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Closer Look at Collaborations within an Academic Medical Center · The SHEA Podcast

• 0:10
  SPEAKER_01: Welcome to the We're All in This Together, COVID-19 Allies in Infection Prevention Podcast Series, as part of the Society for Healthcare Epidemiology of America Rapid Response Program.
• 0:22
  SPEAKER_01: I am Dr.
• 0:23
  SPEAKER_01: Julie Trevetti, the Medical Director of Infection Prevention for the UT Southwestern Health System, and I am here with Dr.
• 0:29
  SPEAKER_01: Carolie Estelle, Associate Chief and Interim Chief of Hospital Epidemiology at Parkland Health and Hospital System.
• 0:36
  SPEAKER_01: We are both assistant professors in the Division of Infectious Diseases and Geographic Medicine in the Department of Medicine at UT Southwestern Medical Center, and we'll be your speakers for today's podcast.
• 0:47
  SPEAKER_01: Discussion on the podcast does not reflect the perspective of SHAY, UT Southwestern, or Parkland Hospital, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:59
  SPEAKER_01: Today's episode will focus on collaborations between multiple hospitals and health systems that comprise an academic medical center and how we as a team can work together to address the most important questions surrounding the COVID-19 outbreak.
• 1:13
  SPEAKER_01: Let's get started.
• 1:14
  SPEAKER_01: Dr.
• 1:15
  SPEAKER_01: Estelle, what were some of the challenges you experienced in the early days of the pandemic, and how has that changed over the past few months?
• 1:23
  SPEAKER_00: In the early days, we were really busy and required us to develop processes and make many decisions with information that was changing every day, sometimes even multiple times a day.
• 1:35
  SPEAKER_00: There was such little information known about the risk factors and symptoms of COVID-19.
• 1:41
  SPEAKER_00: And we had to make some really tough and sometimes empiric decisions.
• 1:47
  SPEAKER_00: For example, about how to update our infection risk screen questions that are in EPIC from Ebola and MERS previously.
• 1:55
  SPEAKER_00: And it required us to continually stay on top of the reports coming out of China, the WHO and CDC.
• 2:02
  SPEAKER_00: And it really did emphasize the importance of us being able to rely on each other and share information.
• 2:09
  SPEAKER_00: Then over the past few months, the volume and complexity of information coming out in the literature has been exponential.
• 2:16
  SPEAKER_00: What has really helped tremendously has been having so many more people across the institution that we're here at at UT Southwestern and Parkland and the VA available to help.
• 2:26
  SPEAKER_00: And that stretches from the command center to our hospitalists and critical care specialists and physicians, and then even inside of our own division in infectious diseases.
• 2:37
  SPEAKER_00: I recall the daily updates.
• 2:39
  SPEAKER_00: Julie, you remember that you were providing the case counts to everyone and on both sides of the street.
• 2:45
  SPEAKER_00: And those were so helpful.
• 2:47
  SPEAKER_00: I I thought that was really great.
• 2:48
  SPEAKER_00: And I got a lot out of it, and I think a lot of our colleagues did.
• 2:51
  SPEAKER_00: One of the things that I've learned is finding that intersection between what's the correct textbook answer is not actually the right course of action.
• 3:01
  SPEAKER_00: And that's one of the huge things that I've learned in this pandemic.
• 3:04
  SPEAKER_00: Here's what we should do based on what I've learned from a textbook standpoint, from here's how it should be done, right?
• 3:10
  SPEAKER_00: But then the right course of action has to be what you can do with the available logistics and materials and resources.
• 3:18
  SPEAKER_00: And so the right answer isn't the textbook answer if it can't be accomplished.
• 3:23
  SPEAKER_00: And in the beginning, maybe just because I I'm green, it created a lot of cognitive dissonance for me, feeling like we're not doing the right thing because we couldn't do what that was.
• 3:35
  SPEAKER_00: But now understanding that the right thing is where all of those intersect sort of.
• 4:35
  SPEAKER_00: And so I think that all of those things made every decision that much more difficult.
• 4:42
  SPEAKER_00: For you though, how has the experience been over on the ET side?
• 4:47
  SPEAKER_01: Yeah, it's been a whirlwind.
