The current research joins previous studies in examining post-traumatic stress disorder (PTSD) and burnout among healthcare workers. The research focuses on the experiences of pediatric residents working in an emergency department both in normal times and during the Covid pandemic. Research conducted prior to and during the Covid pandemic outbreak shows negative psychological effects among healthcare workers. Most of that research was conducted within the positivistic-quantitative paradigm. The current study is qualitative and focuses on pediatric residents who provide medical services to a unique population in a peripheral region of Israel, namely the Bedouin-Arab population. The research questions are the following: What characterizes pediatric residents’ work, in general and during the pandemic? Do they show signs of burnout and secondary trauma? How do they perceive their work with the Bedouin-Arab population, especially during the pandemic? The study, conducted within the phenomenological genre, included 14 pediatric residents in a large hospital in Israel’s periphery. Semi-structured clinical interviews were employed, in addition to questionnaires that examined PTSD and burnout to enhance the reliability of the findings. The results show that all residents reported stressful incidents in which patients’ physical integrity was threatened. The residents described the special nature of the medical cases they treated in routine times and during the pandemic outbreak, which stems mostly from the specific characteristics the population of Israel’s periphery. While at the early stages of the pandemic, the residents experienced reduced work pressure, they reported substantial difficulties later in the crisis, which intensified their sense of physical and emotional stress. Most residents reported feeling inadequately prepared for dealing with traumatic events. According to the results, most residents displayed secondary trauma (12 participants in interviews and 11 in questionnaires), which can be classified into categories based on the DSM-5. In the interviews, all 14 participants reported various signs of burnout. The questionnaires indicated burnout symptoms among 10 participants. Giving a voice to pediatric residents, the study highlights the complexity of their routine work as well as their role during the Covid crisis. Based on the findings, recommendations have been made for policymakers. The study highlights the importance of raising awareness to the implications of the residents’ rough work conditions in routine and emergency times and to the need
References
[1]
Davidovitch, N., Levi, B. and Arazi, R. (2021) The Health Workforce in Israel During the Covid-19 Pandemic: An Overview. Taub Center for Social Policy Studies in Israel, Jerusalem. https://www.taubcenter.org.il/wp-content/uploads/2021/12/Health-Overview-ENG-2021.pdf
[2]
Martini, S., Arfken, C., Churchill, A. and Balon, R. (2004) Burnout Comparison among Residents in Different Medical Specialties. Academic Psychiatry, 28, 240-242. https://doi.org/10.1176/appi.ap.28.3.240
[3]
Prasad, K., McLoughlin, C., Stillman, M., Poplau, S., Goelz, E., Taylor, S., Nankivil, N., Brown, R., Linzer, M., Cappelucci, K., Barbouche, M. and Sinsky, C.A. (2021) Prevalence and Correlates of Stress and Burnout among U.S. Healthcare Workers during the COVID-19 Pandemic: A National Cross-Sectional Survey Study. E Clinical Medicine, 16, Article ID: 100879. https://doi.org/10.1016/j.eclinm.2021.100879
