Latest / The SHEA Podcast / COVID-19 Impact On Trainees & Students, 3/25/21

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COVID-19 Impact On Trainees & Students, 3/25/21 · The SHEA Podcast

• 0:08
  SPEAKER_03: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, SHAY, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:24
  SPEAKER_03: I'm Dr.
• 0:24
  SPEAKER_03: Jessica Howard Anderson, Infectious Diseases Fellow at the Emory University School of Medicine, and I will serve as your moderator today.
• 0:31
  SPEAKER_03: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:41
  SPEAKER_03: Shay is excited to launch this episode of the podcast, COVID-19 Updates, What We Know Now.
• 0:46
  SPEAKER_03: Today's discussion will focus on the COVID-19 impact on trainees and students.
• 0:51
  SPEAKER_03: Our speakers today are Dr.
• 0:53
  SPEAKER_03: Christopher Graber, Professor of Clinical Medicine in the David Geffen School of Medicine at UCLA, and program director for the UCLA Multi-Campus Fellowship in Infectious Diseases.
• 1:03
  SPEAKER_03: And Dr.
• 1:03
  SPEAKER_03: Carrie Tom, Professor of Epidemiology and Public Health and Medicine, and Associate Dean for Student Affairs at the University of Maryland School of Medicine.
• 1:12
  SPEAKER_03: Thank you for joining us today.
• 1:13
  SPEAKER_03: Before we start our discussion, I would like to turn it over to Dr.
• 1:16
  SPEAKER_03: Ishra Kamal Ahmed to get us started with a brief news and guidance update for the week.
• 1:22
  SPEAKER_00: Hello.
• 1:23
  SPEAKER_00: For our news update, globally, as of 24th of March 2021, there have been 124 million confirmed cases of COVID-19, including 2.7 million deaths reported to the WHO.
• 1:36
  SPEAKER_00: A total of 443 million vaccine doses have been administered.
• 1:40
  SPEAKER_00: In the US update, the Center for Disease Control and Prevention reported on Wednesday, March 24, 2021, that about 85 million or 25.7% of total population have received at least one dose of COVID-19 vaccine, including about 46 million or 14% people who have been fully vaccinated.
• 2:00
  SPEAKER_00: For population age 65 and over, 70.3% received at least one dose and 43.8% are fully vaccinated.
• 2:09
  SPEAKER_00: In an early released article in MMW on March 24, 2021, called Counties with High COVID-19 incidents and relatively large racial and ethnic minority populations, United States, April 1st, December 22nd, 2020, it was found that longstanding systemic health and social inequities have placed many racial and ethnic minority groups at increased risk for COVID-19.
• 2:32
  SPEAKER_00: CDC examined two population-based measures incidents of COVID-19 at the county level during three successive two-week periods during April 1st, December 22nd, 2020, and the percentage of the county population accounted for by each racial and ethnic minority group.
• 2:49
  SPEAKER_00: The study found that as the geographic distribution of counties reporting high COVID-19 incidents changed regionally throughout the course of the US pandemic, the potential COVID-19 impact on each racial and ethnic minority group also changed.
• 3:02
  SPEAKER_00: During April 1st through 14th, 11.4% of counties reported high COVID-19 incidents, including 28.7% and 27.9% of counties with large Asian and black populations respectively.
• 3:16
  SPEAKER_00: Four months later, during August 5th through 18th, this percentage was 64.7%, including 92.4% and 74.5% of counties with large black and Hispanic populations respectively.
• 3:30
  SPEAKER_00: As the COVID-19 pandemic evolves, public health efforts can be tailored to the needs of communities of color that may be experiencing high COVID-19 impact and integrated with longer-term plans to improve health equity.
• 3:43
  SPEAKER_00: In another early released article published in MMWR on March 19, 2021, called Low SARS COVID-2 Transmission in Elementary Schools, Salt Lake County, Utah, December 3, 2020, January 3, 2021, it was found that despite high community incidence and an inability to space a student's classroom seats more than six feet apart, in-person elementary schools can be opened safely with minimal in-school transmission when critical prevention strategies including mask use are implemented.
• 4:15
  SPEAKER_00: SARS COVID-19 testing was offered to 1,041 school contacts of 51 index patients across 20 elementary schools.
• 4:25
  SPEAKER_00: In this high community transmission setting, low school associated transmission was observed with only a 0.7% secondary attack rate.
• 4:34
  SPEAKER_00: Now for vaccine-related studies.
• 4:36
  SPEAKER_00: Two studies published on March 23rd, 2021 in the New England Journal of Medicine provide early evidence of the effect of SARF-COVID-19 to vaccines.
• 4:46
  SPEAKER_00: One study was at the University of Texas Southwestern Medical Center that reported that just 4 out of 8,121 frontline employees at the university became infected with COVID after being fully vaccinated.
• 5:01
  SPEAKER_00: Again, that's 4 out of 8,121.
• 5:04
  SPEAKER_00: Another study at UC San Diego Health and David Geffen School of Medicine at the University of California, Los Angeles found that only 7 out of almost 15,000 workers tested positive two or more weeks after receiving a second dose of COVID-19 vaccines.
• 5:21
  SPEAKER_00: Both studies show how well the vaccines work in the real world and during a period of intense transmission.
• 5:29
  SPEAKER_00: And for our last update, a study published in the International Journal of Audiology that looked at a systematic review of SARS-CoV-19 and audiovestibular symptoms, the author concluded that there were multiple reports of audiovestibular symptoms associated with COVID-19.
