The Fellowship Milieu in Adult Cardiothoracic Anesthesiology—Fostering Psychological Well-being During the Coronavirus Crisis
2020; Elsevier BV; Volume: 34; Issue: 10 Linguagem: Inglês
10.1053/j.jvca.2020.04.031
ISSN1532-8422
AutoresJared W. Feinman, Lourdes Al-Ghofaily, John Augoustides,
Tópico(s)Long-Term Effects of COVID-19
ResumoTHE pandemic from coronavirus disease-19 (COVID-19) is now a global crisis.1He Y Wei J Bian J et al.Chinese Society of Anesthesiologists expert consensus on anesthetic management of cardiac surgical patients with suspected or confirmed coronavirus disease 2019.J Cardiothorac Vasc Anesth. 2020; 34: 1397-1401Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 2Bhatraju PK Ghassemieh BJ Nichols M et al.COVID-19 in critically ill patients in the Seattle region – case series.N Engl J Med. 2020; (Accessed by April 9, 2020)https://doi.org/10.1056/NEJMoa2004500Crossref PubMed Scopus (1796) Google Scholar, 3He H Zhao S Han L et al.Anesthetic management of patients undergoing aortic dissection repair with suspected severe acute respiratory syndrome Coronavirus-2 infection.J Cardiothorac Vasc Anesth. 2020; 34: 1402-1405Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar The tsunami of healthcare demands for patients with severe COVID-19 has overwhelmed acute care services and has challenged the fellowship training milieu in adult cardiothoracic anesthesiology. 4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar The magnitude of this challenge is directly proportional to the intensity of the pandemic at a given institution, which prompted the Accreditation Council for Graduate Medical Education (ACGME) to publish a staged classification system to help guide fellowship management and navigation during the crisis.4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar The ACGME described 3 stages: Stage 1—usual operations with minor disruption of fellowship activities; stage 2—adjusted operations with mild-to-moderate disruption of fellowship activities; and stage 3—crisis mode with moderate-to-severe disruption of fellowship activities (full details available at www.acgme.org/covid-19, last accessed April 6, 2020). 4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar The purpose of this freestanding editorial is to highlight the significant threats of the current pandemic on the psychological well-being of fellows in adult cardiothoracic anesthesiology.4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar,5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar These perspectives will attempt to define the challenges and solutions for the program leadership to foster the psychological well-being of the fellows and faculty through the duration of this health crisis. The references provide further detail for program leaders to manage the psychological demands of the pandemic in the year ahead. The program should maintain an approachable leadership style that listens carefully to the fellows and faculty; relates important information from the ACGME, institutional graduate medical office, and department leadership; and maintains a focus on the psychological well-being of fellows.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar, 6Brakke T Thompson A Shilcutt Sk et al.Burnout in cardiothoracic anesthesiology – expert perspectives in the contemporary era.J Cardiothorac Vasc Anesth. 2019; 33: 1766-1770Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 7Hernandez-Garcia I Gimenez-Julvez T Assessment of health information about COVID-19 prevention on the internet: An infodemiological study.Public Health Surveill. 2020; 6: e18717Crossref PubMed Scopus (149) Google Scholar, 8Zaracostas J How to fight an infodemic.Lancet. 2020; 395: 676Abstract Full Text Full Text PDF PubMed Scopus (1333) Google Scholar, 9Jinling Hua Shaw R. Coronavirus (COVID-19) 'infodemic' and emerging issues through a data lens: The case of China.Int J Environ Res Public Health. 2020; 17: 2309Crossref Google Scholar The necessity of maintaining psychological health among physicians on the frontline of the pandemic has prompted an analysis of the literature to better understand the threats that COVID-19 poses.10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar,11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar The psychological effects of the SARS-associated coronavirus (SARS-CoV) epidemic during 2003 to 2004 have served as a template for understanding the full spectrum of psychological responses to this crisis.11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar, 12Maunder R The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers among frontline health care workers in Toronto: Lessons learned.Phil Trans R Soc Lond B Biol Sci. 2004; 359: 1117-1125Crossref PubMed Scopus (289) Google Scholar, 13Roberston E Herschenfiled K Grace SL et al.The psychosocial effects of being quarantined following exposure to SARS: A qualitative study of Toronto health care workers.Can J Psychiatry. 2004; 49: 403-407Crossref PubMed Scopus (223) Google Scholar, 14Reynolds DL Garay JR Deamond SL et al.Understanding, compliance and psychological impact of the SARS quarantine experience.Epidemiol Infect. 