[4]
Zafar, W., Khan, U.R., Siddiqui, S.A., Jamali, S. and Razzak, J.A. (2016) Workplace Violence and Self-Reported Psychological Health: Coping with Post-Traumatic Stress, Mental Distress, and Burnout among Physicians Working in the Emergency Departments Compared to Other Specialties in Pakistan. The Journal of Emergency Medicine, 50, 167-177. https://doi.org/10.1016/j.jemermed.2015.02.049
[5]
Creese, J., Byrne, J.-P., Conway, E., Barrett, E., Prihodova, L. and Humphries, N. (2021) “We All Really Need to Just Take a Breath”: Composite Narratives of Hospital Doctors’ Well-Being during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 18, Article 2051. https://doi.org/10.3390/ijerph18042051
[6]
Ey, S., Soller, M. and Moffit, M. (2020) Protecting the Well-Being of Medical Residents and Faculty Physicians during the COVID-19 Pandemic: Making the Case for Accessible, Comprehensive Wellness Resources. Global Advances in Health and Medicine, 9. https://doi.org/10.1177/2164956120973981
[7]
Chew, Q.H., Chia, F.L., Ng, W.K., Lee, W.C.I., Tan, P.L.L., Wong, C.S., Puah, S.H., Shelat, V.G., Seah, E.D., Huey, C.W.T., Phua, E.J. and Sim, K. (2020) Perceived Stress, Stigma, Traumatic Stress Levels and Coping Responses amongst Residents in Training across Multiple Specialties during COVID-19 Pandemic: A Longitudinal Study. International Journal of Environmental Research and Public Health, 17, Article 6572. https://doi.org/10.3390/ijerph17186572
[8]
Li, Y., Scherer, N., Felix, L. and Kuper, H. (2021) Prevalence of Depression, Anxiety and Post-Traumatic Stress Disorder in Health Care Workers during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. PLOS ONE, 16, e0246454. https://doi.org/10.1371/journal.pone.0246454
[9]
Dimitriu, C.T.M., Pantea-Stoian, A., Smaranda, A.C., Nica, A.A., Carap, A.C., Constantin, V.D., Davitoiu, A.M., Cirstoveanu, C., Bacalbasa, N., Bratu, O.G., Jacota-Alexe, F., Badiu, C.D., Smarandache, C.G. and Socea, B. (2020) Burnout Syndrome in Romanian Medical Residents in Time of the COVID-19 Pandemic. Medical Hypothesis, 144, Article ID: 109972. https://doi.org/10.1016/j.mehy.2020.109972
[10]
Swirski, S., Konor-Attias, E. and Lieberman, A. (2018) Israel: A Social Report-2017. https://adva.org/wp-content/uploads/2018/07/social-2017-ENG.pdf
[11]
Naimer, S., Press, Y., Weissman, C., Zisk-Rony, R.Y., Weiss, Y.G. and Tandeter, H. (2018) Medical Students’ Perceptions of a Career in Family Medicine. Israel Journal of Health Policy Research, 7, Article No. 1. https://doi.org/10.1186/s13584-017-0193-9
[12]
Israeli Ministry of Health (2016) Health Inequity and Dealing with It. https://www.health.gov.il/publicationsfiles/inequality-2016.pdf
[13]
Almasi, O. and Weissblei, E. (2020) The Bedouin Population in the Negev: A Selection of Data. Knesset Israel, Jerusalem. https://fs.knesset.gov.il/globaldocs/MMM/1b42e9c5-70e0-ea11-8107-00155d0aee38/2_1b42e9c5-70e0-ea11-8107-00155d0aee38_11_16417.pdf
[14]
Strosberg, N., Naon, D. and Ziv, A. (2008) Special-Needs Children in the Bedouin Population of the Negev: Characteristics, Patterns of Service Use, and the Impact of Caring for the Children on the Mothers. Myers JDC Brookdale, Jerusalem. https://brookdale.jdc.org.il/wp-content/uploads/2018/01/503-08-BedouinChildren-REP-HEB.pdf
[15]
Weissman, C., Zisk-Rony, R.Y., Avidan, A., Elchalal, U. and Tandeter, H. (2018) Challenges to the Israeli Healthcare System: Attracting Medical Students to Primary Care and to the Periphery. Israel Journal of Health Policy Research, 7, Article No. 28. https://doi.org/10.1186/s13584-018-0218-z
