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BACKGROUND: Burnout continues to impact health care workers and its effect takes a toll on their lives and wellbeing, especially in primary care. Relatively few studies have focused specifically on the perspective of clinicians in Federally Qualified Health Centers (FQHCs), which offer crucial, preventative health care services to vulnerable and underserved patient populations. OBJECTIVE: To examine the perspectives of clinicians working at an FQHC in the Northeast United States after the implementation of a year-long wellness initiative. DESIGN: A qualitative analysis of clinician's discussion during focus groups conducted after the wellness initiative. SUBJECTS AND SETTING/LOCATION: A total of 28 clinicians (primary care physicians and nurse practitioners) in an FQHC in the Northeast United States. INTERVENTIONS: A one-year wellness initiative with programs and activities designed to bolster wellness. OUTCOME MEASURES: Analyzed NVIVO-coded transcripts of focus group discussion to generate codes and used modified grounded theory to extrapolate meaningful themes. RESULTS: Five key themes emerged from the qualitative analysis: (1) clinicians often felt burdened by their workload and personally responsible when they were not able to provide optimal care to patients; (2) burnout was exacerbated by systemic problems at the FQHC; (3) medical assistants, medical scribes, schedulers, and other support staff played a crucial role in the wellness of the entire team; (4) perceived differences in priorities between administration and health care workers may have contributed to burnout; and (5) a communicative and stable team helped clinicians effectively care for their patients. CONCLUSIONS: Clinician burnout is a complex problem at FQHCs with many root causes. Addressing burnout and improving clinician wellness at FQHCs will require a multifaceted approach encompassing systemic, team, and individual components. The perspectives from the clinicians at our FQHC may inform wellness strategies for other safety net, clinical institutions in the primary care setting.

[This is an excerpt.] We know from the literature that residents experience high rates of burnout, the consequences of which include the erosion of empathy, worse patient outcomes, and threatened professional endurance. In their qualitative study of resident thriving, Hyman and Doolittle attempt to broaden our gaze as researchers of physician well-being beyond a disease model of burnout toward a health model of thriving. Much of the research on resident well-being has relied on unidimensional measures, such as life or work satisfaction or overall quality-of-life scales. This approach leaves gaps in our understanding of physician thriving. [To read more, click View Resource.]

PURPOSE: To identify reasons for burnout, characterize the effect of lifestyle medicine (LM) practice on burnout, and assess the risk of burnout in relation to the proportion of LM practice. DESIGN: Analysis of mixed methods data from a large, cross-sectional survey on LM practice. SETTING: Web-based survey platform. PARTICIPANTS: Members of an LM medical professional society at the time of survey administration. METHODS: Practitioner members of a medical professional society were recruited to a cross-sectional, online survey. Data were collected on LM practice and experiences with burnout. Free-text data were thematically grouped and counted, and the association of burnout with the proportion of lifestyle-based medical practice was analyzed using logistic regression. RESULTS: Of 482 respondents, 58% reported currently feeling burned out, 28% used to feel burned out but no longer do, and 90% reported LM had positively impacted their professional satisfaction. Among LM practitioners surveyed, practicing more LM was associated with a 43% decrease (0.569; 95% CI: 0.384, 0.845; P = 0.0051) in the odds of experiencing burnout. Top reasons for positive impact included professional satisfaction, sense of accomplishment, and meaningfulness (44%); improved patient outcomes and patient satisfaction (26%); enjoyment of teaching/coaching and engaging in relationships (22%); and helps me personally: quality of life and stress (22%). CONCLUSION: Implementing LM as a greater proportion of medical practice was associated with lower likelihood of burnout among LM practitioners. Results suggest that increased feelings of accomplishment due to improved patient outcomes and reduced depersonalization contribute to reduced burnout.