• 4:49
  SPEAKER_01: I mean, I definitely recall those phone calls in the beginning that we had with our clinical informatics teams to integrate the symptoms and travel history and exposure risk factors into some kind of a meaningful decision support algorithm, predominantly at that time, so that our ambulatory clinics actually knew what to do.
• 5:07
  SPEAKER_01: Sending out those updates, you know, it started out from an update to just some of the hospital leadership and really expanded out to over 70 people across the institution, including leadership and colleagues at Parkland and VA and UT Southwestern and Children's, just in a way to really be able to make sure that we were all seeing the same information that was coming out and to really keep everyone informed.
• 5:29
  SPEAKER_01: It was so important for me to be able to do that and really crucial for me because it helped me to stay on top of all the new information that was coming out, you know, whether it was internationally in other countries and domestically, a lot of the travel bans that had been announced at that time in February.
• 5:45
  SPEAKER_01: And then, of course, how this was impacting us in Texas and then locally at our own institutions.
• 5:52
  SPEAKER_01: And it's interesting is that when the first case was announced in Washington State around January 21st, that's when all of this all of a sudden became much more real.
• 6:01
  SPEAKER_01: I realized that it was really just a matter of time when we might expect to see something here in our own community and in Dallas.
• 6:09
  SPEAKER_01: And I know that for many of my colleagues who were here in 2014, hearing about COVID reminded them of the time that Ebola showed up unexpectedly as well.
• 6:20
  SPEAKER_01: So I think that there was a lot of emphasis on ensuring that we were prepared as healthcare workers, as hospitals, as in the ambulatory setting.
• 6:29
  SPEAKER_01: And one thing that I found to be challenging was preparing the ambulatory clinics to be able to educate them so that they could identify potential cases, isolate individuals who had symptoms that were concerning for COVID, and then how to ensure that they had open lines of communication with the infection prevention teams about what they were seeing in their own settings.
• 6:49
  SPEAKER_01: We had numerous calls trying to address concerns about PPE masks versus N95s.
• 6:56
  SPEAKER_01: Many of our ambulatory staff were not routinely fit tested because there really was no need for them to have to be fit tested.
• 7:04
  SPEAKER_01: And so, you know, one of the things that we ended up doing was rolling out a mobile fit testing program to be able to reach many of our outpatient settings across North Texas.
• 7:14
  SPEAKER_01: Overall, it was just about working through these processes so that we would minimize risk to the staff and yet make sure that the patients received the care that they needed.
• 7:23
  SPEAKER_01: It was a really A-to-z type of an approach.
• 7:26
  SPEAKER_01: And what I felt was different about COVID was that most other outbreaks, in my experiences, have focused predominantly on preparedness in the inpatient setting and ensuring that our emergency rooms were prepared.
• 7:38
  SPEAKER_01: Did we have rooms to be able to isolate these individuals?
• 7:42
  SPEAKER_01: How are we going to evaluate them?
• 7:44
  SPEAKER_01: But you know, with COVID, given that the symptoms were quite variable and showing a lot of mild respiratory types of symptoms, for us it seemed as if the initial focus was actually on the ambulatory setting because patients were not presenting so severely ill that they were automatically come into the emergency room.
• 8:02
  SPEAKER_01: And that, of course, has changed over time as we have seen the numbers at both of our hospitals increase.
• 8:07
  SPEAKER_01: But at least on the UT Southwestern side, the focus seems to be back in the ambulatory setting, especially as patients who have recovered are now presenting for care.
• 8:17
  SPEAKER_01: So it's a great problem to have that people are having recovered from COVID and now they're trying to follow up for their surgeries and other types of ambulatory visits.
• 8:26
  SPEAKER_01: Caroline, talk to us a little bit about what the numbers of Parkland have been like.
• 8:30
  SPEAKER_01: And you know, with the recent surge in the number of patients being admitted to area hospitals, how has this affected Parkland and who were some allies that you found to be especially helpful in dealing with this pandemic?
• 8:43
  SPEAKER_00: Great question.
• 8:44
  SPEAKER_00: I think I'll I'll talk about our sort of community partners and allies first.
