6, results that evidenced most residents were moderately to severely affected.
When asked to indicate which mental and psychiatric symptoms where experienced with frequency, the most answered were: anxiety (80.9%), difficulty in concentrating (74.5%), insomnia (70.2%), discouragement (57.4%), fatigue (55.3%), irritability (55.3%), changes in appetite (51.1%) and emotional lability (48.9%).
When asked if they had sought psychological or psychiatric support 15 (31.9%) answered “yes”, 13 (27.7%) “no, but had considered it” and 19 (40.4%) answered “no”. The next question “On a scale from 1 to 10, how much is the situation of your residency program is contributing on your actual mental health?” the median was 7 (IQR 5-8) and mode 7, results that evidenced the important influence of the academic situation on their mental state. Finally, they were invited to briefly describe “how the pandemic has affected your residency” and the most frequently repeated answers were regarding the suspension of clinical rotations and loss of practical learning skills, delay of the program activities, long hours spent on screens and uncertainty regarding how the academic programs were going to evolve.
When invited to describe “what have been the main challenges as a PM&R resident during the pandemic” answers included concentrating at home on multiple activities, exclusive online learning specially for first year residents, adapting to new learning modalities, and not being able to share with fellow residents.
Results from this survey made evident the high prevalence of mental health burden during the first wave of the pandemic on Chilean PM&R residents. The survey also showed residents were frequently presenting symptoms that were negatively affecting their learning abilities and quality of life. This is a call for taking into account how program modifications, prolonged hours of online learning, isolation and uncertainty regarding the local and global situation can dramatically affect our residents. It is important for program directors and staff members to be aware of this issue and to modify the academic load and strategy during the pandemic accordingly and also to encourage self care and offer accessible channels of psychological support.
Dr. Constanza Leal
She is the current Country Ambassador for Chile in the World Youth Forum of ISPRM and was a former referent for the Residents Chapter in the Latin American Rehabilitation Medical Association (AMLAR).
She was a former physical medicine and rehabilitation resident from Universidad de Chile during 2018-2021.
Currently graduated, works as a Physiatrist in Hospital Urgencias Asistencia Pública and Hospital Metropolitano in Santiago, Chile.