• 5:45
  SPEAKER_00: However, there is a dart of high-quality studies comparing COVID-19 cases and control.
• 5:51
  SPEAKER_00: The purpose of the systematic review on this topic was to provide timely evidence for decision makers.
• 5:58
  SPEAKER_00: After rejecting 850 records, 28 case report series and 28 cross-sectional studies met the inclusion criteria.
• 6:06
  SPEAKER_00: Hearing loss, tinnitus, and vertigo were among the common symptoms associated with COVID-19.
• 6:12
  SPEAKER_00: That's all we have for today, and thank you.
• 6:15
  SPEAKER_03: Thank you, Dr.
• 6:15
  SPEAKER_03: Kamal Ahmed.
• 6:16
  SPEAKER_03: I now want to move into the discussion with our speakers.
• 6:19
  SPEAKER_03: Thanks again for being here.
• 6:21
  SPEAKER_03: So as an introduction, I'd like to ask you both to each briefly describe your role as it relates to students or trainees, and then describe some of the most significant ways the COVID-19 pandemic has impacted the lives of students or trainees.
• 6:36
  SPEAKER_01: Great.
• 6:36
  SPEAKER_01: Thank you.
• 6:36
  SPEAKER_01: Thank you, Jessica.
• 6:37
  SPEAKER_01: So you know, I, as many infectious diseases clinicians in academic medicine, I wear a lot of hats.
• 6:43
  SPEAKER_01: I'm a program director of the UCLA Multi-Campus Infectious Diseases Fellowship.
• 6:47
  SPEAKER_01: And so, you know, we have five hospitals, and there's a need for lots of adjustment and flexibility in emergency times.
• 6:53
  SPEAKER_01: And so I'll talk a little bit about that.
• 6:54
  SPEAKER_01: I'm also an ID clinician and director of a stewardship program at the VA Greater Los Angeles healthcare system, where we've had you know had a lot of input on COVID-related policies that impact residents and research on antimicrobial stewardship, and particularly how to influence students, residents, fellows in decision making.
• 7:12
  SPEAKER_01: And I think there's been some impact there.
• 7:13
  SPEAKER_01: And then lastly, I'm a faculty sponsor for a medical student ID interest group, which actually came in handy during this pandemic, which I'll talk about.
• 7:20
  SPEAKER_01: And so, you know, I see this all as how how COVID has impacted our trainees as a contrast.
• 7:26
  SPEAKER_01: There's the opportunity gained by having fellows basically have a front row seat for the defining healthcare moment of a generation and the difficulty of maintaining their usual educational and research activities and other social needs.
• 7:38
  SPEAKER_01: So trying to find that right balance of making sure we get you know benefit from you know what's been going on, but at the same time trying to minimize all the downsides.
• 7:47
  SPEAKER_01: And so, you know, we've had a lot of trainees participate in our policymaking.
• 7:50
  SPEAKER_01: As a result of having led the ID interest group, I actually had our chief of staff text me out of the blue one day and said, Hey Chris, do you know of any medical students who want to help participate in some of our policymaking?
• 8:02
  SPEAKER_01: Kind of serve as a chief of staff for our chief of infectious diseases and our chief of staff just kind of you know help them out with stuff.
• 8:07
  SPEAKER_01: And I'm like, actually, yeah, I do.
• 8:10
  SPEAKER_01: There's some really hyper-qualified people who may be able to help.
• 8:13
  SPEAKER_01: We had one student who used to work for the WHO in like you know, vaccine delivery, and so she came in handy.
• 8:19
  SPEAKER_01: We had another medical student who worked at a university hospital prior to coming to medical school where he worked in logistics.
• 8:26
  SPEAKER_01: And so you know, we put him in, you know, kind of in charge of logistics.
• 8:29
  SPEAKER_01: And it was it was an incredible experience for them and and us as well.
• 8:34
  SPEAKER_01: And so, you know, just trying to look for those opportunities I thought was I thought was really important.
• 8:38
  SPEAKER_01: We had a lot of opportunity for fellows to participate in research.
• 8:42
  SPEAKER_01: We wrote an MMWR paper based on our the outbreak we had in our community living center, you know, based on our nursing home on campus.
• 8:48
  SPEAKER_01: Five fellows were authors on that, so you know, really giving them the opportunity, I felt like was important.
• 8:54
  SPEAKER_01: But the downsides are you know things like our first-year fellow class really didn't get a chance to bond.
• 8:59
  SPEAKER_01: They all know each other and they kind of sign out to each other and kind of this like kind of one-to-one thing, but you know, the the the prior class used to go to Tribuneite together and like do all these like activities, and the first year class missed that.
• 9:10
  SPEAKER_01: Things like journal clubs, you know, retreats.
• 9:13
  SPEAKER_01: We have our retreat scheduled for this afternoon, and it's gonna be over Zoom and not nearly as cool as last year's retreat.
• 9:18
  SPEAKER_01: So there's all kinds of things relating on to that.
• 9:21
  SPEAKER_01: And I think there's a lot of things that come up with logistics, like what happens when a resident gets sick, and the testing procedures are different from one hospital to the next, and how do we get them tested quickly and you know figure out a disposition and coverage and things like that.
