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ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 21-30

Public Sector Resident Doctors’ Knowledge and Practices Amidst COVID-19: A Cross-Sectional Analysis


1 Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
2 Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
3 Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India

Date of Submission26-Sep-2020
Date of Decision16-Feb-2021
Date of Acceptance22-Feb-2021
Date of Web Publication28-Apr-2021

Correspondence Address:
Dr. Saket Prakash
Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi 110002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_105_20

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  Abstract 


Background and Purpose: COVID-19 was declared as a pandemic on March 11, 2020 by World Health Organization. Resident doctors, including interns, are the frontline of health care workers, have always been at risk of infectious diseases, and the spread of the novel severe acute respiratory syndrome (SARS)-CoV-2 virus. The purpose of this survey was to gather opinions about personal safety, general knowledge, preventive behaviors, attitude, risk perception on COVID-19, and institutional approach toward this pandemic. Methods: This cross-sectional, online survey-based study was conducted from April 18, 2020 to April 21, 2020 in India. Data was collected from health care professionals, mainly frontline doctors, that is, residents and interns. Questionnaire consisted of 41 questions, statistical analysis was done using SPSS software version 26 (IBM Corp). Chi-square test was used to investigate the level of association among variables at the significance level of P < 0.05. Results: About 332 doctors completed the survey. Most of the junior resident (academic), from category A, B, and C received training for donning and doffing, and we found they were aware of donning and doffing (P-value < 0.05). It was also found that N95 was the most common personal protective equipment (PPE) stock missing in the institution. Survey also revealed that most of the surgeons had stopped planned surgery (P-value < 0.05) and also there was a significant decrease in emergency surgery and consultations (P-value < 0.05). Conclusion: We have restricted access to essential PPE. Protecting health care workers had been a governmental health priority. Institutions and government should urgently implement policies to support health care workers in the time of the COVID-19 pandemic.

Keywords: Attitude, COVID-19, health care workers, knowledge, practice


How to cite this article:
Prakash S, Kumar R, Patel S, Patralekh MK, Maini L. Public Sector Resident Doctors’ Knowledge and Practices Amidst COVID-19: A Cross-Sectional Analysis. MAMC J Med Sci 2021;7:21-30

How to cite this URL:
Prakash S, Kumar R, Patel S, Patralekh MK, Maini L. Public Sector Resident Doctors’ Knowledge and Practices Amidst COVID-19: A Cross-Sectional Analysis. MAMC J Med Sci [serial online] 2021 [cited 2021 Aug 1];7:21-30. Available from: https://www.mamcjms.in/text.asp?2021/7/1/21/314871




  Introducion Top


In late November 2019 the severe acute respiratory syndrome (SARS)-CoV-2 originated from a live seafood market in Wuhan, China and was termed as COVID-19.[1] Its mechanism of transmission is through inhalation of airborne droplets sprayed into the atmosphere by sneezing and coughing of infected (but usually asymptomatic) akin to SARS and middle east respiratory syndrome (MERS) epidemic.[2] World Health Organization (WHO) declared COVID-19 as a pandemic on march 11, 2020 causing the entire world into a lockdown with borders sealed, road, train, and air transportation was brought in to a standstill. Social distancing became the new norm.[3] Doctors, especially the residents, are frontline health care workers (FLHCW). They called us corona warriors to push our spirit. But because of an exponential rise in patient load, medical experts from diverse specialties who are not expert in infectious disease and support equipment like ventilators are being channelized to reinforce the FLHCW, toward care of seriously ill COVID-19 patients.[4],[5] It has heightened apprehensions about the wellbeing of FLHCW. Personal protective equipment (PPE) is being utilized by HCW to safeguard from SARS-CoV-2. It is imperative to have knowledge of donning and doffing. But it is a double-edged sword, as violations in any step of donning and doffing may lead to infection.[6],[7]

The purpose of this survey was to gather information about personal safety, general knowledge on COVID-19, institutional approach to combat this pandemic, burnout, do they have access to PPE, safety protocols, how this pandemic has changed their routine practices, to search for discrepancy on access to PPE, human resources, and health care policies among health care workers during the current COVID-19 outbreak.

The momentum with which COVID-19 had advanced across the world orders an appraisal of the reality of health care workers threatened to COVID-19 subjects.


  Methods Top


Study design and population

This was a cross-sectional, online survey-based study and data was collected from health care professionals, mainly frontline doctors in India. A questionnaire was developed and distributed using Google Forms (questionnaire uploaded as supplementary material). Questionnaires were distributed through the social networking websites and applications including WhatsApp, Facebook, and emails.

It required no ethical approval for this survey as we kept identity anonymous and confidential and no personal questions were asked. We conducted the survey from April 18, 2020 to April 21, 2020.

Statistical analysis

Descriptive statistics, frequencies, and percentages of response to questions were calculated according to the number of respondents per response to the number of total responses of a question and presented as categorical variables. Cross-tabulations were performed to identify associations between variables. The chi-square test was utilized to compare proportions and to analyze the differences in categorical variables. During data analysis, many cell counts were less than five, so we tried performing Exact test to decipher significance, but again exact test was taking a lot of time. So we performed Monte Carlo test (confidence interval 99%).[8] All tests were two-tailed, with a significance level of P < 0 · 05. We performed statistical analysis on IBM SPSS Statistics (IBM Corp., Armonk, NY, USA).