• 8:48
  SPEAKER_00: As a county hospital for Dallas, we really do get the honor and the privilege of getting to care for some of the most vulnerable populations here in Dallas.
• 9:01
  SPEAKER_00: We've got a highly underinsured population, and they're very vulnerable.
• 9:05
  SPEAKER_00: They've got high rates of transmission and they face really unique challenges.
• 9:11
  SPEAKER_00: A lot of them are in the sort of essential workers, frontline workers, breadwinners for their families.
• 9:17
  SPEAKER_00: And in many cases, they can't really always effectively self-isolate or quarantine because of more crowded living situations and spending more time in public transmit and the like.
• 9:28
  SPEAKER_00: And so we get to take care of the patients that have really been disproportionately affected by this pandemic here in the United States or in Dallas.
• 9:38
  SPEAKER_00: And then additional to that would be the homeless populations and our jail patient population as well.
• 9:44
  SPEAKER_00: And so we work really closely with the health department, Dallas County Health Department.
• 9:49
  SPEAKER_00: And we have come up with a really great way to become an extension of them.
• 9:54
  SPEAKER_00: Our clinical informatics team was able to sort of harness that power to identify certain hotspots in the around Dallas.
• 10:03
  SPEAKER_00: And we used those to create robocalls and text messages to reach out to those parts of our community and let them know what's going on, that there is increased COVID activity in their areas.
• 10:15
  SPEAKER_00: Here's what the symptoms are to look out for, and here's the testing sites.
• 10:19
  SPEAKER_00: We used that data and those sort of pockets of hotspots to decide where to put our community testing sites, put them in at least seven of our different community clinics, and then have also partnered with the county and the city in creating the mass testing sites as well, which we have been running.
• 10:36
  SPEAKER_00: And so trying to increase the access of care to that population by partnering with our public health colleagues and our local government officials as well.
• 10:47
  SPEAKER_00: On the inpatient side, COVID has really impacted Parkland in a pretty significant way on the inpatient side.
• 10:55
  SPEAKER_00: We have so far taken care of more than 1,400 patients on the inpatient category since March.
• 11:02
  SPEAKER_00: And what we were able to do very quickly was in a matter of five days converted our operating rooms into, or the entire OR suites into COVID unit, COVID care unit.
• 11:16
  SPEAKER_00: This has enabled us to be able to accommodate up to about 200 patients in a very short amount of time.
• 11:24
  SPEAKER_00: In the beginning, it was a matter of let's make the beds.
• 11:26
  SPEAKER_00: And over time, through a variety of the furloughing processes, staff members getting COVID potentially in the community, needing people to work in different assignments because of other medical conditions and the like, or what have you, staffing has been one of the biggest issues.
• 11:44
  SPEAKER_00: And because we created all of this additional space to keep patients, we didn't have the staffing for those beds.
• 11:51
  SPEAKER_00: It went very quickly from let's make sure we have bed capacity to how are we going to get people capacity to take care of these patients?
• 12:00
  SPEAKER_00: And so that is still a challenge that we are facing at this time.
• 12:04
  SPEAKER_00: And of course, as everyone I think experienced, is the PPE limitations, the testing limitations, and just the gymnastics that were waged to keep that afloat, to protect our patients and to protect our staff, because those are our two biggest priorities.
• 12:23
  SPEAKER_00: I think that that's kind of really been some of the biggest challenges through all of that, is really been the availability of resources, both material and human, have been really huge.
• 12:35
  SPEAKER_00: I will say though, that we really have been fortunate because our local government has really reached out to us and we have been able to provide infectious diseases and healthcare epidemiology expertise to our local government officials to help guide them in policies and the community response at large.
• 12:53
  SPEAKER_00: And that has also really been a great honor.
• 12:57
  SPEAKER_01: Yeah, that's really amazing.
• 12:58
  SPEAKER_01: And I would completely agree with you about the sense of community that has then been created in the middle of this pandemic and hearing about the ways many divisions had to come together and work together in the hospitals, both at Parkland and at the UT side, it's heartwarming in a real way because I think it's a time when many of us realize that we had to put aside our own individual interests, let's say, collectively speaking, and really come together for a common good.