• 9:33
  SPEAKER_01: And so, you know, and you know, we we have educational opportunities where you know we had a dedicated TV rotation, but then the TV ward turned into a COVID ward, and just having another COVID rotation maybe not as fun.
• 9:44
  SPEAKER_01: So, yeah, all those things I feel like uh you know we we we've been impacted in one way or another.
• 9:49
  SPEAKER_03: Yeah, thanks, Dr.
• 9:49
  SPEAKER_03: Graber.
• 9:50
  SPEAKER_03: I think you've hit on a lot of different topics we're gonna discuss throughout this podcast, but it's inspiring to hear how you've involved students and trainees at all levels.
• 10:00
  SPEAKER_03: And I know, you know, being a fellow, that finding that balance between COVID and non-COVID can be challenging.
• 10:05
  SPEAKER_03: So, Dr.
• 10:06
  SPEAKER_03: Tom, I'd love to hear from you as well.
• 10:08
  SPEAKER_02: Yeah, so like Dr.
• 10:09
  SPEAKER_02: Graber and many of us, I have historically worn a number of different hats in academia.
• 10:17
  SPEAKER_02: I've spent most of my career as one of our associate hospital epidemiologists.
• 10:22
  SPEAKER_02: I do research in infection prevention, in hospital EPI and antimicrobial stewardship.
• 10:31
  SPEAKER_02: I have worked with hospital administration and patient safety.
• 10:36
  SPEAKER_02: I'm an infectious disease clinician doing consults in our general and transplant patient populations.
• 10:44
  SPEAKER_02: And since the beginning of my career, I have been very passionate about medical education and have found ways to incorporate that as well into my career and professional life.
• 10:57
  SPEAKER_02: And for what it's worth, coincidentally or not, as of March of last year, I transitioned my job almost full-time into our Office of Student Affairs as the associate dean.
• 11:10
  SPEAKER_02: And in that role, my what I do is support, guide, advise, and advocate for our students in all aspects of their undergraduate medical training.
• 11:21
  SPEAKER_02: So I came into a new role right at the start of a pandemic as we were all moving to telework and changing everything.
• 11:29
  SPEAKER_02: Additionally, because we all like to have so much on our plates.
• 11:32
  SPEAKER_02: I was also coincidentally a part of a medical leadership team here at our institution who is implementing and developing a new four-year curriculum, which was set to begin and did begin on August 1st of this past year.
• 11:46
  SPEAKER_02: So right in the midst of a pandemic.
• 11:49
  SPEAKER_02: And that has posed a great deal of learning and creativity and flexibility, but certainly uh have come out the other side stronger for it.
• 12:01
  SPEAKER_02: In so many ways, I can see the pandemic has impacted medical education.
• 12:07
  SPEAKER_02: Back in the spring, folks were either embarking on the next stage of their career, or many were just starting a new stage in their career, either coming to medical school, leaving medical school, coming to ID fellowship, leaving fellowship, coming to residency or leaving.
• 12:23
  SPEAKER_02: And that was a stressful time for anybody to have to undergo such a big change.
• 12:28
  SPEAKER_02: And I think that was one of the biggest initial impacts, obviously.
• 12:33
  SPEAKER_02: Some of the things that we've seen for the medical students, clearly, the medical students who are graduating are our next wave of frontline providers.
• 12:43
  SPEAKER_02: And we saw earlier in the pandemic how important it was to have those frontline providers.
• 12:49
  SPEAKER_02: And so it became very critical early on as we were starting to remove medical students from the clinical setting in order to support the healthcare system in this pandemic time to really find creative and novel ways to make sure they learn what they needed to learn, gained the skills they needed to gain, and graduate on time so that they could be our next frontline providers come basically this July.
• 13:13
  SPEAKER_02: And so there was so much to do with that, to you know, create new curriculums for clinical students, give them something to do and ways to engage.
• 13:24
  SPEAKER_02: And it was so wonderful to see the creativity and the passion that came out of that.
• 13:29
  SPEAKER_02: We had students volunteering across the country as they were pulled from their rotations to contribute to the pandemic by helping procure PPE, helping distribute PPE, doing fit testing, doing humanizing projects for patients in the wards, finding creative ways for our patients to be able to communicate with their healthcare teens and their families and loved ones.
• 13:52
  SPEAKER_02: And as Dr.
• 13:53
  SPEAKER_02: Graber mentioned, there's also, as we've started to get students back in, there's a lot of nuances that have really affected that education and that normal flow, right?
• 14:04
  SPEAKER_02: We all know from the infection prevention side that being in close spaces in those tiny team rooms on the medical wards is a big area where transmission can occur.
• 14:16
  SPEAKER_02: And so distancing folks and having them physically removed from their team is a big impact on that learning of just how to be a resident, missed time due to exposure and illness.
• 14:28
  SPEAKER_02: Those are all sort of the big points that we tried to overcome with our clinical students.
• 14:33
  SPEAKER_02: And similarly, first year students, just like first-year fellows or residents across the country, joined at a time where they couldn't get together.
• 14:42
  SPEAKER_02: And I know many first-year students in medical school came to a new city to be part of a new community that they were part of virtually and never really had that opportunity to form those bonds and that sense of community and oneness.
• 14:55
  SPEAKER_02: So those have been some of the biggest challenges to overcome.
• 14:58
  SPEAKER_03: Thanks, Dr.
• 14:59
  SPEAKER_03: Tom.
• 14:59
  SPEAKER_03: Very impressive.