2006; 136: 997-1007Crossref Scopus (639) Google Scholar The first set of presentations that program directors may encounter relate to anxiety with or without somatic features.10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar, 11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar, 12Maunder R The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers among frontline health care workers in Toronto: Lessons learned.Phil Trans R Soc Lond B Biol Sci. 2004; 359: 1117-1125Crossref PubMed Scopus (289) Google Scholar, 13Roberston E Herschenfiled K Grace SL et al.The psychosocial effects of being quarantined following exposure to SARS: A qualitative study of Toronto health care workers.Can J Psychiatry. 2004; 49: 403-407Crossref PubMed Scopus (223) Google Scholar, 14Reynolds DL Garay JR Deamond SL et al.Understanding, compliance and psychological impact of the SARS quarantine experience.Epidemiol Infect. 2006; 136: 997-1007Crossref Scopus (639) Google Scholar Concomitant sleep disorders also were seen commonly, with insomnia being the most prevalent issue.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,14Reynolds DL Garay JR Deamond SL et al.Understanding, compliance and psychological impact of the SARS quarantine experience.Epidemiol Infect. 2006; 136: 997-1007Crossref Scopus (639) Google Scholar, 15Rabelo I Lee V Fallah MP et al.Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia – a qualitative study.Front Public Health. 2016; 4: 142Crossref PubMed Scopus (90) Google Scholar Etiologies of this anxiety included fear of the outbreak, concerns about vulnerability to infection, uncertainties about the treatment process, social distancing, work disruptions, and balancing multiple responsibilities.14Reynolds DL Garay JR Deamond SL et al.Understanding, compliance and psychological impact of the SARS quarantine experience.Epidemiol Infect. 2006; 136: 997-1007Crossref Scopus (639) Google Scholar, 15Rabelo I Lee V Fallah MP et al.Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia – a qualitative study.Front Public Health. 2016; 4: 142Crossref PubMed Scopus (90) Google Scholar, 16Sim K Chan YH Chong PN et al.Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease.J Psychosom Res. 2010; 68: 195-202Crossref PubMed Scopus (262) Google Scholar Mood disturbances were also common, including irritability, anger, grief, and depression that were at times associated with suicidal ideation or substance abuse.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar,11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar A mix of anxiety and depression could persist and present later as posttraumatic stress traits, or in severe cases, as posttraumatic stress disorder.10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar,11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar,15Rabelo I Lee V Fallah MP et al.Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia – a qualitative study.Front Public Health. 2016; 4: 142Crossref PubMed Scopus (90) Google Scholar, 16Sim K Chan YH Chong PN et al.Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease.J Psychosom Res. 2010; 68: 195-202Crossref PubMed Scopus (262) Google Scholar, 17Taha S Matheson K Cronin T et al.Intolerance of uncertainty, appraisals, coping, and anxiety: The case of the 2009 H1N1 pandemic.Br J Health Psychol. 2014; 19: 592-605Crossref PubMed Scopus (248) Google Scholar The psychological effects of the quarantine process and social distancing similarly include anxiety, frustration, anger, depression, substance abuse, burnout, and posttraumatic stress disorder.4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar,5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar As such, the reactions to this social isolation are a major consideration in the maintenance of psychological well-being during the coronavirus crisis, as psychological care of our fellows and ourselves is a professional and personal imperative.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,18Kuhn CM Flanagan EM Self-care as a professional imperative: Physician burnout, depression, and suicide.Can J Anaesth. 2017; 64: 158-168Crossref PubMed Scopus (133) Google Scholar There are several factors that may negatively affect a trainee's ability to cope with the psychological stress of the pandemic and accompanying quarantine, and they can be divided into 3 phases: before the crisis, during the crisis, and after the crisis.19Torales J O'Higgins M Catadelli-Maia JM et al.The outbreak of COVID-19 coronavirus and its impact on global mental health.Int J Soc Psych. 2020; (Accessed by April 19, 2020)https://doi.org/10.1177/0020764020915212Crossref PubMed Scopus (1852) Google Scholar The stressors that may erode resilience before the crisis include baseline anxiety, depression, substance abuse, and burnout syndrome, in addition to social support system factors such as marital status, number of children, and extended family.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar, 11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar, 12Maunder R The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers among frontline health care workers in Toronto: Lessons learned.Phil Trans R Soc Lond B Biol Sci. 2004; 359: 1117-1125Crossref PubMed Scopus (289) Google Scholar The factors that threaten psychological well-being during the crisis include the duration, anxiety about the risk of infection, financial concerns, and health system factors such as interruptions in essential supplies and chaotic communication.