[This is an excerpt.] Nearly every minute in Alberta, paramedics are called to a potential emergency that may require the use of medical and pharmaceutical interventions, as well as a variety of psychosocial skills, to save lives and prevent further illness. Hence, paramedics and the work they do on the streets (in ever-changing and unpredictable environments) and off the streets (in hospitals and other facilities) are central to the provision of health care in Alberta. For many Albertans, paramedics are the first point of contact in the health and social care system in the province. Suffice it to say, paramedics are a key component of this system. Prehospital emergency medical services and the workers central to the system — the paramedics — are in a state of crisis in Alberta. This is evidenced by increased rates of paramedic burnout/moral injury, staff retention issues, increased response times, increased number of code reds/red alerts” (which refers to instances where no ambulances are available for emergency calls for a specific community), and paramedics being “parked”/stuck in emergency departments. While SARS-COV-2 (hereafter COVID-19) and the opioid and overdose crisis (hereafter overdose crisis) have exacerbated the challenges experienced by paramedics in Alberta, the root of the current crisis dates back at least to the amalgamation of emergency medical services in the province in 2009. [To read more, click View Resource.]

[This is an excerpt.] This toolkit offers a blueprint for crafting a well-organized Listening Campaign, provides a framework to prioritize and execute improvement initiatives, and sheds light on strategies to overcome common challenges in engaging leaders and physicians, fostering active involvement in improvement work. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

Research shows that healthcare providers encounter stress in their workplaces whether in a home or a healthcare facility that results in reduced job satisfaction, burnout, and inadequate care of patients. There is a gap in the literature regarding the lived experiences of nurses caring for children in all work settings, including the home care setting, regarding stress and burnout. The lived experiences of pediatric nurses working in home care settings were explored to discover conditions that contribute to their occupational stress and burnout. The occupational stress model with a major focus on the job demands-resources occupational stress model was used to guide the qualitative, transcendental phenomenological study. Data were collected through semistructured interviews with 17 pediatric nurses from a northeaster U.S. state. Results showed that poor condition of homes causes stress and burnout and that patients’ families, uncooperative parents, fear of losing patients, lack of equipment, patient load, and solo decision making all contributed to stress. Long working hours caused burnout. Nurses should be supported to deal with stress, and self-care is critical in the mitigation of stress and burnout. Implications for positive social change including providing information to healthcare administrators that can lead to creating programs that can help eliminate stress and burnout among pediatric home care nurses and hence improve overall patient quality of care.

INTRODUCTION: Emotional intelligence (EI) as a concept is becoming increasingly relevant in the healthcare industry. In order to examine the relationship between EI, burnout, and wellness, we administered these measures quarterly in resident physicians and analyzed the variables in each subset to gain insights and understanding of their relationship. METHODS: In 2017 and 2018, all residents entering the training programs in year one (PGY-1) were administered The Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), The Maslach Burnout Inventory (MBI), and The Physician Wellness Inventory (PWI). The questionnaires were completed quarterly. Statistical analysis included ANOVA and ANCOVA. RESULTS: The overall combined PGY-1 resident year (n = 80) had an EI global trait mean score of 5.47 (SD: 0.59) at the beginning of their first year. The domains of burnout and physician wellness were examined across four different time points during the resident's first year. Domain scores changed significantly over the four time points during the first year. There was a relative 46% increase in exhaustion (P < .001), 48% increase in depersonalization (P < .001), and an 11% decrease in personal achievement (P < .001). Physician wellness domains also changed significantly between time 1 and the end of the year (time 4). There was a relative 12% decrease in career purpose (P < .001), a 30% increase in distress (P < .001), and 6% decrease in cognitive flexibility (P < .001). Each burnout domain and physician wellness domain were highly correlated with emotional quotient (EQ). Emotional quotient was independently assessed with each domain at baseline and with changes overtime. The lowest EQ group reported their distress increased significantly over time (P = .003) and a decline in career purpose (P < .001) and cognitive flexibility (P = .04). The response rate was 100%. CONCLUSION: Emotional intelligence is associated with well-being and burnout in individual residents; therefore, it is important to identify those who require increased support during residency in order to succeed.