• 15:00
  SPEAKER_03: And you obviously described a lot of the changes that your program implemented, I think, from all different levels of trainees.
• 15:07
  SPEAKER_03: I wonder if you could highlight just one or two that you think have maybe been the most successful or well received that you might want to share with other listeners.
• 15:14
  SPEAKER_02: I think perhaps the biggest thing we've learned that I hope many others have learned as well is just that we have the ability within us to be creative and be flexible when the time comes.
• 15:26
  SPEAKER_02: And I think just keeping that in mind going forward is so important and will be such a great value to us and that we can really tackle these big issues as long as we come together and do so cohesively.
• 15:39
  SPEAKER_02: One wonderful example of this in clinical medicine also relates to medical education, and that's telemedicine.
• 15:47
  SPEAKER_02: We've been years trying to gain grounds in telemedicine.
• 15:52
  SPEAKER_02: And certainly through the pandemic, we've gained strides that we haven't been able to do in decades.
• 15:58
  SPEAKER_02: And it's been a wonderful opportunity to again bring those students who maybe couldn't be there in person right into that space, in that learning space.
• 16:08
  SPEAKER_02: So not only is that a benefit from the patient perspective, from the student perspective, we're all so excited to kind of go back to a lot of normal.
• 16:15
  SPEAKER_02: And certainly we want to go back to bedside, but it will be nice to have this option that we've created going forward when it's necessary or when it's beneficial to the patient, to the learners, to the patient-physician relationship.
• 16:29
  SPEAKER_02: So really incorporating that virtual aspect has been wonderful.
• 16:34
  SPEAKER_02: Probably another thing that folks think about when medical school, we all think back to our medical school experiences, one of the biggest memories many of us have is our first time in the anatomy lab.
• 16:45
  SPEAKER_02: And so really thinking through medical student experience this year where they haven't been in the anatomy lab.
• 16:52
  SPEAKER_02: They're learning anatomy virtually.
• 16:54
  SPEAKER_02: And again, here's where that creativity comes in.
• 16:57
  SPEAKER_02: But we've really been able to pull together and collaborate and use our technology to make this a wonderful learning experience that hopefully we can continue to incorporate in the future.
• 17:09
  SPEAKER_02: Schools are using collaborators in radiology, in pathology, as well as anatomy to really think through how best to teach anatomy in each of the different systems and using this wonderful technology of video recording and digital dissections to really enhance knowledge.
• 17:34
  SPEAKER_02: And that's been so interesting to see how that has played out.
• 17:39
  SPEAKER_03: Thank you.
• 17:39
  SPEAKER_03: Dr.
• 17:40
  SPEAKER_03: Graber, what do you think have been kind of the most successful or well-received changes in your program?
• 17:45
  SPEAKER_01: I want to echo Dr.
• 17:46
  SPEAKER_01: Tom's comment about the flexibility and you know just being being able to kind of adapt on the fly.
• 17:52
  SPEAKER_01: We actually got a little bit lucky.
• 17:54
  SPEAKER_01: You know, I we made a change in our schedule.
• 17:56
  SPEAKER_01: We were used to have kind of monthly blocks where fellows were on one rotation for the whole entire month and then you know kind of kind of go on to the next.
• 18:02
  SPEAKER_01: And we actually switched it up for kind of somewhat unrelated reasons prior to the pandemic to every two-week blocks.
• 18:07
  SPEAKER_01: And I think that actually made a really big difference in terms of you know making sure fellows don't get burned out on one rotation before going on to another, and because every rotation kind of handled COVID a little bit differently, all the hospitals.
• 18:17
  SPEAKER_01: And so some got busier, and well, everyone got busy to some extent, but some got a little bit more.
• 18:21
  SPEAKER_01: And so having that more frequent kind of changing, I think it was also good for you know just putting you know different faculty and fellows together, and you know, more relationships kind of get made a little bit faster.
• 18:30
  SPEAKER_01: Things aren't as organic in an environment where a lot of our kind of teaching and stuff has gone virtual.
• 18:35
  SPEAKER_01: Yeah, and moving all the conferences to virtual was challenging as well.
• 18:39
  SPEAKER_01: As being a program that's kind of far flung and people at like you know, five different sites, we really rely on our Tuesday morning conference where everyone got together in one room and we kind of hashed out some cases as you know, really kind of one of the core things that brought everyone together and trying to do that via Zoom.
• 18:54
  SPEAKER_01: There's some challenges associated with that.
• 18:55
  SPEAKER_01: And so I think we worked through some of those issues, you know, in terms of you know being active on the chat versus you know speaking at the conference, like when to turn your camera on, when to turn it off, and going through all those things.
• 19:06
  SPEAKER_01: You know, moving our journal clubs online was you know, unfortunately, something we had to do.
• 19:10
  SPEAKER_01: And you know, those journal clubs were another chance for everyone to bond.
• 19:13
  SPEAKER_01: We took a more of a kind of an equity focus in our journal clubs this year, though, which I actually think is something that I think we want to kind of maintain that theme moving forward because I felt like it was really rewarding and valuable.
• 19:23
  SPEAKER_01: But then there's you know, lots of opportunities opened up for you know fellows who were on elective who wanted to pitch in and help out.
• 19:30
  SPEAKER_01: And I think they learned a lot from that process as well.
• 19:32
  SPEAKER_01: But yeah, it all comes down to flexibility and being able to kind of adjust on the fly.