[16]
Zoorob, D., Shah, S., La Saevig, D., Murphy, C., Aouthmany, A. and Brickman, K. (2021) Insight into Resident Burnout, Mental Wellness, and Coping Mechanisms Early in the COVID-19 Pandemic. PLOS ONE, 16, e0250104. https://doi.org/10.1371/journal.pone.0250104
[17]
Montagna, E., Donohoe, J., Zaia, V., Duggan, E., O’Leary, P. and Waddington, J. (2021) Transition to Clinical Practice during the COVID-19 Pandemic: A Qualitative Study of Young Doctors’ Experiences in Brazil and Ireland. BMJ Open, 11, e053423. https://doi.org/10.1136/bmjopen-2021-053423
[18]
Daphna-Tekoah, S., Megadasi Brikman, T., Scheier, E. and Balla, U. (2020) Listening to Hospital Personnel’s Narratives during the COVID-19 Outbreak. International Journal of Environmental Research and Public Health, 17, Article 6413. https://doi.org/10.3390/ijerph17176413
[19]
Creese, J., Byrne, J.-P., Matthews, A., McDermott, A.M., Conway, E. and Humphries, N. (2021) “I Feel I Have No Voice”: Hospital Doctors’ Workplace Silence in Ireland. Journal of Health Organization and Management, 35, 178-194. https://doi.org/10.1108/JHOM-08-2020-0353
[20]
Turner, S., Botero-Tovar, N., Herrera, M.A., Borda Kuhlmann, J.P., Ortiz, F., Ramírez, J.C. and Maldonado, L.F. (2021) Systematic Review of Experiences and Perceptions of Key Actors and Organizations at Multiple Levels within Health Systems Internationally in Responding to COVID-19. Implementation Science, 16, Article No. 50. https://doi.org/10.1186/s13012-021-01114-2
[21]
Kolehmainen, C., Stahr, A., Kaatz, A., Brennan, M., Vogelman, B., Cook, J. and Carnes, M. (2015) Post-Code PTSD Symptoms in Internal Medicine Residents Who Participate in Cardiopulmonary Resuscitation Events: A Mixed Methods Study. Journal of Graduate Medicine Education, 7, 475-479. https://doi.org/10.4300/JGME-D-14-00424.1
[22]
He, K., Stolarski, A., Whang, E. and Kristo, G. (2020) Addressing General Surgery Residents’ Concerns in the Early Phase of the COVID-19 Pandemic. Journal of Surgical Education, 77, 735-738. https://doi.org/10.1016/j.jsurg.2020.04.003
[23]
Navinés, R., Olivé, V., Fonseca, F. and Martín-Santos, R. (2021) Work Stress and Resident Burnout, before and during the COVID-19 Pandemic: An Up-Date. Medicina Clínica (Barc), 157, 130-140. https://doi.org/10.1016/j.medcli.2021.04.003
[24]
Jackson, T., Provencio, A., Bentley-Kumar, K., Pearcy, C., Cook, T., McLean, K., Morgan, J., Haque, Y., Agrawal, V., Bankhead-Kendall, B., Taubman, K. and Truitt, M.S. (2017) PTSD and Surgical Residents: Everybody Hurts… Sometimes. The American Journal of Surgery, 214, 1125-1126. https://doi.org/10.1016/j.amjsurg.2017.10.014
[25]
Rodrigues, H., Ney Cobucci, R., Oliveira, A., Carbral, J.V., Medeiros, L., Gurgel, K., Souza, T. and Gonçalves, A.K. (2018) Burnout Syndrome among Medical Residents: A Systematic Review and Meta-Analysis. PLOS ONE, 13, e0206840. https://doi.org/10.1371/journal.pone.0206840
[26]
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. https://doi.org/10.1176/appi.books.9780890425596
[27]
National Collaborating Center for Mental Health (UK) (2005) Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. Gaskell, Leicester, UK.
[28]
Figley, C.R. (1999) Compassion Fatigue: Toward a New Understanding of the Cost of Caring. In: Stamm, B.H., Ed., Secondary Traumatic Stress, Sidran Institute, Towson, MD, 3-28.
