Impact of the COVID-19 Pandemic on Nephrology Fellow Training and Well-Being in the United States: A National Survey
Authors: Pivert Kurtis A. , Boyle Suzanne M. , Halbach Susan M. , Chan Lili , Shah Hitesh H. , Waitzman Joshua S. , Mehdi Ali , Norouzi Sayna , Sozio Stephen M. 
Published: March 2021

Significance Statement
The effects of the coronavirus disease 2019 (COVID-19) pandemic on adult and pediatric nephrology fellows’ education, preparedness for unsupervised practice, and emotional wellbeing are unknown. The authors surveyed 1005 nephrology fellows-in-training and recent graduates in the United States and 425 responded (response rate 42%). Nephrology training programs rapidly adopted telehealth and virtual learning to meet pandemic-mandated safety measures. Despite these changes, 84% of respondents indicated programs successfully sustained their education and helped them progress to unsupervised practice and board certification. Although 42% of respondents perceived that the pandemic negatively affected their overall quality of life and 33% reported a poorer work-life balance, only 15% met the Resident Well-Being Index distress threshold. As the pandemic continues, nephrology training programs must continue to provide a safe educational environment and monitor fellows’ wellbeing.

Background
The coronavirus disease 2019 (COVID-19) pandemic’s effects on nephrology fellows’ educational experiences, preparedness for practice, and emotional wellbeing are unknown.

Methods
We recruited current adult and pediatric fellows and 2020 graduates of nephrology training programs in the United States to participate in a survey measuring COVID-19’s effects on their training experiences and wellbeing.

Results
Of 1005 nephrology fellows-in-training and recent graduates, 425 participated (response rate 42%). Telehealth was widely adopted (90% for some or all outpatient nephrology consults), as was remote learning (76% of conferences were exclusively online). Most respondents (64%) did not have in-person consults on COVID-19 inpatients; these patients were managed by telehealth visits (27%), by in-person visits with the attending faculty without fellows (29%), or by another approach (9%). A majority of fellows (84%) and graduates (82%) said their training programs successfully sustained their education during the pandemic, and most fellows (86%) and graduates (90%) perceived themselves as prepared for unsupervised practice. Although 42% indicated the pandemic had negatively affected their overall quality of life and 33% reported a poorer work-life balance, only 15% of 412 respondents who completed the Resident Well-Being Index met its distress threshold. Risk for distress was increased among respondents who perceived the pandemic had impaired their knowledge base (odds ratio [OR], 3.04; 95% confidence interval [CI], 2.00 to 4.77) or negatively affected their quality of life (OR, 3.47; 95% CI, 2.29 to 5.46) or work-life balance (OR, 3.16; 95% CI, 2.18 to 4.71).

Conclusions
Despite major shifts in education modalities and patient care protocols precipitated by the COVID-19 pandemic, participants perceived their education and preparation for practice to be minimally affected.