Leitman, I Michael

Abstract Purpose Crisis periods—defined as sustained disruptions to the clinical environment resulting in increased workload, exposure to high-acuity patient care, or limited access to coping resources—can lead to posttraumatic stress disorder (PTSD) among residents and fellows (trainees). By examining self-reported pandemic-related PTSD symptoms, associated risk factors, and their consequences, this study aims to identify vulnerable groups and inform institutional strategies to support trainee well-being during and after crisis events. Method A multi-institutional cross-sectional survey was conducted at 3 U.S. academic medical centers between April and May 2022. Measures included the Primary Care PTSD Screen for DSM-5 (range 0 to 5, scores ≥4 indicate probable PTSD), 4-item PROMIS Social Isolation scale (normed T-score range 0 to 100 scale with higher scores indicating greater isolation), items exploring intent to stay at one’s institution, and demographics. Multivariable analysis adjusted for demographics, specialty, and postgraduate year. Results Of 6,057 eligible trainees, 3,185 (53%) participated in the survey, with 3,109 completing the PTSD screening. A total of 190 (6%) trainees screened positive for self-reported PTSD symptoms. Multivariable analysis revealed that female trainees had a higher odds of screening positive for self-reported PTSD symptoms compared to males (odds ratio [OR] 1.45; 95% confidence interval [CI], 1.03-2.04; P = .03). Greater social isolation was independently associated with increased PTSD risk (OR 1.09; 95% CI, 1.07-1.11; P < .001). Additionally, trainees who did not intend to remain at their institution after training were more likely to screen positive for PTSD (OR 1.74; 95% CI, 1.17-2.58; P = .01). Conclusions Female gender, greater social isolation, and reduced intention to remain at one’s institution are independently associated with self-reported PTSD symptoms in trainees. Recognizing these relationships may enable health care leaders to proactively identify trainees at higher risk during crisis periods and to implement targeted, evidence-based interventions that promote well-being and workforce retention.