HomeCirculationVol. 142, No. 2Reinforcing Cardiology Training During a Pandemic Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessArticle CommentaryPDF/EPUBReinforcing Cardiology Training During a PandemicAn Open Letter to Our Leaders Elizabeth H. Dineen, DO Jeffrey J. Hsu, MD, PhD Anum SaeedMD Elizabeth H. DineenElizabeth H. Dineen Department of Cardiology, Prebys Cardiovascular Institute, Scripps Clinic, La Jolla, CA (E.H.D.). *Drs Dineen, Hsu, and Saeed contributed equally. Search for more papers by this author , Jeffrey J. HsuJeffrey J. Hsu Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California–Los Angeles (J.J.H.). *Drs Dineen, Hsu, and Saeed contributed equally. Search for more papers by this author and Anum SaeedAnum Saeed Anum Saeed, MD, Heart and Vascular Institute, Department of Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, S-553 Scaife Hall, Pittsburgh, PA 15213. Email E-mail Address: [email protected] https://orcid.org/0000-0003-1783-678X Heart and Vascular Institute, Department of Medicine, University of Pittsburgh Medical Center, PA (A.S.). *Drs Dineen, Hsu, and Saeed contributed equally. Search for more papers by this author Originally published1 May 2020https://doi.org/10.1161/CIRCULATIONAHA.120.047593Circulation. 2020;142:95–97The global spread of severe acute respiratory syndrome coronavirus-2 has toppled the educational landscape of cardiology Fellows in Training (FITs). Coronavirus disease 2019 (COVID-19) not only poses grave physical and mental health risks to trainees but also threatens the hands-on learning environment that has traditionally been a standard for clinical training.1 Already tasked with the rigorous demands of fellowship, FITs now face this historic challenge at a particularly vulnerable career stage.Program directors are rapidly needing to adapt their curricula to a new COVID-19 world yet must maintain a continued focus on the core aspects of fellowship training. In this unprecedented time, we propose a set of recommendations from the voice of trainees to program leaders, highlighting priorities in indispensable areas that should be cultivated as we transcend through COVID-19.EducationGiven social distancing mandates, training programs face a paradigm shift in their traditional educational structures, with most pivoting to virtual conferencing platforms. Simultaneously with the evolving COVID-19 literature, an entirely new field of medicine is emerging. During this time, we propose the following:Strengthen core tenets: Despite an overwhelming attention on COVID-19, it remains crucial to continue structuring around central cardiovascular didactics. COVID-19 cardiovascular manifestations can be incorporated by chief fellows into these core curriculum lecture series.Innovate: The global COVID-19 pandemic presents an opportunity to leverage novel multidisciplinary approaches to generate solutions. Innovate curricula to include the use of newer technologies (eg, point-of-care ultrasound, diagnostics, wearables), incorporate relevant public health topics, and facilitate opportunities for interested trainees to more deeply engage in social media education platforms.Embrace virtual collaboration: One redeeming aspect of this pandemic has been the emergence of interinstitutional and societal collaboration. Several institutions and professional societies have developed high-yield, both related to and not related to COVID-19, Grand Rounds and webinars that are open to the medical community. Integration of these opportunities into the curriculum offers an efficient way to continue to provide valuable educational content to trainees.By strengthening existing resources, incorporating newer educational platforms, and forging collaborations across institutions and professional societies, our leaders can shape an environment in which trainees can thrive.Clinical CareReductions in clinical and procedural volumes are occurring worldwide. Adaptations are needed to help compensate for these issues, in particular, as they pertain to competency assessment and meeting graduation requirements. We suggest the following:Assess virtual clinical decision making: As programs are adopting telehealth platforms, trainees can continue to be supervised and evaluated in this new era of clinical decision making. In addition, case-based virtual scenarios can be integrated into the learning platforms discussed earlier. Trainees’ clinical decision making in these settings, and their contributions to COVID-19 rotations when redeployed, as well, should be incorporated into the assessment of their clinical competency.Evaluate procedural skills: Simulation centers, where available, should be used to enhance skills, although simulations may be less fruitful for FITs nearing independent practice. The independent practice competency evaluation of each fellow remains up to the program directors,2 and we recommend proactive discussions with FITs at risk of not meeting their required numbers.With programmatic adjustments, FITs will ideally not require