INTRODUCTION AND OBJECTIVE: Burnout is a pervasive issue in healthcare, with urology trainees reporting burnout rates as high as 63.8%. Resilience training is a proven tool to prevent burnout and improve performance in high stress working environments, with demonstrated efficacy in surgical residency programs. Enhanced Stress Resilience Training (ESRT) is a mindfulness-based cognitive skills training developed and validated by Dr. Carter Lebares and the UCSF Center for Mindfulness in Surgery. ESRT offers tools to reframe thoughts and promote emotional regulation. The primary goal of this study is to assess feasibility and to introduce a curriculum to expand a pre-existing program focused on wellness and individual skill development. METHODS: Through consultation with Dr. Lebares, we customized course structure to include a didactics presentation and five ESRT sessions taught over Zoom by a certified ESRT instructor, a retired surgeon. We conducted the sessions in place of standard departmental conferences to mitigate personal time used for the training. Baseline descriptive pre and post course data was collected using validated surveys, including the Mental Health Continuum Short Form, Physician Wellbeing Index, and the Connor Davidson Resilience Index, with a subsequent focus group to gain qualitative data on overall course perception. Using two-sample t-tests, we compared differences between and pre and post course responses. RESULTS: There were 33 participants in the course, with 20 residents, 7 faculty, and 6 others (student/APP). Surveys were completed by 30 participants pre course and 15 participants post course, with 15 sets of paired data. There were no statistically significant differences in self-reported wellbeing or stress response after course participation; however, participants were significantly more likely to use meditation as a stress coping mechanism after the course (p=0.008). Qualitative descriptive results demonstrated a 15% increase in participants’ understanding of the impact mindfulness practices have on work performance. CONCLUSIONS: Our program successfully implemented ESRT via a novel remote delivery format. Although our analysis was limited by small sample size, our pilot study highlights feasibility in implementation. This curriculum also showed resident skill development in stress regulation through mindfulness practices. Next steps would include repeat delivery within the program to promote durability, and possible expansion beyond our single program.

INTRODUCTION AND OBJECTIVE: Urology residents have reported greater levels of professional burnout compared to other specialties. Recently, increased awareness of risk factors for burnout and interventions to enhance trainee well-being may have contributed to changes in the prevalence of resident burnout. We aimed to measure burnout and career choice regret in a national sample of urology residents. METHODS: We analyzed residents’ responses to the AUA Census in 2019, 2020, and 2021. We compared urology residents’ responses to the 22-item Maslach Burnout Inventory in 2019 vs 2021, including overall professional burnout and the emotional exhaustion and depersonalization subscales. We also assessed responses to questions about career and specialty choice regret in 2019 vs 2020-2021. RESULTS: Among 415 respondents in 2019 and 166 respondents in 2021, the prevalence of professional burnout was 47% and 48%, respectively. 7% and 10% of residents met criteria for emotional exhaustion, while 47% and 48% of residents met criteria for depersonalization. Burnout symptoms were highest among second-year residents in both cohorts (65% and 69%). In 2019, among the 53% of residents who had ever reconsidered career or specialty choice, a majority (54%) experienced this most frequently during the second year of residency. Similarly, in 2020-2021, among the 51% who had reconsidered career or specialty choice, 57% said it was most frequent during the second year. There was no significant difference between the cohorts in terms of the prevalence of burnout, emotional exhaustion, or depersonalization, or in terms of the frequency of career and specialty choice regret (all p>0.05). Finally, there was no significant gender disparity in either cohort regarding the prevalence of career and specialty choice regret: 58% women vs 50% men in 2019, and 56% women vs 49% men in 2020-2021 (all p>0.05). CONCLUSIONS: In a national sample of urology residents, the prevalence of professional burnout has remained unchanged between 2019 and 2021. Second-year residents appear to be at greatest risk for career and specialty choice regret. Interventions targeting early-career residents may reduce the psychosocial burden of residency on trainees.

In turbulent times like these, it’s natural for people to hold back and avoid taking risks at work. This can mean a reluctance to report mistakes, ask questions, offer new ideas, or challenge a plan. People, whether they’re aware of it or not, try to protect their reputations and jobs. Unfortunately, the same behaviors that feel risky to individual employees are precisely what their companies need in order to thrive in this uncertain economic climate. To solve this dilemma, we encourage leaders to adopt a “winning formula” for achieving a more psychologically safe workplace and the benefits it provides.

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Psychological Safety).