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,19Torales J O'Higgins M Catadelli-Maia JM et al.The outbreak of COVID-19 coronavirus and its impact on global mental health.Int J Soc Psych. 2020; (Accessed by April 19, 2020)https://doi.org/10.1177/0020764020915212Crossref PubMed Scopus (1852) Google Scholar,20Chopra V Toner E Waldhorn R et al.How should US hospitals prepare for coronavirus disease 2019 (COVID-19)?.Ann Int Med. 2020; (Accessed by April 19th 2020)https://doi.org/10.7326/M20-0907Crossref Scopus (120) Google Scholar After the crisis has passed, stressors that may slow the return of normalcy include financial losses and the effects of social stigma at work and at home.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar,11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar The threats to psychological health from COVID-19 can therefore be understood in a phasic model related to the advent, duration, and the departure of the crisis. These effects may affect not only the fellows and faculty in the work environment, but also the family unit that is the focus of the following section. The psychological effects of the coronavirus crisis also significantly may affect the family.21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar, 22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar, 23Liu JJ Bao Y Huang X et al.Mental health considerations for children quarantined because of COVID-19 [E-pub ahead of print].Lancet Child Adolesc Health. 2020; 4: 347-349Abstract Full Text Full Text PDF PubMed Scopus (516) Google Scholar Children may experience significant disruptions to their daily routine and social support structures. 21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar These disruptions may stem from multiple factors including infection with COVID-19, school closure, social distancing, and the quarantine process.21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar,22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar The effects of prolonged school closure and home confinement can precipitate high levels of anxiety, frustration, boredom, depression, and posttraumatic stress disorder.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar, 22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar, 23Liu JJ Bao Y Huang X et al.Mental health considerations for children quarantined because of COVID-19 [E-pub ahead of print].Lancet Child Adolesc Health. 2020; 4: 347-349Abstract Full Text Full Text PDF PubMed Scopus (516) Google Scholar The psychological reaction patterns of a child may resemble those of an adult during a pandemic but are significantly influenced by the child's age, level of understanding, and innate coping skills.22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar, 23Liu JJ Bao Y Huang X et al.Mental health considerations for children quarantined because of COVID-19 [E-pub ahead of print].Lancet Child Adolesc Health. 2020; 4: 347-349Abstract Full Text Full Text PDF PubMed Scopus (516) Google Scholar, 24Sprang G Silman M Posttraumatic stress disorder in parents and youth after health-related disasters.Disaster Med Public Health Prep. 2013; 7: 105-110Crossref PubMed Scopus (729) Google Scholar The response of the community may also be an important modifying factor, including the availability of online platforms for continuation of schooling activities and socialization with friends.21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar, 22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar, 23Liu JJ Bao Y Huang X et al.Mental health considerations for children quarantined because of COVID-19 [E-pub ahead of print].Lancet Child Adolesc Health. 2020; 4: 347-349Abstract Full Text Full Text PDF PubMed Scopus (516) Google Scholar The psychological stress from the COVID-19 crisis may affect fellows and faculty as individuals or as members of a tight-knit social community in and out of the workplace.10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar, 11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar, 12Maunder R The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers among frontline health care workers in Toronto: Lessons learned.Phil Trans R Soc Lond B Biol Sci. 2004; 359: 1117-1125Crossref PubMed Scopus (289) Google Scholar,25Kang L Ma S Chen M et al.Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study.Brain Behav Immun. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/j.bbi.2020.03.028Crossref Scopus (923) Google Scholar It is very helpful for the faculty and fellows to self-monitor these stressors based on an understanding of what they might be and how their effects may be expressed.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,18Kuhn CM Flanagan EM Self-care as a professional imperative: Physician burnout, depression, and suicide.Can J Anaesth. 2017; 64: 158-168Crossref PubMed Scopus (133) Google Scholar,25Kang L Ma S Chen M et al.Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study.Brain Behav Immun. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/j.bbi.2020.03.028Crossref Scopus (923) Google Scholar Psychological well-being during the coronavirus crisis ideally should be part of a multimodal approach to contain the crisis, including synchronized strategies for surges in patient volume, patient acuity, and healthcare supplies, including personal protective equipment.1He Y Wei J Bian J et al.Chinese Society of Anesthesiologists expert consensus on anesthetic management of cardiac surgical patients with suspected or confirmed coronavirus disease 2019.J Cardiothorac Vasc Anesth. 2020; 34: 1397-1401Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 2Bhatraju PK Ghassemieh BJ Nichols M et al.COVID-19 in critically ill patients in the Seattle region – case series.N Engl J Med. 2020; (Accessed by April 9, 2020)https://doi.org/10.1056/NEJMoa2004500Crossref PubMed Scopus (1796) Google Scholar, 3He H Zhao S Han L et al.Anesthetic management of patients undergoing aortic dissection repair with suspected severe acute respiratory syndrome Coronavirus-2 infection.J Cardiothorac Vasc Anesth. 2020; 34: 1402-1405Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar The fellows can participate as stakeholders during the crisis with the development and deployment of transparent and open communication that includes weekly townhall-style meetings using remote conferencing technology.20Chopra V Toner E Waldhorn R et al.How should US hospitals prepare for coronavirus disease 2019 (COVID-19)?.Ann Int Med. 2020; (Accessed by April 19th 2020)https://doi.org/10.7326/M20-0907Crossref Scopus (120) Google Scholar The program leadership should endeavor to manage the flood of incoming information (the "infodemic") by highlighting those aspects that are most germane to the fellows from all levels, including the ACGME, the institution, and the department.4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar, 5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar, 6Brakke T Thompson A Shilcutt Sk et al.Burnout in cardiothoracic anesthesiology – expert perspectives in the contemporary era.J Cardiothorac Vasc Anesth. 2019; 33: 1766-1770Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 7Hernandez-Garcia I Gimenez-Julvez T Assessment of health information about COVID-19 prevention on the internet: An infodemiological study.Public Health Surveill. 2020; 6: e18717Crossref PubMed Scopus (149) Google Scholar, 8Zaracostas J How to fight an infodemic.Lancet. 2020; 395: 676Abstract Full Text Full Text PDF PubMed Scopus (1333) Google Scholar, 9Jinling Hua Shaw R. Coronavirus (COVID-19) 'infodemic' and emerging issues through a data lens: The case of China.Int J Environ Res Public Health. 2020; 17: 2309Crossref Google Scholar This ongoing conversation with all stakeholders will facilitate a smooth integration of the adult cardiothoracic anesthesiology fellowship with the larger response to the COVID-19 crisis at departmental, institutional, and national levels.4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar The management of the fellowship will be most challenged during the Stage 3 "crisis mode scenario," as outlined by the ACGME, wherein fellows may be deployed to other clinical areas in a safe and coordinated fashion to assist in the clinical care of patients with COVID-19.4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar The program director should focus on the graduation trajectory of each fellow to ensure that this goal is preserved during and after the crisis. This path to graduation should be adjusted in realtime with the fellow and his or her mentor network as mandated by the fellow's performance and dynamic policy changes from the ACGME, the American Board of Anesthesiology, and the National Board of Echocardiography.26Goldhammer J Herman CR Heitz JW et al.ACGME accreditation guide for the adult cardiothoracic anesthesiology fellowship.J Cardiothorac Vasc Anesth. 2018; 32: 2395-2401Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 27Capdeville M Hargrave J Patel PA et al.Contemporary challenges for fellowship training in adult cardiothoracic anesthesiology: Perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 17, 2020)https://doi.org/10.1053/j.jvca.2020.02.011Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 28Black S Capdeville M Augoustides JG et al.Clinical competency committee in adult cardiothoracic anesthesiology – perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2019; 33: 1819-1827Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar The fellows may benefit from wellness resources available from their institution.4Feinman J Al-Ghofaily L Augoustides JG Fellowship training in adult cardiothoracic anesthesiology – navigating the new educational landscape due to the coronavirus crisis.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 18, 2020)https://doi.org/10.1053/j.jvca.2020.04.019Abstract Full Text Full Text PDF Scopus (7) Google Scholar,5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar The institutional response to the COVID-19 crisis likely will include a wellness center with a menu of services to engage and support all trainees in their ongoing self-care and maintenance of psychological wellness.10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar,11Chew QH Wei KC Vasco S et al.Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic.Singapore Med J. 2020; (Accessed by April 19, 2020)https://doi.org/10.11622/smedj.2020046Crossref Scopus (13) Google Scholar,25Kang L Ma S Chen M et al.Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study.Brain Behav Immun. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/j.bbi.2020.03.028Crossref Scopus (923) Google Scholar These pooled resources may include discussion groups, regular news updates, and links to programs that cultivate mindfulness, relaxation, and cognitive skill-building.29Pospos S Young IT Downs N et al.Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare among healthcare students and professionals: A systematic review.Acad Psych. 2018; 42: 109-120Crossref PubMed Scopus (73) Google Scholar The ACGME also has a catalogue of wellness resources on its website, including a workshop for cognitive skill development, a wellness mobile application that can be easily downloaded on a mobile device, and a set of podcasts.30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar The workshop provides a platform for program directors to discuss wellness and develop cognition skills with the fellows, covering concepts such as problematic mindsets, metacognition, mindful awareness, cognitive distortions, and cognitive restructuring.30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar After a review of these concepts, the curriculum then develops a set of cognitive tools and strategies that can be applied effectively during this time of crisis.30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar The mobile application has been designed to teach the fellows about common negative routines that promote stress and burnout and offer a set of cognitive behavioral strategies to move beyond these negative routines to build a cognitive culture of wellness.30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar The podcast series for the fellows similarly covers common negative mindsets and solutions to encourage psychological health.30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar The podcast series for program leaders has been arranged to introduce available wellness resources and the latest evidence to inform and invigorate the wellness milieu of the fellowship.30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar Beyond these excellent resources from the ACGME, there are further web-based and mobile applications that may help to manage the negative psychological effects of the current crisis.29Pospos S Young IT Downs N et al.Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare among healthcare students and professionals: A systematic review.Acad Psych. 2018; 42: 109-120Crossref PubMed Scopus (73) Google Scholar A recent systematic review identified the following web-based and mobile resources that can effectively foster wellness in these categories: meditation (headspace; guided meditation audios); breathing routines (breath2relax); web-based cognitive behavioral therapy (moodgym; stress gym); and suicide prevention applications (stay alive; virtual hope box).29Pospos S Young IT Downs N et al.Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare among healthcare students and professionals: A systematic review.Acad Psych. 2018; 42: 109-120Crossref PubMed Scopus (73) Google Scholar This set of resources also can serve to engage the fellows and program leaders in a collaborative effort to foster psychological well-being through and beyond the coronavirus crisis.29Pospos S Young IT Downs N et al.Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare among healthcare students and professionals: A systematic review.Acad Psych. 2018; 42: 109-120Crossref PubMed Scopus (73) Google Scholar The goal of these activities is to position the fellows and ourselves firmly in the path toward wellness.29Pospos S Young IT Downs N et al.Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare among healthcare students and professionals: A systematic review.Acad Psych. 2018; 42: 109-120Crossref PubMed Scopus (73) Google Scholar,30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar Many of these strategies could have a role in promoting wellness not only for the individual but also for the family unit.29Pospos S Young IT Downs N et al.Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare among healthcare students and professionals: A systematic review.Acad Psych. 2018; 42: 109-120Crossref PubMed Scopus (73) Google Scholar,30Accreditation Council for Graduate Medical Education well-being resources. Available at: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/AWARE-Well-Being-Resources. Accessed by April 6, 2020.Google Scholar Effective age-appropriate communication has been emphasized in the promotion of psychological well-being for children during the coronavirus pandemic.21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar,22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar This communication should be gentle but honest.31Dalton L Rapa E Ziebland S et al.Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent.Lancet. 