• 19:36
  SPEAKER_03: Yeah, I miss our in-person journal clubs as well.
• 19:39
  SPEAKER_03: And interestingly, our program did a similar thing with shortening our blocks initially to two weeks when the COVID volumes were really high.
• 19:46
  SPEAKER_03: So I think that helped.
• 19:47
  SPEAKER_03: So you both have talked about changing conferences and educational content to virtual settings.
• 19:54
  SPEAKER_03: I think most programs have done that.
• 19:57
  SPEAKER_03: Dr.
• 19:57
  SPEAKER_03: Graber, do you have suggestions for specific educational activities that have worked well online or other things that you've done besides just transitioning everything to Zoom?
• 20:08
  SPEAKER_01: Yeah, it's tough.
• 20:09
  SPEAKER_01: You know, I think a lot of the things we do just to try to keep people engaged.
• 20:13
  SPEAKER_01: It's hard to stare at a screen for you know many, many hours on end.
• 20:17
  SPEAKER_01: And so, you know, are there ways to work audience participation technology into your presentation, things like pull everywhere?
• 20:22
  SPEAKER_01: You know, I think some of our some of our more tech savvy fellows have been able to incorporate that into our presentations, and same goes for the attendings and just keeping that chat box active.
• 20:31
  SPEAKER_01: But we we've gained a lot as well.
• 20:33
  SPEAKER_01: You know, uh so our Thursday conference, which is normally kind of at our big university hospital where you know sometimes in rush hour LA, it's kind of hard to get to.
• 20:41
  SPEAKER_01: We've had better attendance as a result.
• 20:43
  SPEAKER_01: Uh we've been able to engage outside speakers who otherwise wouldn't be able to travel.
• 20:46
  SPEAKER_01: Like we got Rochelle Walensky to talk to us the week before she took over CDC.
• 20:50
  SPEAKER_01: That was awesome.
• 20:51
  SPEAKER_01: You know, and and the other thing that we've seen is in that conference, we've been able to have more collaboration from outside services.
• 20:57
  SPEAKER_01: So it's been a lot easier for you know algae and immunology to come and talk about a particular patient or have radiology you know weigh in on uh a particularly interesting finding.
• 21:05
  SPEAKER_01: It's actually now kind of a weird competition amongst our fellows as to like who can involve the most like ancillary services or you know, collaborative services in our hospital.
• 21:13
  SPEAKER_01: I actually think we kind of need to tone it down a bit.
• 21:15
  SPEAKER_01: But yeah, so I think that that's been a benefit as well.
• 21:18
  SPEAKER_01: Your your ability to coordinate things, you know, actually you have some actually more degrees of freedom than than you had before.
• 21:24
  SPEAKER_03: And Dr.
• 21:24
  SPEAKER_03: Tom, medical student education is obviously very different, though it has a lot of similarities.
• 21:29
  SPEAKER_03: Do you have tips for what has worked well?
• 21:31
  SPEAKER_02: I'll echo the last thing Dr.
• 21:32
  SPEAKER_02: Graper said, and I really hope that's something that we can continue.
• 21:36
  SPEAKER_02: Again, can't wait to get back and sitting in the same room together doing these lectures, but it would be nice to have the hybrid live stream where we can invite these collaborators to come in so easily and share their knowledge and wisdom with us.
• 21:51
  SPEAKER_02: So I really hope we continue to utilize that.
• 21:54
  SPEAKER_02: I had mentioned that we were about to embark on a new curriculum and we had many goals.
• 22:00
  SPEAKER_02: we were trying to accomplish, but one really was to really reform the way we spent time learning in the pre-clerkship time period.
• 22:09
  SPEAKER_02: So this is, you know, where we think back to sitting in long classrooms for me when I was in medical school, sitting in classrooms for six to eight hours a day.
• 22:19
  SPEAKER_02: Fortunately no one makes students do that anymore, but they do still have to learn in the classroom in didactic and small group settings.
• 22:27
  SPEAKER_02: And one of our goals was really to change that learning into just as Dr.
• 22:33
  SPEAKER_02: Graper said, a much more interactive space.
• 22:36
  SPEAKER_02: We had planned to use interaction for lecture time.
• 22:41
  SPEAKER_02: We had planned to do a great deal of small group activities that were not just problem-based learning, but team-based learning to really emphasize and focus the team nature of medicine.
• 22:53
  SPEAKER_02: And I'm not going to lie, when we realized the pandemic was happening right when we were about to implement this, we all kind of took a sigh and said, how are we going to do this?
• 23:06
  SPEAKER_02: But what we realized is we could still do a lot of that.
• 23:09
  SPEAKER_02: We just needed to change the how.
• 23:11
  SPEAKER_02: And we were lucky because we had already been thinking about ways to make things more interactive.
• 23:16
  SPEAKER_02: And so just pivoting and trying to use a lot of that technology again, you know, during my lectures, as many of our faculty members are doing, we were able to use turning point or poll everywhere to really engage students in a variety of ways, to answer questions, to give opinions really similar to in classroom, to be able to pause and just go into breakout rooms in Zoom and be able to answer some questions amongst themselves and come back and report to the larger team.
• 23:46
  SPEAKER_02: And we found ways using those same technologies to really be able to separate students into small groups.
• 23:52
  SPEAKER_02: This again helps with that cohesiveness that we talked about and team bonding even in the virtual setting to do that practice-based learning and team-based learning.