Reach new levels of organizational productivity and achievement by redefining the phrase “workplace health” In Make Work Healthy, a team of distinguished organizational transformation professionals delivers an insightful how-to manual for improving organizational performance with a new approach to workforce management. The book offers organizations, leaders, and managers with the knowledge, data, frameworks, and methodologies they need to radically transform how they approach day-to-day operations into a sustainable and resilient business success model. The authors focus on workplace health—in a broad sense—as a way of focusing organizational attention on culture, building work capacity, productivity, and sustainability. They explain the tangible business value that comes from focusing on wellbeing as well as the symbiotic relationship between organizational health and employee health. Make Work Healthy includes: Strategies for moving beyond typical “wellness” initiatives such as just addressing illness and absence reduction to a more holistic understanding of “healthy work” Ways to locate, attract, recruit, and retain talent over the long-term by aligning organizational goals with employee health Tactics to help managers of dispersed, hybrid, and remote teams manage feelings of pressure and isolationAn indispensable, effective, and holistic new take on organizational and employee health, Make Work Healthy will earn a place in the hands of managers, executives, board members, and other business and human resources leaders who seek impressive gains in company productivity and fulfilment.

OUTCOMES: 1. Describe the components of CASE, a US Department of Veterans Affairs clinical ethics consultation tool and opportunities to resolve ethical dilemmas near end of life. 2. Identify resources and collaborative opportunities for inpatient palliative care and ethics consultation teams caring for dying patients and distressed families and healthcare providers. BACKGROUND: Ethical dilemmas commonly complicate care and comfort near end of life. Family members and providers may especially experience ethical dilemmas when surrogates are required for patients without capacity or known wishes. The US Department of Veterans Affairs (VA) aims to improving ethical quality through its implementation of a standardized approach to ethics consultation based on consistent and systematic use of widely accepted ethical standards and norms and by recruiting consultants from the interdisciplinary team. CASE DESCRIPTION: An 87-year-old hospitalized veteran with low blood pressure and hypoactive delirium was identified as seriously ill and at high risk for imminent death. The cosurrogate daughters reported their mother shared no prior preferences for care near her end of life. Despite early palliative care team involvement, the daughters could not reach treatment decisions and reported their own moral distress. After 10 days, concerned nurses called for an ethics team consultation to “help with patient suffering and family disagreement.” The palliative care team and the ethics team together applied the novel VA ethics consultation model and collaboratively addressed the ethical dilemma, aligned care to maximize comfort, and alleviated staff moral injury. DISCUSSION: We will describe the structure and application of the VA Ethics Consultation Program's CASE approach (clarify, assemble, synthetize, explain, support) as a tool with which palliative care teams may effectively resolve surrogate conflict near a loved one's end of life when no prior preferences are known. Through CASE methodology, including review of substituted judgment/best interest standards and specific negotiating techniques, the ethics and palliative care teams supported successful quality outcomes for the patient, family, staff, and the healthcare system. CONCLUSION: A systematic approach of ethical reasoning, such as CASE, can support interdisciplinary palliative care teams to resolve ethical dilemmas while improving quality outcomes when death is expected and imminent.

INTRODUCTION: A New York State initiative requests that Emergency Department (ED) providers document in the electronic health record (EHR) each admitted patient’s employment status and, if applicable, their mode of commute. This initiative diverts them from their primary duties and increases the likelihood they will either disregard the request or input incorrect information to complete the data fields as fast as possible. This study intends to understand how well providers adhere to this regulation, which, while important for society as a whole, has little clinical relevance, especially in the ED, where the focus is to identify and treat emergent conditions. We hypothesized that clinician-collected employment data would contain many more "N/A" responses than registration-collected employment data (the "gold standard"). METHODS: We took a randomly selected convenience sample of 100 patients admitted from the ED and compared each patient’s provider-entered response to the employment data field to the registration-recorded response. The EHR operates such that the "Employment" field must be completed in order to complete the admission electronically. Data fields collected were: last name, first name, date of birth, medical record number, date and time of arrival, date and time of admission, attending physician, resident physician (if there was one), mid-level provider (if there was one), provider-entered employment status, registration-entered employment status, admitting service (eg, Medicine, Surgery, OB/Gyn), and disposition level (eg, ICU). We assessed the percent of employment data that was concordant between the provider's entry and the registration clerk's entry. We also assessed for the potential confounding variable of how busy the ED was at time of admission, as providers may not take ask about employment or enter such data during particularly busy times. Finally, we interviewed providers to elicit reasons they did not enter accurate data. Statistical significance was set a priori at p <0.05. RESULTS: One hundred six patients were screened; six were excluded because one of the authors (MR) was their attending physician. For 92 of the remaining 100 patients, providers recorded employment as “N/A," and for eight patients they recorded “retired." For seven of these eight patients, provider entry matched registration entry (87.5% concordance). To adjust for whether how busy the ED was may have impacted the accuracy of data entry, admissions were categorized according to what time of day the patient was admitted. There was no statistically significant correlation between how busy the ED was and accuracy of data entry. The majority of providers stated they responded "NA" because the employment information was unrelated to the ED visit. CONCLUSION: In New York, for each patient admitted from the ED, the ED provider is requested to enter the patient's job information and, if they commute to work, the method they use. However, this takes providers' attention away from what they should be doing most: diagnosing and treating patients. This study highlights the unintended consequence of requesting data fields that are not clinically relevant and, from the patient and provider perspective, are not good investments of time and energy and distract from the clinical visit. Persons interpreting such clinically irrelevant data should do so with caution, as the results are unlikely to reflect the truth of what the questions intend to determine.

