Appl Clin Inform 2021; 12(03): 507-517
DOI: 10.1055/s-0041-1731000
Research Article

Impact of Changes in EHR Use during COVID-19 on Physician Trainee Mental Health

Katherine J. Holzer
1   Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States
Sunny S. Lou
1   Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States
Charles W. Goss
2   Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States
Jaime Strickland
3   Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States
Bradley A. Evanoff
3   Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States
Jennifer G. Duncan
4   Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
Thomas Kannampallil
1   Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States
5   Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri, United States
› Author Affiliations


Objectives This article investigates the association between changes in electronic health record (EHR) use during the coronavirus disease 2019 (COVID-19) pandemic on the rate of burnout, stress, posttraumatic stress disorder (PTSD), depression, and anxiety among physician trainees (residents and fellows).

Methods A total of 222 (of 1,375, 16.2%) physician trainees from an academic medical center responded to a Web-based survey. We compared the physician trainees who reported that their EHR use increased versus those whose EHR use stayed the same or decreased on outcomes related to depression, anxiety, stress, PTSD, and burnout using univariable and multivariable models. We examined whether self-reported exposure to COVID-19 patients moderated these relationships.

Results Physician trainees who reported increased use of EHR had higher burnout (adjusted mean, 1.48 [95% confidence interval [CI] 1.24, 1.71] vs. 1.05 [95% CI 0.93, 1.17]; p = 0.001) and were more likely to exhibit symptoms of PTSD (adjusted mean = 15.09 [95% CI 9.12, 21.05] vs. 9.36 [95% CI 7.38, 11.28]; p = 0.035). Physician trainees reporting increased EHR use outside of work were more likely to experience depression (adjusted mean, 8.37 [95% CI 5.68, 11.05] vs. 5.50 [95% CI 4.28, 6.72]; p = 0.035). Among physician trainees with increased EHR use, those exposed to COVID-19 patients had significantly higher burnout (2.04, p < 0.001) and depression scores (14.13, p = 0.003).

Conclusion Increased EHR use was associated with higher burnout, depression, and PTSD outcomes among physician trainees. Although preliminary, these findings have implications for creating systemic changes to manage the wellness and well-being of trainees.

Protection of Human and Animal Subjects

This study was reviewed by the Washington University Institutional Review Board.

Publication History

Received: 22 January 2021

Accepted: 03 May 2021

Article published online:
02 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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