• 24:02
  SPEAKER_02: And you know we will get back to being in person and adjust to that very easily, I'm sure.
• 24:10
  SPEAKER_02: But in the meantime, these tools have been very successful in making that work.
• 24:15
  SPEAKER_02: Great, thank you.
• 24:16
  SPEAKER_03: So Dr.
• 24:17
  SPEAKER_03: Graeber, going back to something you said earlier about figuring out how to balance COVID-19 and non-COVID-19 education, have you done anything specifically to try to create this balance and how do you think this can be done effectively?
• 24:30
  SPEAKER_01: Yeah, the the the balance can be can be tricky sometimes.
• 24:33
  SPEAKER_01: I mean you know I think all of us get coveted out at you know one point or another, but nonetheless it's really kind of the defining moment of our specialty.
• 24:42
  SPEAKER_01: So we really need to use the opportunity to educate fellows and just in things like study design, dealing with the media.
• 24:47
  SPEAKER_01: I think there's a lot of lessons to be learned in that.
• 24:50
  SPEAKER_01: And you really use the opportunity to celebrate our field and highlight colleagues that are making a difference.
• 24:54
  SPEAKER_01: I think it's really fun for you know fellows to go back home at night and then turn on CNN and there's someone that they know like talking you know randomly to you know one of the hosts.
• 25:04
  SPEAKER_01: But at the same time, you know there's other non-COVID stuff that comes out we actually did a rapid fire journal club called What You Might Have Missed While Saving the World from COVID where everyone got to pick their favorite article and they had five minutes to talk about it.
• 25:17
  SPEAKER_01: And my my colleague Jen Fulger was timing them like to make sure on her on her phone to make sure that you know no one no one went past their five minutes.
• 25:24
  SPEAKER_01: That was really fun.
• 25:25
  SPEAKER_01: We covered a lot of ground.
• 25:26
  SPEAKER_01: A lot of times in journal clubs we wanted to use COVID as an example of a disruptor in how we've done things to plan innovative studies and how healthcare should be delivered moving forward you know as it pertains to telehealth equity that sort of thing.
• 25:37
  SPEAKER_01: But you know I there's this balance you know I think there's times where there's going to be a clear need for dissemination of important COVID related information in journal clubs and things like that.
• 25:46
  SPEAKER_01: And then there's also times to kind of back off and focus on the non-COVID stuff.
• 25:49
  SPEAKER_01: Just so having the ability to kind of go with the flow I think I think is important.
• 25:52
  SPEAKER_03: Yeah and Dr.
• 25:53
  SPEAKER_03: Tom have you specifically integrated COVID into the medical student education?
• 25:57
  SPEAKER_02: Yeah interesting I I totally agree balance is the way I would describe it and different learners at different stages need different things.
• 26:06
  SPEAKER_02: As we mentioned before we did have a group of students who was really leaving the classroom and embarking on clerkships for the first time right in the midst of the early pandemic.
• 26:17
  SPEAKER_02: And as these students had to delay actually by one month entering the clerkship setting for a variety of reasons, we very quickly created a new course that was called COVID-19 Bench to bedside.
• 26:30
  SPEAKER_02: And this was a virtually delivered course where students learn the basics of public health and infection prevention.
• 26:37
  SPEAKER_02: They learn specifics of care for COVID-positive patients across the life cycle from pregnant women to pediatric patients to the elderly they learn up to the minute advances in knowledge from experts.
• 26:50
  SPEAKER_02: We're also lucky at an academic center and in this virtual world to be able to pull these experts together and give their knowledge at the time and all sorts of things from unique aspects of care like psychiatric consequences to the toll of the healthcare providers and social isolation.
• 27:08
  SPEAKER_02: One of the most interesting things students got to do and this was again back in mid-April May was a virtual rounds right into the ICU.
• 27:19
  SPEAKER_02: So our critical care team took the iPad into the ICU and they got to watch them get dressed and interact in there and talk to patients in that setting and hear about rounds on the COVID unit.
• 27:32
  SPEAKER_02: And that was very eye-opening for students.
• 27:35
  SPEAKER_02: And it allowed them to just gain that little bit of confidence and knowledge that when they did enter the clinical setting that they really were able to both protect themselves and meaningfully contribute to the team as they started to head in.
• 27:49
  SPEAKER_02: So that was a great utilization for for those students with that particular need.
• 27:54
  SPEAKER_02: Wow yeah it was it was a really great course and just to see my colleagues develop that so quickly and on the fly was was really just amazing.
• 28:04
  SPEAKER_03: Great.
• 28:05
  SPEAKER_03: I love that idea with the medical students being virtual in the ICU.
• 28:08
  SPEAKER_03: I think that's awesome.
• 28:09
  SPEAKER_03: Now I'm going to touch on I think a really difficult topic as we've mentioned all the conference and activities have largely been virtual and so trainees can feel isolated from the rest of their division or department especially those that started a new program in July of 2020.
• 28:26
  SPEAKER_03: What our will is starting 2021 and so what have you done to maintain the culture and support of trainees or students during this challenging time?
• 28:34
  SPEAKER_01: It's difficult.
• 28:35
  SPEAKER_01: And I think things like periodic check-ins are are really important.
• 28:38
  SPEAKER_01: Just you know checking in with everyone at conference hey how's it going?
• 28:41
  SPEAKER_01: Anyone going through some stuff hey let me know.