[29]
Argentero, P. and Setti, I. (2011) Engagement and Vicarious Traumatization in Rescue Workers. International Archives of Occupational and Environmental Health, 84, 67-75. https://doi.org/10.1007/s00420-010-0601-8
[30]
Kleim, B. and Westphal, M. (2011) Mental Health in First Responders: A Review and Recommendation for Prevention and Intervention Strategies. Traumatology, 17, 17-24. https://psycnet.apa.org/doi/10.1177/1534765611429079 https://doi.org/10.1177/1534765611429079
[31]
Greinacher, A., Derezza-Greeven, C., Herzog, W. and Nikendei, C. (2019) Secondary Traumatization in First Responders: A Systematic Review. European Journal of Psychotraumatology, 10, Article ID: 1562840. https://doi.org/10.1080/20008198.2018.1562840
[32]
Mealer, M., Burnham, E.L., Goode, C.J., Rothbaum, B. and Moss, M. (2009) The Prevalence and Impact of Post-Traumatic Stress Disorder and Burnout Syndrome in Nurses. Depression and Anxiety, 26, 1118-1126. https://doi.org/10.1002/da.20631
[33]
Maslach, C., Schaufeli, W.B. and Leiter, M.P. (2001) Job Burnout. Annual Review of Psychology, 52, 397-422. https://doi.org/10.1146/annurev.psych.52.1.397
[34]
Chetlen A.L., Chan T.L. and Ballard D.H. (2019) Adressing Burnout in Radiologists. Academic Radiology, 26, 526-533. https://doi.org/10.1016/j.acra.2018.07.001
[35]
Wilson, J.M., Lee, J. and Shook, N.J. (2021) COVID-19 Worries and Mental Health: The Moderating Effect of Age. Aging & Mental Health, 25, 1289-1296. https://doi.org/10.1080/13607863.2020.1856778
[36]
Levkovich, I. and Shinan-Altman, S. (2021) Impact of the COVID-19 Pandemic on Stress and Emotional Reactions in Israel: A Mixed-Methods Study. International Health, 13, 358-366. https://doi.org/10.1093/inthealth/ihaa081
[37]
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T. and Li, R. (2020) Factors Associated with Mental Health Outcomes among Health Care Workers Exposed to Coronavirus Disease. JAMA, Netw Open, 3, 1-12. https://doi.org/10.1001/jamanetworkopen.2020.3976
[38]
Shanafelt, T., Ripp, J. and Trockel, N. (2020) Understanding and Addressing Sources of Anxiety among Health Care Professionals during the COVID-19 Pandemic. JAMA, 323, 2133-2134. https://psycnet.apa.org/doi/10.1001/jama.2020.5893 https://doi.org/10.1001/jama.2020.5893
[39]
Wu, P., Fang, Y. and Guan, Z. (2009) The Psychological Impact of the SARS Epidemic on Hospital Employees in China: Exposure, Risk Perception, and Altruistic Acceptance of Risk. The Canadian Journal of Psychiatry, 54, 302-311. https://doi.org/10.1177/070674370905400504
[40]
Espinosa-Guerra, E.A., Rodríguez-Barría, E.R., Donnelly, C.A. and Carrera, J.-P. (2021) Prevalence and Associated Factors with Mental Health Outcomes among Interns and Residents Physicians during COVID-19 Epidemic in Panama: A Cross-Sectional Study. Medrxiv, The Reprint Server for Health Sciences. https://doi.org/10.1101/2021.03.26.21254435
[41]
Abu-Bader, S. and Gottlieb, D. (2009) Poverty, Education and Employment in the Arab-Bedouin Society: A Comparative View. National Insurance Institute Research Fund, Jerusalem, Israel.
[42]
Creswell, J.W. and Poth, C.N. (2018) Qualitative Inquiry Research Design: Choosing among Five Approaches. Sage, Thousand Oaks.
[43]
Plakht, Y., Tailakh, M.A., Barabi, T. and Shiyovich, A. (2012) Ethnic Disparities in Emergency Department Utilization Patterns in Southern Israel: A Population-Based Study. Internal and Emergency Medicine, 7, 547-555. https://doi.org/10.1007/s11739-012-0835-4
[44]
Haklai, Z., Liphshiz, I., Aburbeh, M., Applbaum, Y., Goldberger, N., Gordon, E.-S. and Mostovoy, D. (2020) Emergency Room Visits 2017. State of Israel, Ministry of Health, Jerusalem. https://www.health.gov.il/PublicationsFiles/emergency_2019.pdf
[45]
Israel Ministry of Health (2021) PTSD Checklist for DSM-5 (PCL-5). https://www.health.gov.il/Services/Committee/psychologists_council/Documents/PCL-5_info.pdf
[46]
