Well-Being During a Pandemic: A Focus on Resiliency and Addressing System Issues

By Christine Sullivan, MD; Sara Gardner, MD; Nurry Pirani, MD; and Brenda Rogers, MD

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Emergency medicine residents and faculty practice yoga as a stress relief.

Physician well-being has received increasing focus as associations between patient safety, medical error and attrition rates in the workplace have been attributed to stress, fatigue and burnout. Accrediting organizations such as the Accreditation Council for Graduate Medical Education (ACGME) and the Liaison Committee for Medical Education (LCME) have increasingly emphasized wellness and the learning environment.

Deeply embedded within medicine is physician altruism, namely putting patients ahead of ourselves. The COVID-19 pandemic has caused physicians to reflect on their roles and responsibilities, knowing that there is an ongoing threat of contracting COVID-19 and/or inadvertently exposing family members and loved ones. Emotional fatigue from the increased number of patients who are critically ill and dying is occurring. Rightfully, the pandemic has brought physician wellness to the forefront.

We will describe what the University of Missouri-Kansas City School of Medicine (UMKC SOM) has implemented to address well-being for medical students, residents and faculty physicians, focusing on issues that arose due to the pandemic. Further, we will comment on current needs and concerns of these groups and report some preliminary data.

Common to whether one is a student, resident/fellow or a faculty member are concerns beyond the ever-present threat of health exposure risk. Many have had to juggle their current role of learner and/or physician with caretaker and virtual school teacher. Social isolation from learning and/ or working from home, especially as the pandemic continues with no clear end in sight, threatens well-being. The ability to be flexible and embrace multiple changes in the learning and working environment can vary, sometimes with changes seemingly on a daily or weekly basis. This results in stress even among the most seasoned physicians.

MEDICAL STUDENTS

In March 2020, concerns about personal protective equipment (PPE) availability and uncertainty about COVID-19 disease risk prompted many conversations about medical student learning. The Association of American Medical Colleges (AAMC) released guidance to: 1) remind schools that medical students are learners and not part of the health care work force; 2) urge medical schools to transition education to a virtual setting if possible; and 3) reassure schools that the LCME would support schools developing a virtual learning plan.1 In mid-March, UMKC transitioned entirely to a virtual curriculum. Knowing that this sudden change and uncertainty would result in significant added stress for both students and faculty, a coordinated response between educators and the administration ensued.

The curriculum office provided faculty with numerous resources to develop a virtual curriculum that replaced in-class learning and clinical experiences. Computer services aided numerous students who found themselves relocated to places where internet access was unreliable, and assisted faculty as they implemented technology to help in teaching and monitoring students taking exams securely.

Teaching faculty provided flexibility in teaching methods, testing times and virtual office hours to accommodate students who lived in different time zones and/or faced other challenges. Students were assisted in leaving campus as campus housing closed with little warning. Students required reassurance and information about the completion of graduation requirements, grading and plans to maintain their educational timeline.

Celebrations, such as Residency Match Day and Commencement, were produced for a quality virtual experience. For several months United States Medical Licensing Examination (USMLE) tests were not offered, which required flexibility about testing requirements while providing ongoing test preparation services.

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