BACKGROUND: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. OBJECTIVE: The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled conscience among registered nurses (RNs) working in nursing homes. RESEARCH DESIGN: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. ETHICAL CONSIDERATIONS: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. FINDINGS: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. DISCUSSION: Troubled conscience meant experiencing continuous and simmering tension between one's ideals and realities and feeling a drive to preserve accountability and one's moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. CONCLUSION: Nurses' troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state's intentions can be realised within the given framework are important for individual nurses' occupational health as well as the quality of care provided to patients.

INTRODUCTION: EHRs are associated with improved patient outcomes, but the inefficiency of time spent on EHR may contribute to healthcare provider stress, exhaustion and burnout. EHR use associates with higher prevalence of burnout in Neonatal Intensive Care Units (NICUs), but the relationship between EHR use and burnout in other inpatient settings remains unclear. This study sought to identify subjective and objective markers of EHR use associated with provider burnout in the pediatric inpatient setting. METHODS: Attendings, fellows, hospitalists, and nurse practitioners from a quaternary children’s hospital who work primarily in the inpatient setting were included in our study. We collected five months (June-October 2020) of EHR-use and schedule data for these providers. This data was then linked to 2020 annual wellness survey (September-October) data which included a 4-item EHR experience score and the Stanford Professional Fulfillment Index. We evaluated associations using Pearson correlation, lasso regression for variable selection, and mixed effect linear regression. RESULTS: Of 246 eligible providers, 179 (73%) responded to the survey. Average EHR experience score was 2.2±0.8, range 0-4, and average burnout score was 1.1±0.7, range 0-4, with burnout prevalence of 32%. Average number of notes/orders placed was independently associated with the EHR experience scores (coefficient -0.013, p=.04). EHR experience scores were negatively correlated with provider burnout scores (r -0.18, p=.03), but not independently associated after adjustment for work setting and role. EHR task count per patient, division, and role were selected as important predictor variables for burnout via lasso regression. Among these, the Pediatric Intensive Care Unit (PICU) division was independently associated with higher burnout scores (coefficient 0.36, p=.016). None of the EHR use measures were independently associated with burnout. CONCLUSIONS: Burnout is prevalent among inpatient providers, and being a PICU provider was independently associated with burnout. Although routinely collected EHR use measures may associate with negative EHR experience, we did not identify independent associations with burnout among this sample of inpatient pediatric providers. Larger studies are needed to investigate this relationship further.

[This is an excerpt.] Moral distress is indeed distressing for those who experience it and whose sense of integrity can be shaken by exposure to events or situations that test their core values and ethical belief systems. But the meaning of this term—both from a conceptual and an empirical perspective—continues to be a source of contention. [To read more, click View Resource.]

