The Perceived Influence of the COVID-19 Pandemic on the Medical Education of Residents in 2021 and 2022 Open Access

The consequences of the COVID-19 pandemic for the medical community have been investigated in various studies.^1-10  Yet, working and educational conditions for medical residents (herein referring to junior doctors undertaking postgraduate medical training) were changing rapidly within the COVID-19 pandemic, even from 2021 to 2022. There is a lack of studies on the consequences of the pandemic over time and across different medical disciplines.

Although the working conditions of the medical staff were already known to be difficult (eg, contributing to high burnout rates),¹¹  the sudden disturbance of the COVID-19 pandemic had a massive effect on the daily life of health care workers.^12,13  Aside from the loss of their habitual routines,²  additional clinical demands, social distancing, and concern for their own personal health/safety,⁶  medical residents also had to face feelings of isolation⁵  as well as the shift to digital teaching and education.^1,2,6,14  These changes resulted in feelings of grief,²  resignation, and anxiety, alongside with worries about the loss of hands-on experience and their future careers.^4,8  These worries seem to be justified since learning opportunities³  did decline, and remote learning may be less effective.^3,9  Residents reported a decreased motivation/concentration as a consequence of the restrictions imposed on their educational training.⁵ 

Aside from its negative consequences, the COVID-19 pandemic has also led people in the medical community to feel positive emotions, such as relief.²  Research has revealed that the COVID-19 pandemic was sometimes seen as a formal excuse to slow down, and many were fond of the autonomy and the benefits brought by digital teaching and meetings.^1,2,6  In Switzerland, residents have the opportunity to work part-time (ie, they can negotiate to work less than 95% per contract). Part-time working among the medical community is rare but is becoming more popular in Switzerland. Approximately 16% of the physicians working in Swiss hospitals work part-time. Part-time work could theoretically have protected residents against COVID-19 pandemic effects because the organization of the education (time and duration) allows for more flexibility (eg, time frames for completing educational requirements are longer).

There are concerns about whether residents had received enough exposure in specific specialties during the height of the pandemic, and whether the effects of the pandemic led to lower examination performances or reduced preparedness for autonomous practice.¹⁵  Though many studies have analyzed the influence of the COVID-19 pandemic, there is a lack of data on its consequences^16,17  or on whether the detrimental impact of the pandemic has diminished completely.¹⁸  Knowledge about the long-term consequences of the COVID-19 pandemic, such as delays or extension in education or competency development, is essential for the organization of the medical education system, for the continuous provision of medical treatments and care for the population, and to meet national demand. It is therefore important to study the consequences of the COVID-19 pandemic on the medical education system more thoroughly over time. An examination across the different medical disciplines, as well as in terms of residents’ work status (ie, part- vs full-time) appears necessary.

The data were collected in summer 2021 and 2022 as part of the annual quality assessment of institutions delivering postgraduate medical education in Switzerland.¹⁹  The questions were developed by the Swiss Federal Institute of Technology (ETH) and the Swiss Institute for Medical Education.

In both years, approximately 12 000 residents from Switzerland received a hard-copy questionnaire¹⁹  from their supervisors. Residents returned the completed questionnaires to the ETH anonymously via mail. The full methods are described elsewhere.¹⁹ 

To assess the influence of the COVID-19 pandemic, we used the following items in both years: General negative influence of the COVID-19 pandemic was assessed with a 5-point bipolar item and had the following wording: “The COVID-19 pandemic affected my education… (5=very negatively, 1=very positively).” For the assessment of “reduction of time for education/training” we included the item: “During the course of the pandemic the available time for my education… (5=decreased a lot, 1=increased a lot).” The “impairment of education” was assessed with the item: “The teaching of education content has been impaired by the pandemic (eg, due to digital teaching),” using a 4-point response scale (1=does not apply, 4=applies completely).

We used 1-sample t tests against the scale mean to analyze the residents’ opinion regarding the influence of the pandemic and unpaired t tests for the comparison across time, as well as for detecting potential differences between part-time and full-time working residents. Additionally, t tests were conducted for investigating the effects separately for the different specialties.

Ethical approval for this research was given by the ethics committee from the ETH Zürich (EK-2021-N-93-A).