• 13:26
  SPEAKER_01: And you know, everything that you said about Parkland and the patient population that's there is amazing.
• 13:32
  SPEAKER_01: And of course, it's one of the top reasons that many of our faculty, trainees, and students, and other staff actually come to this campus, come to be a part of UT Southwestern.
• 13:42
  SPEAKER_01: And many of that is specifically to be able to provide care for the patients at Parkland and in the Parkland system.
• 13:50
  SPEAKER_00: It certainly is what brings me joy, honestly, even in the hard days, getting to be part of this response and for this patient population and part of this health system at UT and Parkland and BA and children's, and being a part of that huge collaborative effort to care for patients and protect the staff.
• 14:11
  SPEAKER_00: It's just been really awesome.
• 14:13
  SPEAKER_00: And speaking of the faculty, trainees, and students, one of the areas that really did get exposed by this pandemic is the importance of occupational health.
• 14:22
  SPEAKER_00: We have a bit of a unique situation here in that most of the residents and fellows are actually employed by Parkland, a few of them being employed by UT Southwestern and Children's, while the faculty and the students of all different kinds are actually UT, sort of they interface with the occupational health team on the UT Southwestern side.
• 14:46
  SPEAKER_00: Do you mind talking a little bit more about that, Juliana?
• 14:48
  SPEAKER_00: It's a very unique situation to navigate those differences and how that impacts those people with different occupational health porting structures.
• 14:58
  SPEAKER_01: Absolutely.
• 14:59
  SPEAKER_01: And of course, with occupational health containing really privileged information about the employees and students and residents, one of the biggest things that we had to do was be able to facilitate more communication between the two occupational health departments.
• 15:14
  SPEAKER_01: This certainly has put a highlight on occupational health.
• 15:17
  SPEAKER_01: It came into the spotlight, really emphasized the invaluable and often behind-the-scenes types of service they provide.
• 15:24
  SPEAKER_01: We tend to think of occupational health as doing the annual TB testing or fit testing or if we had a bloodborne pathogen exposure.
• 15:32
  SPEAKER_01: As you mentioned, the occupational health team at UT Southwestern oversees the faculty, learners, and all of our other clinical and non-clinical staff at the university hospitals, but then also at more than 100 ambulatory clinics spread throughout North Texas, our research facilities, and this encompasses a whopping, you know, nearly 19,000 individuals.
• 15:56
  SPEAKER_01: Our faculty and our learners rotate from different clinical sites on and off campus, including many ambulatory settings within the UT Southwestern system, but then also at Parkland.
• 16:06
  SPEAKER_01: Many of us would serve on the consult services at Parkland, and the Parkland House staff would be coming over to UT Southwestern for some of the medicine services and other specialties.
• 16:16
  SPEAKER_01: So this really highlighted the absolutely essential nature of aligning our occupational health protocols, not only with regard to travel and then community and workplace exposures, but of course, and even maybe more importantly, employees.
• 16:31
  SPEAKER_01: And when I say employees, I do mean residents, trainees, and learners as well.
• 16:36
  SPEAKER_01: Employees who were ill or who then tested positive.
• 16:39
  SPEAKER_01: We needed to really make sure that the same set of guidance was being followed for residents and faculty, especially in the context of any workplace exposures.
• 16:48
  SPEAKER_01: I think there was a lot of confusion, a lot of angst when you'd have individuals in a team being given slightly different recommendations about whether or not they were going to be furloughed, et cetera.
• 16:59
  SPEAKER_01: And what we realized was a lot of occupational health still is quite nuanced.
• 17:04
  SPEAKER_01: There's only so much that you can actually put into an algorithm.
• 17:08
  SPEAKER_01: And really the rest of it, to some degree, has to be done on a case-by-case basis.
• 17:13
  SPEAKER_01: We really had to increase the amount of staff working in our occupational health area.
• 17:20
  SPEAKER_01: And with the hospital and the system kind of shutting down in March and in April and everybody really working from home, this did make available many individuals who did not have, say, any work types of responsibilities at that time.
• 17:32
  SPEAKER_01: We were able to leverage that to bring them into occupational health.