2019; 393: 1164-1176Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar,32Christ GH Christ AE Current approaches to helping children cope with a parent's terminal illness.CA Cancer J Clin. 2006; 56: 197-212Crossref PubMed Scopus (104) Google Scholar It is important to consider most children between the ages of 4 and 7 years old may have "magical thinking" that may lead the them to blame themselves for the current crisis as a result of their thoughts and behavior.21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar, 22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar, 23Liu JJ Bao Y Huang X et al.Mental health considerations for children quarantined because of COVID-19 [E-pub ahead of print].Lancet Child Adolesc Health. 2020; 4: 347-349Abstract Full Text Full Text PDF PubMed Scopus (516) Google Scholar, 24Sprang G Silman M Posttraumatic stress disorder in parents and youth after health-related disasters.Disaster Med Public Health Prep. 2013; 7: 105-110Crossref PubMed Scopus (729) Google Scholar Therefore, listening carefully to their understanding of the crisis remains important to ensure that it is accurate and that it does not burden them with anxiety and guilt.21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar, 22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar, 23Liu JJ Bao Y Huang X et al.Mental health considerations for children quarantined because of COVID-19 [E-pub ahead of print].Lancet Child Adolesc Health. 2020; 4: 347-349Abstract Full Text Full Text PDF PubMed Scopus (516) Google Scholar, 24Sprang G Silman M Posttraumatic stress disorder in parents and youth after health-related disasters.Disaster Med Public Health Prep. 2013; 7: 105-110Crossref PubMed Scopus (729) Google Scholar Clearly, children should be referred for professional help as the need arises to ensure that they are able to successfully cope with the psychological demands of the pandemic.5Brooks SK Webster RK Smith LE et al.The psychological impact of quarantine and how to reduce it: Rapid review of the evidence [E-pub ahead of print].Lancet. 2020; 395: 912-920Abstract Full Text Full Text PDF PubMed Scopus (9573) Google Scholar,10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar, 10Ho CSH Chee CYI Ho RCM Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic.Ann Acad Med Singapore. 2020; 49: 155-160Crossref PubMed Google Scholar,21Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/S0140-6736(20)30547-XAbstract Full Text Full Text PDF Scopus (1213) Google Scholar, 22Dalton L Rapa E Stein A Protecting the psychological health of children through effective communication about COVID-19.Lancet Child Adolesc Health. 2020; 4: 346-347Abstract Full Text Full Text PDF PubMed Scopus (358) Google Scholar, 23Liu JJ Bao Y Huang X et al.Mental health considerations for children quarantined because of COVID-19 [E-pub ahead of print].Lancet Child Adolesc Health. 2020; 4: 347-349Abstract Full Text Full Text PDF PubMed Scopus (516) Google Scholar, 24Sprang G Silman M Posttraumatic stress disorder in parents and youth after health-related disasters.Disaster Med Public Health Prep. 2013; 7: 105-110Crossref PubMed Scopus (729) Google Scholar A focused but balanced approach to the fellows can maximize their psychological well-being during the current crisis. The ingredients for a successful collective strategy include frequent communication at all levels, in-depth listening to concerns, developing solutions in real time, and an emphasis on collective responsibility and teamwork through all phases of the crisis.25Kang L Ma S Chen M et al.Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study.Brain Behav Immun. 2020; (Accessed by April 19, 2020)https://doi.org/10.1016/j.bbi.2020.03.028Crossref Scopus (923) Google Scholar The overall strategy for navigating the crisis successfully with concomitant promotion of well-being should be dynamic and synchronized to the intensity of the crisis, as defined by the ACGME.33Ross SW Lauer CW Miles WS et al.Maximizing the calm before the storm: Tiered surgical response plan for the novel coronavirus (COVID-19).J Am Coll Surg. 2020; (Accessed by April 17, 2020)https://doi.org/10.1016/j.jamcollsurg.2020.03.019Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar,34Fausto J Hirano L Lam D et al.Creating a palliative care inpatient response plan for COVID-19 – the UW Medicine experience.J Pain Symptom Manag. 2020; (Accessed by April 18, 2020)https://doi.org/10.1016/j.jpainsymman.2020.03.025Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar The fellowship timeline with its goals and activities should be managed in an fluid fashion dependent on the impact of the crisis in real time. The response phases could be thought of as conventional capacity (appropriate for stage 1 in the ACGME framework), contingency capacity (appropriate for stage 2 in the ACGME framework), and crisis capacity (appropriate for stage 3 in the ACGME framework).33Ross SW Lauer CW Miles WS et al.Maximizing the calm before the storm: Tiered surgical response plan for the novel coronavirus (COVID-19).J Am Coll Surg. 2020; (Accessed by April 17, 2020)https://doi.org/10.1016/j.jamcollsurg.2020.03.019Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar,34Fausto J Hirano L Lam D et al.Creating a palliative care inpatient response plan for COVID-19 – the UW Medicine experience.J Pain Symptom Manag. 