Fitness app for resident wellness during COVID‐19

Residency training is known to be stressful, with an estimated 33% of Canadian internal medicine residents screening positive for depression and 15% for suicidal ideations.1 The current COVID-19 pandemic is expected to worsen these statistics due to the psychological, emotional and physical burdens it imposes on residents. A survey of internal medicine residents at McGill University (Montreal, Quebec, Canada) conducted during the second wave of the COVID-19 pandemic using the Maslach burnout inventory scale revealed that 25% of residents felt that residency training during the pandemic was hardening them emotionally with 28% feeling more callous when compared to the start of their training and 13% feeling unmotivated to create interpersonal relationship at work during this stressful time of isolation. The McGill Internal Medicine Residency Program launched a 3-week wellness challenge intended to increase physical fitness, interpersonal relatedness and overall wellbeing of residents while respecting the social isolation guidelines. This team-based health and fitness challenge was facilitated by a mobile app called Outbreak, a commercial app widely available on mobile app stores. The goal of each resident/attending physician was to run away from or combat virtual zombies to ensure their own character and team's survival. They did so through exercises synced to the game via wireless fitness devices such as Fitbit. One hundred fifty internal medicine residents (100% inclusion with no opt-out option) and thirty attending physicians (on a volunteer basis) participated in the challenge. Through pre-assigned teams, participants who usually work in different hospitals were given an opportunity to meet virtually, connect and work towards a common goal—that of combating zombies. In-game chat rooms created a platform for discussion, motivation and encouragement between the colleagues. A survey based on the Maslach burnout inventory scale conducted pre- and post-wellness challenge yielded some important differences in emotional exhaustion, physical accomplishment and depersonalisation. We summarised the changes in participant response to the sub-questions under each of the three Maslach burnout dimension. Approximately 8%–15% of residents felt less emotionally drained after participating in this challenge, indicating that they felt more energetic after the challenge. Also, 12.8%–22.3% had a greater feeling of personal accomplishment post wellness challenge, stating that they felt they could deal with emotional problems more calmly. Furthermore, 14%–19% felt more motivated to create interpersonal relationship with their peers and patients and 12%–13% felt more physically active post-challenge. While some engaged in fitness training (e.g., jogging and biking), many reported changes in lifestyle habits (e.g., taking stairs and walking/biking to work). We identified several elements that contributed to the overall positive effects of this challenge. The random team assignments allowed the formation of new relationships between junior residents, senior resident and attending physicians across different training sites, thereby enabling residents to feel connected with others despite physical isolation. Attendings' participation allowed residents to appreciate the non-medical side of their mentors. The challenge was a welcomed distraction and brought positivity into residents' daily routine strained by the pandemic. Major challenges encountered included lack of activity/interaction with teammates from approximately 20 out of 180 participants and occasional failed synchronisation with fitness devices. Digital and app-based platforms offer creative ways to enhance residents' physical fitness, relatedness and general wellbeing and have the unique advantage of supporting interpersonal connections across physical distances and over time. They should be considered for every residency program both within and beyond the context current pandemic and may be especially of value in larger programs with distributed training sites.

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