• 17:37
  SPEAKER_01: There was a lot of using process maps to help make sure that our processes were thorough.
• 17:43
  SPEAKER_01: And then, of course, relying on IR and IT support to be able to bring things online so that it was less of a manual effort for wherever it was possible to be able to do so.
• 17:55
  SPEAKER_01: So, I mean, I'd say that where we are now with occupational health compared to where we were in the beginning, it's it's a huge, vast difference.
• 18:03
  SPEAKER_01: And it's really been, I think, phenomenal.
• 18:06
  SPEAKER_00: One of the most pivotal moments for us was actually having one of our ID faculty become the point person for all the AUC health-related issues, spanning across Parkland and ET Southwestern.
• 18:19
  SPEAKER_00: It really encouraged more open communication between both our AUCH Health teams and it allowed us to train both of them in using the same set of protocols, especially when we started restricting travel and more recently when we put protocols in place for screening of all the employees for symptoms.
• 18:38
  SPEAKER_00: And I think that was really instrumental and a huge area of cooperation that both institutions, which are separate fiscal entities, would also allow us to have one of our sort of centralized team coordinated response from both.
• 18:54
  SPEAKER_01: Of course, May and June brought new concerns.
• 18:57
  SPEAKER_01: The highly anticipated arrival of new interns, fellows, and students coming from all over the US and even around the world.
• 19:04
  SPEAKER_01: It was vital really at that time for infection prevention and occupational health to then work with medical school and GME leadership so that we could assess the incoming folks for symptoms, any risk factors such as exposures to COVID, whether it be from close contacts, through any of their clinical work that they had been doing, or through travel from hotspots, which at that time was pretty heavily the Northeast, Pacific Northwest, California, and then several other cities.
• 19:34
  SPEAKER_01: At the time, the state of Texas required a 14-day quarantine for people coming in from certain states, such as New York, New Jersey, and some of these other hotspots.
• 19:44
  SPEAKER_01: And we quickly realized that if we were to furlough the more than 500 trainees alone, it would significantly impact our residency and fellowship training programs, knowing that not everyone would be able to be here for 14 days prior to their start date.
• 20:04
  SPEAKER_01: In a way, we kind of lucked out, although it wasn't purely luck.
• 20:08
  SPEAKER_01: I know there was a lot of our faculty and other infectious disease colleagues in the city and in the state working with the governor on this.
• 20:16
  SPEAKER_01: So we kind of lucked out when the trainees were considered essential personnel, then when the mandatory quarantine order was lifted by the governor, I think most academic medical centers probably breathed at least a partial sigh of relief that they wouldn't have to do a mandatory furlough.
• 20:33
  SPEAKER_01: So I know that that raised other concerns and questions.
• 20:37
  SPEAKER_01: So why don't you tell us a little bit more about what we then had to do since we knew we didn't have to furlough all of these incoming trainees?
• 20:44
  SPEAKER_00: I guess it did make onboarding a little easier in some ways.
• 20:49
  SPEAKER_00: Many of us were still concerned about the risk of importing infection from outside of the state.
• 20:54
  SPEAKER_00: We were actually at that time not a hotspot.
• 20:57
  SPEAKER_00: Now we are.
• 20:59
  SPEAKER_00: So that does change sort of the perspective a little bit.
• 21:01
  SPEAKER_00: But since we weren't furloughing the trainees who were going to be coming into our institutions, it was really imperative that we monitor them for symptoms.
• 21:12
  SPEAKER_00: It was challenging, but we were able to do that by working with our IT colleagues to create an electronic symptom diary for them to complete for 14 days after their arrival so that we can kind of be actively monitoring folks to make sure we don't miss anything.
• 21:30
  SPEAKER_00: Julie, throughout the past few months, what do you think has been UT Southwestern's strong point with regard to this pandemic?
• 21:40
  SPEAKER_01: That's a really great question.
• 21:42
  SPEAKER_01: One area that we tend not to think about as far as our response to a pandemic is really our relationship with the media, marketing, and communications team.
• 21:54
  SPEAKER_01: This has been a real forte at UT Southwestern.
