The negative impact of the COVID‐19 pandemic on UK haematology registrars’ well‐being and training: Results of a UK nationwide survey

Abstract The COVID‐19 pandemic has disturbed medical training. Haematology registrars were surveyed using SurveyMonkey. Eighty‐nine out of 269 (24.9%) responded. Reported stressors included concerns about transmitting the infection, disruption of leave, inferior patient outcomes, survivors’ guilt and interruption of career progression. Only 31.2% felt ready to progress to the next training stage. Reported causes of lack of training were disruption of clinics and training days and utilisation of telephone consultations. Several stressors negatively impacted haematology registrars’ well‐being, training and progression. More emphasis on psychological support, outpatient clinic work and e‐learning is needed.


INTRODUCTION
The COVID-19 pandemic first started in China in December 2019 and subsequently rapidly spread worldwide. The multidimensional impacts of the ongoing pandemic include disturbance to all aspects of postgraduate medical education [1][2][3].

RESULTS
The survey was sent to 269 haematology registrars, and 89 completed responses were received (response rate of 24.9%); see Supplementary and 56 (62.9%) were females. Six (6.7%) had active and ten (11.2%) had historic mental health issues.
Stressors affecting the respondents during the pandemic are shown in  Figure 2).
Only 24 respondents (31.2%) thought they had acquired all training needed to progress to the next stage. Thirty-five (45.5%) thought they should be allowed to progress with mitigating measures to replace lost training. Ten (13%) felt they should receive extension of training.
Respondents thought this lack of attainment of required training was due to cancellation of didactic teaching sessions, loss of exposure in the outpatient clinic settings and increased utilisation of telephone consultations (see Table 2). The negative impact caused by can-

DISCUSSION
Our data reveal that, among our respondents, the COVID-19 pandemic was associated with multiple psychosocial and work-related stressors, negative physical and mental health impact, poor academic achieve- Our study showed a high prevalence of negative psychological impact. A previous systematic review showed increased adverse mental health outcomes among healthcare workers (HCWs) during COVID-19, especially if they were in the frontline, working in high risk areas or redeployed to such areas [6]. Distress, depression, anxiety and insomnia affected 30-70% of HCWs according to a study from China [7]. Psychiatric illness caused the loss of 475,000 full-time equivalent days representing 31.8% of all NHS staff absences in June 2020 [8]. This is a 24% increase from pre-pandemic levels [9]. These data indicate that more psychological support is needed.
17.5% of our respondents had SARS-CoV-2 infection, which is much higher than the prevalence of positive antibody tests of 5.6% and 4.2% in England and Wales, respectively, in September 2020 [10], but similar to the rates of infection in HCWs reported in COVID-19 (19%) [11] and during the Middle East Respiratory Syndrome (MERS) outbreak (19.9%) [12]. Sickness absence due to COVID-19 infection was responsible for nearly one third of all NHS staff sickness absence in April 2020 [8].
Our respondents felt that they suffered due to high rates of redeployment and poor preparation to allow this to happen safely. This would raise concerns regarding safety and efficiency, loss of training opportunities, the impact on haematology staffing levels and the risk of cross-contaminating haematology units.
Less than a third of participants thought they had achieved the training required to progress to the next stage. This is much lower than the rate of satisfactory outcome among haematology trainees in 2019 (55%) [13]. The major disruptions of training revealed by our data are in line with a recent General Medical Council survey where more than two thirds reported disruption of training [14]. Reported causes for this lack of achievement were cancellation of didactic teaching sessions, reduced laboratory experience, changes to outpatient clinics and adoption of telephone consultations in preference to face-to-face consultations. Outpatient clinics and laboratory responsibilities represent the majority of haematologists' clinical work. We thus recommend that deaneries, as part of their plans to mitigate the effects of the pandemic, put greater emphasis on allowing registrars to have more access to outpatient clinics and laboratory work. This is especially true as we predict the utilisation of telephone clinics is likely to persist for prolonged periods. Our study shows a need to develop and use local and national virtual morphology training platforms [15]. UK NEQAS EQATE is one such platform [16]. We are unable to assess whether trainees at different stages of training (i.e. pre-or post-exams) were differently impacted by cancellation of teaching. E-learning was recommended to replace lost teaching.
In summary, despite multiple studies examining the impact of COVID-19 on medical school education [17] this is the first published survey to report the negative impact of the COVID-19 pandemic on haematology registrars. The pandemic and its response were associated with many stressors, including negative impact on physical and mental health, poor academic achievement and lack of readiness to progress to the next stage among haematology trainees. Increased emphasis on psychological support, outpatient clinic and laboratory experience and on e-learning are urgently required to compensate for the lost training and to mitigate the future negative effects of COVID-19 as it becomes endemic in society.