Association of COVID-19 Intensity With Burnout and Perceptions of Residency Preparedness Among Medical Students

This cross-sectional study of US medical students assesses the association of COVID-19 intensity in the clinical learning environment with student burnout and perceptions regarding residency preparedness.


Introduction
The prevalence of burnout among physicians increased in parallel with the COVID-19 pandemic. 1spite disruptions in medical education, studies suggest that burnout among medical students has remained stable in recent years. 2,3We analyzed data from the 2019 to 2021 Association of American Medical Colleges (AAMC) Graduation Questionnaire, which is administered to graduating US medical school students, and data on COVID-19 cases and COVID-19-related deaths in the schools' surrounding communities to explore the association between COVID-19 intensity in the clinical learning environment and student burnout and residency preparedness.

Methods
In this cross-sectional study, we obtained population size and Centers for Disease Control and Prevention-recorded daily COVID-19 cases and COVID-19-related deaths for each medical school location in the US except Puerto Rico (eMethods in Supplement 1).Monthly means for cases and deaths were determined, converted to cases per 100 000 population, and divided into quartiles for 2020 and 2021 (eTable in Supplement 1).Schools were assigned quartiles for cases and deaths in 2020 and 2021.This information was shared with the AAMC, which matched the school quartile to the school of the responder, added demographic data previously provided by respondents, and deidentified the data.Because the data were deidentified, the Mayo Clinic and University of Colorado School of Medicine Institutional Review Boards deemed the study exempt from review and informed consent.We followed the STROBE reporting guideline.
The data set included responder demographics and responses to previously validated emotional exhaustion and disengagement Oldenburg Burnout Inventory (OBI) subscales 4 and residency preparedness scale items (Cronbach α = 0.91).This scale included items about students' perceptions of their skills, knowledge, values, and abilities.Univariate differences were examined using 2-sided Kruskal-Wallis tests with statistical significance set at P < .05.Generalized linear regression models were conducted for 2020 and 2021 for the outcomes of interest and were adjusted for quartile of cases or deaths and age, sex, and race and ethnicity.All comparisons were performed using SAS, version 9.4 (SAS Institute Inc).
Associations were found between quartile of COVID-19 cases and the outcomes of interest.Higher 2020 quartile levels of COVID-19-related deaths in the primary learning environment were associated with small increases in mean disengagement scores and decreases in mean residency preparedness scores (Table 1).These associations persisted in multivariable linear regression analyses (Table 2).

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Table 1 .
Emotional Exhaustion, Disengagement, and Residency Preparedness Scores of Graduating Medical Students by Quartile of COVID-19 Cases and COVID-19-Related Deaths in the Communities Surrounding Their Medical Schools, 2020 and 2021

Table 2 .
Multivariable Linear Regression of Associations Between Exhaustion, Disengagement, and Residency Preparedness Scores of Graduating Medical Students by Quartile of COVID-19 Cases and COVID-19-Related Deaths in the Communities Surrounding Their Medical Schools, 2020 and 2021 a Per 100 000 population.Models were adjusted forsex, age at graduation, and race and ethnicity.For the entire cohort, the mean (SD) age at graduation was 27.7 (2.8) years; 48% were men and 52% were women.In terms of race and ethnicity, 0.7% of students were American Indian or Alaska Native; 25.5% were Asian; 7.1% were Black or African American; 8.5% were Hispanic, Latino, or of Spanish ancestry; 0.3% were Native Hawaiian or Other Pacific Islander; 63.1% were White; and 3.7%% were of other race or ethnicity (percentages exceed 100% because participants could select multiple categories).Race and ethnicity data were included in the data set because previous research has found associations between risk of burnout and medical student demographics. a