Weitkamp, K., Daniels, J.K. and Klasen, F. (2014) Psychometric Properties of the Questionnaire for Secondary Traumatization. European Journal of Psychotraumatology, 5, Article ID: 21875. https://doi.org/10.3402/ejpt.v5.21875
[47]
Bride, B.E. (2007) Prevalence of Secondary Traumatic Stress among Social Workers. Social Work, 52, 63-70. https://doi.org/10.1093/sw/52.1.63
[48]
Bride, B.E., Robinson, M.M., Yegidis, B. and Figley, C.R. (2004) Development and Validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14, 27-35. https://doi.org/10.1177/1049731503254106
[49]
Lundgren-Nilsson, Å., Jonsdottir, I.H., Pallant, J. and Ahlborg, G. (2012) Internal Construct Validity of the Shirom-Melamed Burnout Questionnaire (SMBQ). BMC Public Health, 12, Article No. 1. https://doi.org/10.1186/1471-2458-12-1
[50]
Gerber, M., Colledge, F., Mücke, M., Schilling, R., Brand, S. and Ludyga, S. (2018) Psychometric Properties of the Shirom-Melamed Burnout Measure (SMBM) among Adolescents: Results from Three Cross-Sectional Studies. BMC Psychiatry, 18, Article No. 266. https://doi.org/10.1186/s12888-018-1841-5
[51]
Melamed, S., Shirom, A., Toker, S. and Shapira, I. (2006) Burnout and Risk of Type 2 Diabetes: A Prospective Study of Apparently Healthy Employed Persons. Psychosomatic Medicine, 68, 863-869. https://doi.org/10.1097/01.psy.0000242860.24009.f0
[52]
Grossi, G., Perski, A., Evengård, B., Blomkvist, V. and Orth-Gomér, K. (2003) Physiological Correlates of Burnout among Women. Journal of Psychosomatic Research, 55, 309-316. https://doi.org/10.1016/S0022-3999(02)00633-5
[53]
d’Ettorre, G., Ceccarelli, G., Santinelli, L., Vassalini, P., Innocenti, G.P., Alessandri, F., Koukopoulos, A.E., Russo, A., d’Ettorre, G. and Tarsitani, L. (2021) Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. International Journal of Environmental Research and Public Health, 18, Article 601. https://doi.org/10.3390/ijerph18020601
[54]
Barilan, A., Haimov, T., Doplet, K., Matnick, S., Vinker, S. and Kitai, E. (2011) Workload, Burnout and Need to Recover among Female Residents in Internal Medicine and Family Medicine. Harefuahh, 150, 625-629.
[55]
Dewa, C.S., Loong, D., Bonato, S., Lucy Trojanowski, L. and Rea, M. (2017) The Relationship between Resident Burnout and Safety-Related and Acceptability-Related Quality of Healthcare: A Systematic Literature Review. BMC Medical Education, 17, Article No. 195. https://doi.org/10.1186/s12909-017-1040-y
Sagi, D., Pessach-Gelblum, L., Divon-Ophir, O., Rubinstein, R., Laufer, S., Sela, R. and Ziv, A. (2019) Simulation as a Training and Assessment Tool for Competency Based Medical Education: A Regulatory Challenge. Harefuah, 158, 674-679.
[58]
Patel, S.M., Miller, C.R., Schiavi, A., Toy, S. and Schwengel, D.S. (2020) The Sim Must Go On: Adapting Resident Education to the COVID-19 Pandemic Using Telesimulation. Advances in Simulations, 5, Article No. 26. https://doi.org/10.1186/s41077-020-00146-w
[59]
Ryan, R.M. and Deci, E.L. (2017) Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. Guilford, New York. https://doi.org/10.1521/978.14625/28806
[60]
Kennett, P. and Lomas, T. (2015) Making Meaning through Mentoring: Mentors Finding Fulfilment at Work through Self-Determination and Self-Reflection. International Journal of Evidence Based Coaching and Mentoring, 13, 29-44.
[61]
Kalaitzaki, A. and Rovithis, M. (2021) Secondary Traumatic Stress and Vicarious Posttraumatic Growth in Healthcare Workers during the First COVID-19 Lockdown in Greece: The Role of Resilience and Coping Strategies. Psychiatriki, 32, 19-25. https://doi.org/10.22365/jpsych.2021.001
[62]
Calhoun, L.G., Cann, A. and Tedeschi, R.G. (2010) The Posttraumatic Growth Model: Socio-Cultural Considerations. In: Weiss, T. and Bergern R., Eds., Posttraumatic Growth and Culturally Competent Practice: Lessons Learned from around the Globe. Wiley, Hoboken, 1-14. https://doi.org/10.1002/9781118270028.ch1
