Medical education in Canada underwent rapid and unforeseen changes in March 2020, due to the COVID-19 pandemic.1 A transition to online alternatives for medical education was observed. Disciplines that heavily use procedural skills, including anesthesiology, have been the most affected.2 The literature has shown that the COVID-19 pandemic has impacted the mental health of frontline healthcare workers.3 Anesthesiologists and anesthesia residents have been deeply involved in airway management and perioperative and intensive care unit care for COVID-19 patients. Nevertheless, the impact on anesthesia residents during the pandemic have not yet been studied in Canada. We conducted this survey to determine the educational, clinical, and psychological impacts of the COVID-19 pandemic on Canadian anesthesia residents.

Approval was obtained from the Mount Sinai Hospital Research Ethics Board (REB 21-0190-E - September 2021). An 18-question survey was developed based on a literature review and the input of the investigators (Electronic Supplementary Material eAppendix). The questionnaire was pretested to guarantee understandability and usability. The target population was third-, fourth-, and fifth-year trainees from the 17 Canadian anesthesiology residency programs; first- and second-year trainees were not included because these individuals were not in residency before the pandemic. Based on the CAPER (Canadian Post-MD Education Registry) Census of Post-MD Trainees in Canada, our estimated target population was 360 participants. The residents were contacted through their program directors (PDs). An e-mail was sent to the PDs explaining the survey and asking them to disseminate it to their residents. Two subsequent reminder e-mails within a three-week interval were sent. The survey was hosted on the online survey instrument SimpleSurvey (Montreal, QC, Canada [a division of OutSideSoft Solutions Inc.]; available at URL: https://simplesurvey.com [accessed November 2022]) from October to December 2021. Respondents signed an online consent form. Responses were anonymized and confidential. Statistical analysis was descriptive (Microsoft Excel, Microsoft Corporation, Redmond, WA, USA).

One hundred and four residents participated, and 79 completed the questionnaire (22%, 79/360) from 13 different residency programs. Of the residents, 58% (46/79) estimated a reduction in their procedure volumes, 95% (75/79) reported a decrease of in-person virtual educational activities, and 99% (78/79) reported an increase in virtual educational activities. Sixty-one percent (48/79) described a decrease in the overall number of educational activities. Despite 71% (56/79) of respondents alleging that their programs initially showed poor ability to support virtual activities, 99% (78/79) reported improvements later. Of the respondents, 76% (60/79) described a significant level of anxiety at the workplace, and 34% (27/79) related increased consumption of psychoactive substances, such as anxiolytics, alcohol, tobacco, coffee, and marijuana. Nevertheless, only 10% (8/79) sought professional assistance. Regarding how programs monitored wellbeing, 15% (12/79) of the residents alleged they were actively monitored, 68% (54/79) indirectly, and 17% (13/79) not at all. Sixty-seven percent (53/79) of the residents believed the COVID-19 pandemic negatively affected their training. Nevertheless, 64% (50/79) felt the quality of supervision and teaching was similar to before, and 70% (55/79) felt their future career would not be affected by the pandemic (Table). Our results showed that the COVID-19 pandemic had a negative educational, clinical, and psychological impact on Canadian anesthesia residents.

This study has limitations. It is a survey, which inherently contains the risk of respondent bias. In addition, the response rate was low at 22%. This low response rate was possibly caused by the lack of incentive to respond and emotional fatigue due to pandemic stress, which may have led to “survey fatigue.” An expansion of virtual learning was observed, which might be considered a positive “collateral effect” of the pandemic. Even though the superiority of conventional learning cannot be denied in some situations (i.e., clinical training, hands-on practice), we suggest a hybrid learning system should be used moving forward. Our data suggest that Canadian anesthesia programs only partially addressed the issue of the pandemic’s psychological impact on residents. Options to improve the response on this matter would include frequent proactive communication with residents regarding accessible resources to support mental health and creating safe spaces where concerns can be shared and validated.4,5