• 21:57
  SPEAKER_01: And of course, if you go to our COVID 19 Website, you'll be able to see the vast array of information that is kept there, but also much of the messaging that has been sent out to our patients and communities.
• 22:11
  SPEAKER_01: What we found is that when there's so much uncertainty due to rapidly evolving situations, literature that was coming out faster than you can keep up with, when guidelines andor recommendations from many of our public health agencies or even experiences from our other academic medical centers or other institutions, with so much uncertainty surrounding these things and the pace at which this information was coming to light.
• 22:39
  SPEAKER_01: One of the most impactful things I believe an institution can do is to have really frequent and effective communication, not only with its employees, but also with its patients and the overall community at large.
• 22:53
  SPEAKER_01: For us, this started out small in the form of our internal medicine grand rounds in March.
• 22:58
  SPEAKER_01: We presented at that together.
• 23:00
  SPEAKER_01: And this was there to help update our colleagues on the unfolding situation.
• 23:05
  SPEAKER_01: And it was quite interesting because that was also the first day that internal medicine grand rounds were to be held virtually since we had campus-wide restrictions on the number of people that could get together in any type of a room.
• 23:16
  SPEAKER_01: And then these communications really broadened out to the wider UT Southwestern community in the form of town hall sessions that we have done.
• 23:24
  SPEAKER_01: We've had interview-style videos with various experts in infection prevention, antibiotic stewardship, but as well as looking at things like COVID and cancer or COVID and pediatrics.
• 23:36
  SPEAKER_01: So thinking about the different areas that people might have questions about, especially as the situation continued to evolve over time.
• 23:45
  SPEAKER_01: We also had widespread social media campaigns and interviews with the press.
• 23:50
  SPEAKER_01: This was to highlight our epidemiologic modeling that was going on, as well as to shed some light on the extensive involvement with research protocols and campus-wide research that was going on.
• 24:03
  SPEAKER_01: And then, of course, in general, how to stay safe in the pandemic.
• 24:06
  SPEAKER_01: What we found was that many people in the community were hungry for this information.
• 24:12
  SPEAKER_01: And with so much coming out in the media, it was hard for most people to really filter out what was relevant, what was maybe not relevant.
• 24:20
  SPEAKER_01: We were able to serve that role for large portions of our community.
• 24:25
  SPEAKER_01: And I think in that sense, it creates, it creates a sense of trust within the institution.
• 24:31
  SPEAKER_01: There's evidence of transparency and really an opportunity for leadership to be able to acknowledge and accept the uncertainty that we're all facing.
• 24:42
  SPEAKER_01: It allowed a forum for many of our faculty and directors to be able to ask questions about either things that they were witnessing or experiencing.
• 24:52
  SPEAKER_01: In this, we had created several email boxes dedicated to COVID questions, whether from our patients, employees, or the business community to help keep everyone informed.
• 25:03
  SPEAKER_01: I certainly have enjoyed these close interactions with my colleagues.
• 25:07
  SPEAKER_01: It has certainly really been a highly visible time in history for infectious disease specialists, public health specialists, epidemiologists to really be standing at the forefront trying to present the science and expert advice on something that, of course, has generated a lot of conflict or tension in the country at large.
• 25:27
  SPEAKER_01: Carolee, I've been curious about something.
• 25:30
  SPEAKER_01: You just completed your infectious disease fellowship from UT Southwestern in 2017.
• 25:36
  SPEAKER_01: And you took on this role of being the Associate Chief of Hospital Epi and for the past several months have also been serving as the interim chief of hospital epidemiology for Parkland Hospital.
• 25:48
  SPEAKER_01: I'd really like to hear from your perspective what has it been like dealing with the pandemic so early in your career?
• 25:54
  SPEAKER_01: And what words of encouragement or wisdom would you have for other early career professionals?
• 26:00
  SPEAKER_00: That is quite the question.
• 26:02
  SPEAKER_00: It's difficult to articulate, honestly, because this is kind of, I don't want to say what you dream for when you decide to go into healthcare epidemiology or applied epidemiology of any kind, really.
• 26:14
  SPEAKER_00: But it's been extremely exciting for me to be in on the ground floor and really sort of, at least for my little pocket of the world or my community, kind of in the center of a pandemic.
