Implementing a resilience coach program to support first year housestaff during the COVID-19 pandemic: early pilot results and comparison with non-housestaff sessions

In the present intervention, volunteer Penn Medicine employees were trained in therapeutic micro-skills based on PFA [17] and readied to provide a number of therapeutic strategies in virtual, one-on-one virtual sessions, including, active listening and emotional support, promoting client self-efficacy, and improving problem-solving abilities. Volunteers were trained with self-paced online webinars, role-playing sessions with feedback, and session guides. These lay mental health providers (henceforth resilience coaches) followed standard protocols for managing emergency situations and linking individuals to appropriate supports. After each session, resilience coaches systematically tracked participant concerns (e.g., sleep difficulties, loneliness, fear of contracting COVID-19), symptoms (e.g., behavioral, emotional, physical, cognitive), and techniques employed during that session (e.g. relaxation techniques, developing an action plan, ensuring physical safety). Items on these tracking sheets were adapted from established PFA checklists available through the World Health Organization [18, 19]. Session data was directly recorded into REDCap, a secure, web-based electronic data capture and management platform developed by the REDCap Consortium [20]. Licensed mental health professionals reviewed session data, provided feedback, and ensured protocol fidelity during weekly meetings with resilience coaches.

The Penn Medicine CFA program was developed and implemented in a large urban health system within 90 days of the COVID-19 outbreak in the U.S., providing free, timely psychosocial support to all Penn Medicine employees. We find that most of the cohort of first year housestaff that we solicited did not engage with the program: only one in ten made an appointment with a resilience coach. We find that housestaff who attended a resilience coach session presented with only slight differences in emotional symptoms from the comparison group of non-housestaff. This finding suggests that universal wellness initiatives in healthcare systems may be appropriate, and that perhaps only minimal tailoring is needed to target housestaff. Resilience coaches recorded fewer physical or mental health symptoms and held shorter sessions with first year housestaff compared to non-housestaff. It is unclear whether first year housestaff experienced fewer symptoms prior to beginning training despite COVID-19 or if they felt uncomfortable reporting symptomology in an employer-provided program, despite assurances of confidentiality. To account for these possibilities, resilience coaches were given explicit guides to facilitate sessions with individuals that did not present with specific concerns in the following year’s cohort. This refinement shifted the emphasis to proactive tactics, such as a guided exploration of the wellness services in the organization and sharing psychoeducational resources.

The Penn CFA program is among a number of supportive initiatives that sought to improve the wellbeing of healthcare workers at the onset of the COVID-19 pandemic [23, 24]. Many studies detailing the efficacy of these interventions (or lack thereof) are still forthcoming. Nonetheless, multiple reports continue to document the staggering rates of psychological distress among healthcare workers during COVID-19. A recent meta-review reports that the prevalence of psychophysiological stress among healthcare workers globally to be 37.7%, a rate significantly higher than the general public [25]. In North America, rates of anxiety and depressive symptoms among healthcare workers are as high as 14.8% and 18.7%, respectively, nearly four times the rate among the public before the pandemic [26]. We echo the call for more rigorous research of wellness initiatives for healthcare workers to counteract these effects [27].

This study is limited by the lack of systematic information on the composition of the non-housestaff group. Session notes reveal that this group may be composed of administrators, human resources staff, clinical nurse managers, intake specialists, second-year residents, and medical students, however due to confidentiality protocols, most individuals did not disclose their position within the organization. Unlike the first year housestaff, individuals in the non-housestaff group were not directly solicited and instead encountered the CFA program passively through internal messaging, potentially leading to sample bias. The results suggest that the non-housestaff group was composed of individuals in more severe distress than the group of first year housestaff given their higher incidence of symptoms, longer session length, and higher follow-up rate. In addition, we did not collect information from housestaff who opted out of their resilience coach session, so reasons for declining to participate are unknown. The rate of reported symptoms and concerns is that among housestaff who participated in the program, not from the cohort as a whole. Future research on the CFA program should measure psychological wellbeing before and after the intervention period and employ follow-up surveys to track subsequent service utilization in the entire cohort. Of note, the CFA program was and continues to be staffed by volunteers. Consequently, it is unclear how such a program would scale in other settings as implementation support of new interventions can vary across organizational cultures and communities [28, 29]. Subsequent programming should explore non-volunteer models, such as peer support models, which have shown promise in healthcare settings [11, 30].

Although we are unable to gauge the program’s effectiveness, the data described in this study informed ongoing resilience coach training and better equipped coaches to support subsequent cohorts of residents. In line with guidelines described elsewhere [16], we recommend that other organizations who seek to develop initiatives like CFA take a similar approach of iterative testing and refinement to best support healthcare workers during COVID-19 and beyond.

This study is one of the first to document the physical and psychological well-being of a cohort of first year housestaff and the implementation of a low-intensity interventions delivered by lay personnel in the early months of the COVID-19 pandemic in the United States. Although future research will need to evaluate the outcomes of this program, Penn Coping First Aid shows promise as a flexible model for delivering psychosocial support to healthcare workers during times of crisis.