  Results Top


Section 1: Demographic details

About 332 doctors responded to the survey. We categorized the participants into distinct categories based on their departments, as per the guidelines by the Ministry of Health and Family Welfare (MOHFW), India.[9] The mean age of respondent was 27.12 years. Among them, 213 were male and 117 were female, whereas two participants did not wish to disclose their sex. There were interns (n = 49); junior resident academic (n = 199); junior resident nonacademic (n = 24); and senior resident (n = 60) involved in various duties like ward, screening, intensive care unit (ICU), etc. [Figure 1]. We have summarized other demographic details of participants in [Table 1] and [Table 2].
Figure 1 Pie chart showing duties being performed by residents during COVID-19 pandemic

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Table 1 The demographic details

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Table 2 Measures to reduce COVID-19 infections

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Section 2: Knowledge on PPE and preventive measures

Most of the junior resident (academic), from category A, B, and C received training for donning and doffing, and they were aware of donning and doffing (P-value < 0.05). Category F (intern) did not receive training and were less aware (P < 0.05).

In response to difficulty during donning and doffing, most of the participants found it to be easy to wear and difficult to remove (P-value < 0.05) or difficult to wear and difficult to remove (P-value < 0.05) [Figure 2]. Regarding duration of PPE, most doctors (219) suggested it should be between 3 to 6 hours and the comparison was significant (P-value < 0.05) [Figure 3]. In response to grading of PPE against safety on a scale of one to five (1 = not protected to 5 = well protected), 42.5% scaled PPE to three and comparison was significant (P-value < 0.05) [Figure 4].
Figure 2 Clustered bar diagram showing difficulty during donning and doffing as compared with job title

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Figure 3 Clustered bar diagram showing what should be the duration of work with full PPE kit as compared with job title (P-value < 0.05)

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Figure 4 Clustered bar diagram showing grading of PPE against safety as compared with job title (P-value < 0.05)

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Participants responded that they had access to the following essential items: N95 mask (n = 51, 15.4%), and other equipment’s as mentioned in [Figure 5]. N95 was the most commonly PPE stock missing in the institution [Figure 6]. Most of the doctors feel duty hours have changed.
Figure 5 Clustered bar diagram showing types of PPEs accessible to health care workers as compared with job title

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Figure 6 Missing PPE in the institutions in decreasing frequency

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Regarding measures to reduce COVID-19 infections, the average is 65.09%. About 90.4% of the doctors are isolating themselves at home after work. Also 44.3% doctors are using telemedicine/videoconferencing. The participants’ perceptions about their medical institutions taking all necessary steps to deal with COVID-19 pandemic, 58.1% said “yes” whereas 41.9% said “no.” We also asked participants to share their perceptions about, if the country is well equipped to protect their physical integrity in the workplace, 54.8% said “no” whereas 25.3% were not sure.

Section 3: COVID-19, and its effect on health care workers/facilities

Those who were well informed about receiving latest COVID-19 related guidelines were asked about a principal source of knowledge, choices were “WHO, your institution, social media,” and friends. There was a significant relation between them; most of the doctors were well informed on the latest guidelines (P-value < 0.05). About 42.2% doctors preferred to stay at home and observe if they have a suspicion of COVID-19 infection.

Most of the surgeons have stopped planned surgery (P-value < 0.05), also there is a significant decrease in emergency surgery, consultations, and road traffic accident (P-value < 0.05) [Table 3] and [Figure 7]. While 9.6% doctors had already operated on a positive patient, 40.1% will operate in the future. Also 68.7% were enthusiastic to work in ICU if needed.
Table 3 The changes in planned/emergency surgery, consultation, and RTA due to COVID-19 pandemic

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Figure 7 Clustered bar diagram showing changes in planned/emergency surgery, consultation and Road traffic accident (RTA) due to COVID- 19 pandemic. (Decreased includes decreased by 90%, 75%, 50%, 25%, 10%)

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In opinion about best solution to face COVID-19 pandemic, 40.4% (n = 134) suggested for quarantine [Figure 8] and the comparison was significant (P < 0.05). In reply to stress and anxiety, 78.3% answered yes [Table 4].
Figure 8 Clustered bar diagram showing best solution to face COVID-19 pandemic as compared with job title (P-value < 0.05)

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Table 4 COVID-19, and its effects on health care workers

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Section 4: Cross-tabulation between different major variables

Cross-tabulation between different variables has been summarized in [Table 5].
Table 5 Cross-tabulation between major variables

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  Discussion Top


Today we are amid an unprecedented scenario because of the COVID-19 pandemic.