2020; (Accessed by April 18, 2020)https://doi.org/10.1016/j.jpainsymman.2020.03.025Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar This titrated response to the crisis intensity at the departmental and institutional levels will be enhanced greatly with engaged and thoughtful leadership of the fellowship. The value of a planned phasic and compassionate response for the fellowship cannot be overstated for successful navigation through the current crisis.33Ross SW Lauer CW Miles WS et al.Maximizing the calm before the storm: Tiered surgical response plan for the novel coronavirus (COVID-19).J Am Coll Surg. 2020; (Accessed by April 17, 2020)https://doi.org/10.1016/j.jamcollsurg.2020.03.019Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar,34Fausto J Hirano L Lam D et al.Creating a palliative care inpatient response plan for COVID-19 – the UW Medicine experience.J Pain Symptom Manag. 2020; (Accessed by April 18, 2020)https://doi.org/10.1016/j.jpainsymman.2020.03.025Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar This crafted path can deliver high-quality patient care and foster resilient fellows who are ready for graduation and life thereafter as well-adjusted practitioners and leaders in our specialty.26Goldhammer J Herman CR Heitz JW et al.ACGME accreditation guide for the adult cardiothoracic anesthesiology fellowship.J Cardiothorac Vasc Anesth. 2018; 32: 2395-2401Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 27Capdeville M Hargrave J Patel PA et al.Contemporary challenges for fellowship training in adult cardiothoracic anesthesiology: Perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 17, 2020)https://doi.org/10.1053/j.jvca.2020.02.011Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 28Black S Capdeville M Augoustides JG et al.Clinical competency committee in adult cardiothoracic anesthesiology – perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2019; 33: 1819-1827Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar,35Trombetta C Capdeville M Patel P et al.The program evaluation committee in the adult cardiothoracic anesthesiology fellowship – harnessing opportunities for program improvement.J Cardiothorac Vasc Anesth. 2020; 34: 797-904Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, 36Capdeville M Ural KG Patel PA et al.The educational evolution of fellowship training in cardiothoracic anesthesiology – perspectives from program directors around the United States. 2018; 32: 607-620Google Scholar, 37Capdeville M Hargrave J Foshee C et al.Mentoring aspiring program directors in adult cardiothoracic anesthesiology – perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2018; 32: 2381-2394Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The multitude of challenges associated with the COVID-19 pandemic can invigorate the fellowship program with creative leadership in all of its activities. The clinical competency committee will require lean and efficient adaptation to overcome the hurdles through to graduation.26Goldhammer J Herman CR Heitz JW et al.ACGME accreditation guide for the adult cardiothoracic anesthesiology fellowship.J Cardiothorac Vasc Anesth. 2018; 32: 2395-2401Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 27Capdeville M Hargrave J Patel PA et al.Contemporary challenges for fellowship training in adult cardiothoracic anesthesiology: Perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2020; (Accessed by April 17, 2020)https://doi.org/10.1053/j.jvca.2020.02.011Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 28Black S Capdeville M Augoustides JG et al.Clinical competency committee in adult cardiothoracic anesthesiology – perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2019; 33: 1819-1827Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Innovations in the fellowship that were prompted by necessary adaptions to the coronavirus crisis can be captured and developed through the reflections and records of the program evaluation committee. 35Trombetta C Capdeville M Patel P et al.The program evaluation committee in the adult cardiothoracic anesthesiology fellowship – harnessing opportunities for program improvement.J Cardiothorac Vasc Anesth. 2020; 34: 797-904Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar The engaging and energetic landscape of the fellowship can serve as an mentoring platform for the program faculty, including associate and assistant program directors to create and configure the new path ahead through the challenges of this crisis for both the graduating and incoming fellow classes.36Capdeville M Ural KG Patel PA et al.The educational evolution of fellowship training in cardiothoracic anesthesiology – perspectives from program directors around the United States. 2018; 32: 607-620Google Scholar, 37Capdeville M Hargrave J Foshee C et al.Mentoring aspiring program directors in adult cardiothoracic anesthesiology – perspectives from program directors around the United States.J Cardiothorac Vasc Anesth. 2018; 32: 2381-2394Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The intensity of the coronavirus crisis has challenged the psychological well-being of fellows and faculty in adult cardiothoracic anesthesiology. The challenges affect the individual and the family. The strategies to foster psychological resilience should consider input from all of the stakeholders and create a collaborative and supportive atmosphere to promote the psychological safety and wellness of all involved.
Referência(s)