remediation. Nonetheless, given the regional variability of the pandemic, these decisions will ultimately be individualized, requiring flexible integration of each trainee’s career goals with their program requirements.2 If additional training is thought to be required, program directors should advocate for and accommodate these experiences, including extending fellowship with fair financial compensation, if needed.ResearchWith mandatory laboratory closures and clinical trial pauses, research has been upended at many institutions,3 yet the spectrum of COVID-19 cardiac manifestations presents an exciting field of scientific investigation ripe for FIT exploration. We suggest that our leaders do the following:Structure discussion: Organize internal forums in which clinical frontline fellows communicate their meaningful anecdotes to stimulate investigation among colleagues.Channel energy: Channel the invigorated, inquisitive energy of FITs into enriching research projects. Provide a framework for interested fellows to delve into the rapidly evolving COVID-19 literature and to educate others on questions arising in the field.Cultivate ideas into products: Identify trainees with the bandwidth to engage in research endeavors. Provide them with manageable, impactful tasks including idea development, data analysis, and manuscript writing. Support them as they build their individualized research trajectories.It is crucial to explicitly acknowledge that heightened productivity from trainees at this time is a welcomed bonus, but not an expectation.WellnessLast, the most vital component of a program’s response to COVID-19 is a sharpened and structured focus on wellness. In this crisis, the mental and physical well-being of trainees serves as the circle of safety needed to protect and support the aforementioned Education, Clinical Care and Research objectives (Figure).Download figureDownload PowerPointFigure. Educational, clinical care, research, and wellness priorities for cardiovascular trainees during the coronavirus disease 2019 (COVID-19) pandemic. This figure highlights the proposed recommendations to cardiology fellowship program leaders for systemic adaptations and innovations in the 4 priority areas of education, clinical care, research, and wellness of fellows in training during the COVID-19 pandemic.Frontline trainees are physically endangered with infamously precarious access to adequate personal protective equipment. Beyond the constant threat of self-exposure, there is also the anxiety of spreading contagion to loved ones. Additional stressors are financial concerns in economic uncertainty, social isolation, and the humanistic anguish of the rising COVID-19 morbidity and mortality.We urge leaders to construct a holistic approach to program redesign with the following framework:Listen: Proactively seek feedback on issues that are acutely worrying to trainees. Use online surveys or regular virtual town hall meetings to understand crucial issues within your program.Lessen: Ensure measures to provide adequate personal protective equipment to trainees and reduce infection risk. Identify ways to lessen the imposed physical and mental workload by modifying clinical schedules and by finding ways to allow work from home.Lead: Promote a trusting culture by demonstrating actions taken to address trainees’ concerns. Frequent and unified communication, to reiterate the extensive work done by the leadership is crucial. Working side by side with FITs provides steadfast guidance in these uncertain times.As the pandemic evolves, so will the needs of trainees, and responsive program leadership is of paramount importance.ConclusionCOVID-19 is indescribably overwhelming for all—in particular, for FITs—yet we are determined to prevail. Guided through this unprecedented experience with swift and creative adaptations from leadership, we will be ready to guide the next generation of trainees.To our leaders, thank you for listening.AcknowledgmentsThe authors acknowledge Dr Reza (fellow trainee) and Dr Berlacher for their significant contributions to this article. The authors also acknowledge Drs Patel, Suhar, Baas, and Berlacher for their exemplary leadership in trainee education, well-being and safety, and support by their respective institutional leadership during this unprecedented time. Last, the authors acknowledge many frontline national and international colleagues and Fellows in Training, serving on the frontlines in the COVID-19 pandemic, with whom conversations helped inform the content for this article. The views in this On My Mind article are those of the individual authors and do not necessarily represent institutional views.DisclosuresNone.Footnotes*Drs Dineen, Hsu, and Saeed contributed equally.The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.https://www.ahajournals.org/journal/circAnum Saeed, MD, Heart and Vascular Institute, Department of Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, S-553 Scaife Hall, Pittsburgh, PA 15213. Email [email protected]edu