• 28:43
  SPEAKER_01: Really letting your faculty be your eyes and ears and keeping lines of communication open I think is important.
• 28:48
  SPEAKER_01: You know even simple things like quarterly reports, biannual meetings that we all you know do for our fellows they take on an increased importance and they can pay more attention to kind of social side of things I I I think is important.
• 29:00
  SPEAKER_01: Reminding fellows that mental health resources are available.
• 29:03
  SPEAKER_01: They need them you know I think it's important for you know chief fellows to you know maintain social presence and you know I I don't think Zoom happy hours are particularly happy but you know but at least there's something.
• 29:13
  SPEAKER_01: But I think there's also random things that you can do kind of on the edges.
• 29:16
  SPEAKER_01: And so like I mentioned we have our retreat this afternoon which you know probably not as fun as our usual retreats but afterwards we're going to do an online trivia night.
• 29:23
  SPEAKER_01: You know there's companies that for actually not a lot of money can can host a trivia night where you have you know different teams competing and you know we get to go into breakout rooms and talk about your answers and things like that.
• 29:34
  SPEAKER_01: And so I'm going to put all the first years together on a team to make sure you know they they they kind of get some bonding.
• 29:39
  SPEAKER_01: I think there's a lot to be said for flexibility in scheduling things like vacations.
• 29:43
  SPEAKER_01: I got that house scheduled for vacation for like um I can't go anywhere.
• 29:48
  SPEAKER_01: Can I just like help out with code for a bit and then do my vacation later yeah sure you know and then you know some meeting efforts to kind of anticipate for that.
• 29:56
  SPEAKER_01: But also like now's the time to like ask for stuff as ID physicians.
• 30:00
  SPEAKER_01: I think we kind of think of ourselves as kind of on the low end of the totem pole normally when kind of asking for resources but man like now's the time.
• 30:08
  SPEAKER_01: I actually asked our mayor the mayor of Los Angeles to write congratulatory letters for our graduating fellows last spring and yeah that took them a while to get to the request but they did it.
• 30:17
  SPEAKER_01: So that was cool.
• 30:18
  SPEAKER_01: Now's the time to ask for fundraising things too.
• 30:21
  SPEAKER_01: So yes you have to kind of look for look for opportunities.
• 30:24
  SPEAKER_03: Thanks.
• 30:24
  SPEAKER_03: Yeah our program also did an online trivia night and it was really well received.
• 30:29
  SPEAKER_03: So I think your fellows will enjoy it.
• 30:30
  SPEAKER_03: Dr.
• 30:31
  SPEAKER_03: Tom same question to you.
• 30:33
  SPEAKER_02: Yeah it's really been an important topic and like you said Jessica it's it's weighed heavily on a lot of people I think each one of us has lived through this so we know about the isolation and the risks and yet it's hard for me to imagine when I go home and I think of myself being isolated, I am going home to my family who lives with me.
• 30:56
  SPEAKER_02: And many of our trainees our residents, fellows and students are staying at home in an empty apartment and don't have their family and friends nearby and it's been tough on a lot of people, particularly those who were joining a new community like we said earlier and haven't had that chance to form that cohesiveness.
• 31:14
  SPEAKER_02: And I'll echo a lot of the same things that Dr.
• 31:17
  SPEAKER_02: Graber mentioned.
• 31:18
  SPEAKER_02: One of the most important ways particularly early on that we were able to come together and try to overcome some of this was putting their students' passion right back into those volunteer efforts.
• 31:32
  SPEAKER_02: Giving them something to focus on and be a part of the pandemic was huge, particularly early on when they were pausing some of their educational missions.
• 31:45
  SPEAKER_02: We've also lived in a very challenging time even aside from the pandemic this year.
• 31:51
  SPEAKER_02: And there's been a lot of very difficult moments that we've gone through nationally, but also an opportunity for students to come together and really think about how they'd like to advocate for each other and for their patients through social justice efforts and commitments to diversity.
• 32:09
  SPEAKER_02: And that's been a wonderful opportunity for students to really come together and connect on those shared passions.
• 32:16
  SPEAKER_02: What I find most people crave is the same thing that the rest of us want is those interactions, however they can get them.
• 32:24
  SPEAKER_02: And you know our students not only want to get to know each other, but time with faculty as well and really being able to provide that time so that they can just hop in virtually to office hours and chat with us about whatever, right?
• 32:39
  SPEAKER_02: They may have a question about learning, they may have a question about career path or they just might want to talk about a book that they've read and just making sure that we're open to everybody in these office hours and letting them know that they can come by.
• 32:50
  SPEAKER_02: Dr.
• 32:51
  SPEAKER_02: Graber made an important point though not everyone is going to seek that out.
• 32:54
  SPEAKER_02: And so making sure we are checking in with everybody so that no one gets lost or missed through the cracks and we're being able to provide what all of our students and trainees need.
• 33:05
  SPEAKER_02: And then the last thing I'll say is you know we've tried to do some of these everyone gets a little bit of that Zoom fatigue.
• 33:12
  SPEAKER_02: But what I found is if you have enough offerings and a diversity of interest and things to do, folks will find what's interested to them and they will power through several hours of Zoom without thought if it's something that they're really interested in.
• 33:29
  SPEAKER_02: And some of my favorite things that we've done, we started a book club and we've done that virtually so far we read$2 a day, Poverty in America and last night we had one in InShock.