Medicaid is characterized by low rates of provider participation, often attributed to reimbursement rates below those of commercial insurance or Medicare. Understanding the extent to which Medicaid reimbursement for mental health services varies across states may help illuminate one lever for increasing Medicaid participation among psychiatrists. We used publicly available Medicaid fee-for-service schedules from state Medicaid agency websites in 2022 to construct two indices for a common set of mental health services provided by psychiatrists: a Medicaid-to-Medicare index to benchmark each state’s Medicaid reimbursement with that of Medicare for the same set of services, and a state-to-national Medicaid index comparing each state’s Medicaid reimbursement with an enrollment-weighted national average. On average, Medicaid paid psychiatrists at 81.0 percent of Medicare rates, and a majority of states had a Medicaid-to-Medicare index that was less than 1.0 (median, 0.76). State-to-national Medicaid indices for psychiatrists’ mental health services ranged from 0.46 (Pennsylvania) to 2.34 (Nebraska) but did not correlate with the supply of Medicaid-participating psychiatrists. As policy makers look to reimbursement rates as one strategy to address ongoing mental health workforce shortages, comparing Medicaid payment across states may help benchmark ongoing state and federal proposals.

INTRODUCTION: Medical education research often focuses on measuring negative mental states like burnout, rather than focusing on positive states like well-being. Flourishing – a state that includes domains of happiness and mental health - is a way of thinking about well-being that may be relevant to education and research. The purpose of this prospective, observational study was to compare the relationship among flourishing, other well-being measures, and burnout in medical students via a survey administered at two time points. METHODS: We surveyed medical students at one U.S. institution about their flourishing, satisfaction with work-life balance, quality of life, empathic concern, and burnout (emotional exhaustion and depersonalization) before and after the onset of the COVID-19 pandemic. Flourishing was measured using two scores, the Flourish Index (FI) and Secure Flourish Index (SFI), with higher scores indicating greater flourishing. Pre- and post-scores for both measures were compared. RESULTS: 107/585 (18%) medical students responded to the survey and 78/107 (73%) participated in the post survey. At the first time point, respondents reported both a mean FI and SFI 6.7 (SD=1.3); higher levels of flourishing correlated with higher satisfaction with work-life balance (p<.001), higher quality of life (p<.001), and lower levels of burnout (emotional exhaustion p<.001; depersonalization p=.021). SFI scores were higher at the second time point (M=7.1, SD=1.2) than the first (M=6.7, SD=1.3, p=.026). FI, satisfaction with work-life balance, quality of life, empathic concern, and burnout were unchanged at the second time point. DISCUSSION: Like past findings in medical residents, we found medical students’ flourishing—as measured by FI and SFI scores—correlated with greater satisfaction with work-life balance, higher quality of life, and lower burnout. In this limited sample, we found flourishing remained largely unchanged after the COVID-19 pandemic onset.

Healthcare workers (HCWs) witnessed firsthand the detrimental effects of the COVID-19 pandemic as they worked tirelessly to slow the spread of disease and protect communities. Those on the frontline were confronted with a high risk for infection, lack of appropriate protective equipment and medical supplies, unprecedented exposure to death, inadequate emotional support, isolation from their families because of fear of viral transmission, and an unrelenting workload. Thus, it is unsurprising that COVID-19 jeopardized the mental health of HCWs beyond that of the general public across the globe. A plethora of data showed that more than one in five HCWs reported high levels of depression, anxiety, or traumatic stress/posttraumatic stress disorder, while at least two in five experienced significant sleep disturbances. Of particular concern, burnout levels, substance misuse, and suicidal behavior also increased among the workforce compared with prepandemic levels. In addition, a variety of sociodemographic, occupational, and circumstantial risk factors, such as younger age, female sex, risk for infection, mental health history, and low social support intensified these adverse psychological outcomes. By identifying trends and variables that exacerbated the impact on the mental health of HCWs, interventions and strategies can be developed at the local, regional, national, and international level.

Student mental health concerns can manifest in several forms. Medical students juggling a multitude of trials (i.e., intense academic rigor, financial debt, sleep deprivation, lack of control, continual exposure to sickness and death, and training mistreatment) can help explain the higher prevalence of psychological disorders within this population. Furthermore, these mental health difficulties are not static; certain challenges move into the forefront as students face key transition points in schooling. Primary examples include the entry year of medical school, the shift from preclinical curriculum to clinical training, and the final moments prior to beginning residency. Given the existing mental health trends among medical students at baseline, it can be concluded that the COVID-19 pandemic has exacerbated the stress, anxiety, and depression associated with medical education. Solutions do indeed exist to address the moral injury medical students face, from expanded crisis management training and implementation of peer support networks to destigmatization of and improved access to professional mental health resources. It is up to the curators of the medical education system to make these solutions the new status quo.