Third-year dermatology resident anxiety in the era of COVID-19

To the Editor: The coronavirus disease 2019 (COVID-19) pandemic has quickly become a generational health crisis that has abruptly altered many aspects of life across the world. Health care professionals, such as residents across various medical specialties, are facing rapidly evolving practice and educational environments, all while coping with the emotional stressors shared by the general public from the monumental changes to society.^{1 , 2} Understanding the sources of anxiety in our trainees is crucial as organizational leaders work to support the professionals caring for patients.

To help address and better assess some of these issues, we hosted a live webinar with dermatology program directors and chief residents across the United States specifically on resident concerns during the pandemic.³ Topics ranged from the board certification examination to treating nonemergent dermatologic conditions in clinics. Polling questions were used to capture data with the aim to assess which pandemic-related adjustments are most distressing dermatology residents.

Participants were asked about their planned date for the 2020 Initial Certification Exam, the level of anxiety about the timing and manner of the board examinations recently announced by the American Board of Dermatology,⁴ the level of anxiety regarding redeployment to nondermatology medical services, such as the emergency department and COVID-19 units, and the perceived impact of COVID-19 on employment after graduation.

Of the 198 residents participating in the webinar, 60 responded they were third-year residents. The response rate varied between the 4 questions, ranging from 70% to 95%. Most (74%) of the third-year dermatology residents plan to take the board examination in July 2020 (Fig 1 ), and 84% report a “high” or an “extremely high” level of anxiety about the logistical details (Fig 2 ). Most respondents reported high to extremely high levels of anxiety relating to redeployment and employment after graduation, with only 12% and 6% of the polled residents noting “not at all” or “low” worry, respectively (Fig 2). Extrapolating from these data may be difficult due to the inherent selection bias in webinar attendance and the small proportion of third-year dermatology residents captured. We suspect, however, that the angst surrounding these hot topics is under-reported.

Fig 1.

Anticipated date of the initial certification examination.

Fig 2.

Anxiety reported by senior dermatology residents.

The discussion of nationwide organizational decisions and our sampling of third-year resident perspectives reflect the need for further data-driven investigation into trainee apprehension. Despite the limitations of this study, our findings illustrate compelling levels of anxiety among third-year dermatology residents about their certification, clinical practice, and careers. Formal efforts to hear directly from residents and program directors who represent the national pulse of thought are fundamental for institutional leaders to make informed decisions about patient care and resident education that best support the health care providers of the future.