• 33:41
  SPEAKER_02: We also have a course that is humanism in medicine where we come together and talk about current topics, difficult topics and that is my favorite way to spend three hours actually on a Wednesday evening really delving into whatever the students want to talk about.
• 33:58
  SPEAKER_02: It's a student run session and we have deep conversations about isolation, how to keep ourselves well, how to support patients through advocacy, how to communicate with family members around death and dying all sorts of things come up in that conversation.
• 34:15
  SPEAKER_02: And again if that is something that drives you that's wonderful way to spend time and connect with other humans.
• 34:23
  SPEAKER_03: Thank you both I think those are all really interesting ideas and perspectives you've brought up.
• 34:28
  SPEAKER_03: So to conclude this is the Shay podcast so I wanted to ask what you thought was the impact of the COVID-19 pandemic specifically in the areas of healthcare epidemiology, infection prevention and antimicrobial stewardship as it relates to training students or fellows.
• 34:45
  SPEAKER_01: Sure.
• 34:46
  SPEAKER_01: Yeah you know COVID's really kind of the the word unprecedented gets thrown around thrown around a lot but it really is an unprecedented stress to the system I think for particularly inpatient antimicrobial stewardship.
• 34:57
  SPEAKER_01: There's lots of subcraxone is the throatzoincamycin being thrown around kind of despite the despite low rates of bacterial superinfection that have been documented in a number of really really wonderful studies.
• 35:07
  SPEAKER_01: And so I think there's a lot of opportunity for fellows to get involved in as to why that's the case looking at things like institutional patterns of use, reviewing papers.
• 35:15
  SPEAKER_01: You know I I think we kind of you know we we as attendings and academicians when we get requests to review things there are actually tremendous learning opportunities for fellows in in in in the right in the right place.
• 35:26
  SPEAKER_01: You know writing editorials as well I had a fellow write an editorial with me on you know antibiotic use in the in in the midst of a pandemic and that he did an amazing job with wrote it much better than I could have myself and so you know that you know looking for those opportunities I think I think is really critical and lots of opportunities for ID week abstracts.
• 35:42
  SPEAKER_01: I I expect next year's ID week meeting just like last year that fellows are going to you know residents students fellows are all going to hit it out of the park writing up all the interesting stuff that has happened in the past year.
• 35:52
  SPEAKER_01: And there's opportunities for fellows to just get involved locally reviewing the efficacy of infection control policies.
• 35:57
  SPEAKER_01: They're the ones on the front line answering the pages.
• 35:59
  SPEAKER_01: So you know check in with them see what's working and what isn't where where the breakdowns in communication are because they tend to hear about it first and then you know review how does what you do locally differ from what's being recommended at county level, a state level and national level in finding those differences and seeing why what you're doing works whereas it may not work in a different environment and use that as an opportunity for academics as well.
• 36:23
  SPEAKER_02: Dr.
• 36:24
  SPEAKER_02: Tom, what about you?
• 36:25
  SPEAKER_02: I think one of the most interesting and perhaps long lasting effects on all of our trainees, our students, our residents and fellows is really this increasing general awareness and respect for the field.
• 36:40
  SPEAKER_02: And that's hospital epi, antimicrobial stewardship, but really also public health in general no matter what folks go into, they've now really have a much deeper understanding of what is public health and population health, what are the tools, what's the infrastructure, how does hospital epi infection prevention, antimicrobial stewardship fit into all of this?
• 37:04
  SPEAKER_02: And with that knowledge and respect, they have the opportunity particularly as trainees to really use these as building blocks to incorporate this in their future career.
• 37:14
  SPEAKER_02: Whether they end up being infectious disease physicians, whether they end up being internists, pediatricians or surgeons, they will always have this knowledge with them to impart and inform their practice of medicine.
• 37:29
  SPEAKER_02: And I think that is certainly no one wanted a pandemic but it is a wonderful legacy to be able to carry forth is to continue to use that knowledge in a positive way.
• 37:40
  SPEAKER_03: Yeah I definitely think that's one of the positive changes from the pandemic.
• 37:45
  SPEAKER_03: So Dr.
• 37:46
  SPEAKER_03: Graeber and Dr.
• 37:47
  SPEAKER_01: Tom thank you so much do you have any parting thoughts or words before we wrap up I really want to kind of congratulate everyone in the in the healthcare epi field for for making it up until now I think we've learned a lot about our healthcare system as a result and I and I hope we can really kind of apply some of those lessons moving forward.
• 38:04
  SPEAKER_03: All right well thank you very much to both of you for sharing your perspectives and experiences.
• 38:10
  SPEAKER_03: This podcast can be accessed on Shay's online education center, learning CE under the Rapid Response program.
• 38:17
  SPEAKER_03: You will also find resources such as the recorded webinars, healthcare facility outbreak preparedness and the SHA COVID 19 town halls.
• 38:24
  SPEAKER_03: Interested in hearing from expert speakers on COVID-19 and other prevalent healthcare epidemiology topics then join us virtually April 13th through 16th for SHA Spring 2021.
• 38:34
  SPEAKER_03: Early registration closes on Friday March 26th.
• 38:37
  SPEAKER_03: New members can now receive 50% off 2021 SHA membership by using the coupon code WELCOME2021 until March 31st.
• 38:44
  SPEAKER_03: This concludes this episode of the Rapid Response podcast thank you for tuning in