The overall response rate for both years was 70% (2021=8496 of 12 137 total residents and 2022=8823 of 12 604). Our analyses for 2021 are based on N₂₀₂₁=8496 postgraduate medical residents (3643 male and 4794 female residents; 104 selected other response options). Regarding 2022, we had a sample of N₂₀₂₂= 8823 residents (3792 males and 4929 females; 102 selected other response options). The majority of residents (>85%, in 2021: 7389 of 8487 and in 2022: 7465 of 8731) reported working full-time in both years and around 15% (in 2021: 1098 of 8496 and in 2022: 1266 of 8731) reported working part-time (ie, residents reporting to work less than 95%). The number of residents per discipline is reported in the Figure. Numbers vary due to single missing values and because residents staying for <2 months were excluded from analysis.

In 2021 and 2022 the general influence of the COVID-19 pandemic was perceived as clearly negative (both Cohen’s d>0.55, see t tests parameters reported in the Table). Across all medical disciplines, a similar negative influence was observable. As the Figure displays, the orthopedic surgery residents reported the most negative influence in both years (M₂₀₂₁=3.76, M₂₀₂₂=3.63), while pediatrics and adolescent medicine residents reported the least negative scores in 2021 (M₂₀₂₁=3.47) and psychiatry residents in 2022 (M₂₀₂₂=3.32).

We used unpaired t tests to compare the data from 2021 and 2022 (Table) and found that the influence of the COVID-19 pandemic declined in 2022 (d_2021vs2022=0.12). This decline was significant across disciplines (P<.05) except for pediatrics and adolescent medicine (P>.10), which had reported the least impact of the COVID-19 pandemic in the 2021 survey.

In both years, residents reported a reduction in the time available for education/training (d₂₀₂₁=0.76, d₂₀₂₂=0.13), and that their education had been impaired by the COVID-19 pandemic (d₂₀₂₁=0.69, d₂₀₂₂=0.42) as displayed in the Table. T tests against the scale mean showed an effect for both years. These results were similar across disciplines, except that in 2022 residents from pediatrics and adolescent medicine did not indicate a reduction in their time for education (P>.59, Figure). Comparing 2021 and 2022, residents from all disciplines reported relatively less reduction of education time in 2022 than in 2021 (d_2021vs2022=0.61) and less impairment of their education in 2022 than in 2021 (d_2021vs2022=0.26).

Further analyses showed that residents working full-time reported a significantly stronger negative influence of the COVID-19 pandemic (d=-0.08), more reduction of their education time (d=0.17), and more impairment to their education (d=-0.23) than residents working part-time in 2021 (see Table). In 2022, both subsamples judged the influence as less severe than in 2021, also in terms of education time and education impairment. Despite the decline, differences between the subgroups remained significant in 2022: Full-time working residents still perceived the influence of the pandemic as more negative (d=-0.05) and the education to be more impaired (d=-0.18) than did residents working part-time.

Residents indicated that the negative influence of the COVID-19 pandemic was still present in 2022, although less severe than in 2021. This pattern was similar across different medical disciplines. The findings show a decline in the ratings, which seems promising for the medical community. Nevertheless, there are continuing negative consequences of the COVID-19 pandemic that need to be resolved; what is more, understanding the vulnerability of the resident education system may facilitate the development of adaptation strategies and mechanisms to ensure a more efficient handling of future challenges.

In 2021, residents working full-time perceived the influence of the COVID-19 pandemic to be more severe than did those working part-time. The differences declined in 2022 but remained significant, especially regarding the perceived impaired education. Working part-time might have provided more flexibility to deal with the challenges brought about by the situation. The observed effects were rather small (most Cohen’s d scores were below 0.20 suggesting only small effects) and based only on single-item measures. Future research is warranted to gain more insight into the relationship between work status and perception of the COVID-19 pandemic.

The beneficial effect of working part-time aligns with the literature showing a positive effect of part-time work in general on work control and patient satisfaction.²⁰  Working part-time might also be recommended, given that previous studies have consistently shown that the work quality of part-time workers is similar or even higher^21,22  and that patients receiving medical treatments are at least equally satisfied with part-time workers.^20,23,24 

The present research is based only on samples from Switzerland. However, the large size of the samples and the fact that we found similar results across different medical disciplines support the assumption that the effects would be similar in other countries.

The COVID-19 pandemic had detrimental effects on graduate medical education in Switzerland in 2021 and 2022. According to the residents, the negative influence continued but declined to a substantial extent for all medical disciplines. Residents working part- (vs full-) time reported a less severe influence of the COVID-19 pandemic in both years.

The authors would like to thank the medical residents who participated in the annual surveys and the Swiss Institute for Medical Education for the support.

Funding: Data collection was funded by the Swiss Institute for Medical Education, Bern, Switzerland.

Conflict of interest: The authors declare they have no competing interests.