Health professionals, especially resident doctors including interns, who are the FLHCWs, have always been at risk of infectious diseases, and the spread of the novel SARS-CoV-2 virus.[10] Therefore, it is pivotal to evaluate their knowledge about the virus, preventive measures, risk perception, knowledge of PPE, donning and doffing, level of awareness, and anxiety level. This survey sought to provide an insight on the changes in consultation/elective and emergency surgery in health care facilities at tertiary public hospitals, during this COVID-19 pandemic, and the correlation between these major variables. With such information, health policy makers can carry out the appropriate planning to deal with the present prospects and become ready for subsequent demands.

According to our search, this is the first descriptive study among medical residents’ doctors, including intern, involving public tertiary care hospitals of India.

Most junior resident (academic) had received specific training and were aware for donning and doffing (P < 0.05), as matched to interns and senior residents. In this study, there was a significant difference between different doctors for preventive measures and risk assessment. We can ascertain it that the junior resident (academic) from category A, B, and C (as per MOHFW, India) were better educated about latest guidelines (P-value < 0.05) and had specific training (P-value < 0.05). Apart from numerous difficulties cited in difficulties during donning and doffing, some doctors concentrated on new difficulties such as it is very painful to work in PPE even for 6 hours (same has been advocated in our analysis), difficult to communicate with coworkers, increased sweating with PPE, difficulty in breathing, fogging of the goggles and visibility after donning is a serious issue as it is even difficult to cannulate veins, and again lack of proper donning and doffing area. Doctors from different surgical specialties were fulfilling alternate surgical and nonsurgical tasks [Figure 1].

As per the participants there was a shortage of PPE (such as N95 masks, special gown, protective glasses, face shield, medical masks, and gloves), which was like other surveys.[11] Thus, making them exposed to infection and increasing chances to pass on the disease. It might be desirable that adequate protective equipment suited for the pandemic conditions can be useful in lessening stress and anxiety among health care workers. Therefore, to decrease, stress, and anxiety which are serious problems in disease outbreaks.[12],[13] Preventive behavioral training should be strengthened among health care workers. Doctors are currently depleted because of platooning and redeployment policies for residents and faculty coming into play for an unpredictable time period.[14] Senior consultants should be available to train trainee.

Elective procedures have been postponed or cancelled by different institutes all over the world. Surgeries are allowed for urgent/emergency cases only, and all require justification.[15],[16] We found similar results in our survey. Doctors from category B have significantly stopped planned surgery (P-value < 0.05). There was a decrease in emergency surgery which was statistically significant (P-value < 0.05) for anesthesia and general surgery. This stage of “surgical pause” may be an exceptional time for learning, research, and teaching.

It is imperative that risk to surgical work force is minimized. It can be carried out by avoiding surgery where feasible and advocating nonsurgical management.[16],[17]

To quote Henry Thomas Marsh “It takes 3 months to learn how to do an operation, 3 years to know when to do it, and 30 years to know when not to do it.”[18] Rest and recuperation must be provided. Emotional support should be offered to all the team members.

There has been no evidence-based specific treatment for COVID-19, and management has been supportive.[19] In our study in reply to medical management, most of the doctors opined for combination therapy [Figure 9] and quarantine as best solution to face COVID-19 pandemic. The present proposal to COVID-19 is to limit the origin of infection; use infection prevention and control measures to scale down the risk of transmission; and provide early diagnosis, isolation, and supportive care for affected patients.[20] The data of this study could again set priorities in terms of safety and human resources allocation by public health authorities.
Figure 9 Clustered bar diagram showing medical management of COVID-19 pandemic as compared with job title

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We will definitely have a burst of patient post-COVID-19 era, so it is the correct time to embrace ourselves and select steps to take up such a situation, so it is a call of time to move to virtual platforms that will allow patients to engage with physicians such a Face Time/Zoom/Google Duo, and telemedicine visits; in our survey 44.3% doctors were using telemedicine. It might aid in lessening the volume of patients post-COVID-19 era and will again establish social distancing. In this pandemic, there is a wave of webinars too. While to most of us, there seems to be an exuberance of these, our proposal would be to cherry pick the good ones among this plethora. The momentum with which COVID-19 is advancing across the world orders an appraisal of the reality of health care workers threatened to COVID-19 subjects.


  Limitations Top


This survey has several limitations. Participants were asked to respond to very precise queries that might not provide for the complex situation of the personal safety of health care experts. No power estimates were undertaken prior to the initiation of the study. However, the purpose of this research was simply descriptive and not hypothesis testing.

Questionnaire was distributed through social networking sites and applications for a brief time. This means those who were active on social media during the brief span of data collection were the only groups that had the chance to take part in the study. This could cause selection bias and sampling error, which rules out the ability to generalize our results. For some questions there may be satisfying/uncertainty in feedback, which may be politically/psychologically driven.


  Conclusions Top


We had restricted access to essential PPE during the COVID-19 pandemic. Protecting health care workers is a governmental health priority. The ordinary impression of health care professionals about not getting enough assistance from medical institutions and public health authorities raises the desire to urgently implement policies to support health care workers in the time of the COVID-19 pandemic. It is time that we join hands, think out of box, and use our skills to turn out stronger from this catastrophe. Kindness and desire are more infectious than coronavirus.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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