• 26:29
  SPEAKER_00: And outbreaks are what attracted me to the epidemiology component of medicine and infectious diseases.
• 26:37
  SPEAKER_00: I didn't know it when I went to medical school that I was interested in those things.
• 26:42
  SPEAKER_00: But for whatever reason, I just kind of kept following the trail toward that and got really lucky to have been able to come on board straight out of fellowship at a large academic center as associate chief for infection prevention at a really incredible institution, not just UT Southwestern, but I really mean Parkland.
• 27:03
  SPEAKER_00: It's a very large safety net hospital for a pretty large city, county.
• 27:09
  SPEAKER_00: And it's been a real honor.
• 27:12
  SPEAKER_00: I have learned so much.
• 27:14
  SPEAKER_00: I think that my two and a half years getting to be part of this team in particular has been worth more than two and a half years of experience with all the different things, even pre-COVID, just the amount of experiences that I've had and the wealth of resource that's here from a healthcare epidemiology standpoint.
• 27:34
  SPEAKER_00: There is so much here.
• 27:37
  SPEAKER_00: It's been an absolute honor to be part of this team.
• 27:42
  SPEAKER_00: I've learned a lot.
• 27:43
  SPEAKER_00: A pandemic teaches you a lot about yourself, your institution, and your community.
• 27:49
  SPEAKER_00: This is the field to be in.
• 27:51
  SPEAKER_00: There's anybody out there that's infectious diseases fellows or internal medicine residents or even surgeons or medical students, anybody, the opportunity to get to be there for your community in such a massive way, because you're not just protecting your patients and taking care of patients on a large scale.
• 28:11
  SPEAKER_00: You're also protecting the staff that are taking care of them.
• 28:14
  SPEAKER_00: And the impact of that is huge.
• 28:17
  SPEAKER_00: And while sometimes it can feel weighty, it really is an honor and a real sense of kind of purpose if that's something that you find important for your career fulfillment aspects.
• 28:28
  SPEAKER_00: I think that this career in healthcare epidemiology has been one of the best decisions for me.
• 28:36
  SPEAKER_00: I encourage anybody to consider it because you get a little bit of the best of both worlds.
• 28:42
  SPEAKER_00: People talk about being able to care for the individual, and we get to do that still.
• 28:46
  SPEAKER_00: We get to take care of our patients on an individual basis, but we also get to take care of the population.
• 28:52
  SPEAKER_00: And now, normally the population is just our patients in our hospital and making sure that we mitigate their risk of infections while they're here.
• 29:01
  SPEAKER_00: But in this pandemic, that turns into your entire community.
• 29:06
  SPEAKER_00: And by way of your community, even your country.
• 29:10
  SPEAKER_00: And I like seeing the teamwork, the way people come together.
• 29:13
  SPEAKER_00: I think the opportunity to get to be part of the education and action has been incredible.
• 29:21
  SPEAKER_01: I don't think I could have said it any better myself.
• 29:24
  SPEAKER_01: And I echo all of those sentiments.
• 29:27
  SPEAKER_01: Hopefully, this will have a positive impact.
• 29:30
  SPEAKER_01: And it seems like it might be on people who are now interested in infectious diseases as a career because it seems like there are more people who have been looking into infectious disease fellowship programs.
• 29:40
  SPEAKER_01: And of course, as you know, we begin to move towards doing that for the interview season in a virtual platform, it'll be really important.
• 29:48
  SPEAKER_01: There's one thing that I would say about you.
• 29:50
  SPEAKER_01: I don't think it was luck that brought you that position.
• 29:53
  SPEAKER_01: I think that you are a brilliant, intelligent, charismatic, and well-spoken individual.
• 29:58
  SPEAKER_01: And you have certainly been such an important and vital contributor to everything that has gone on at the institution.
• 30:05
  SPEAKER_01: So we truly value everything that you have brought, which is really remarkable, especially since it's only been about two and a half years with us.
• 30:12
  SPEAKER_00: You're very kind.
• 30:14
  SPEAKER_00: Thank you so much, Julie.
• 30:15
  SPEAKER_00: And you have been so wonderful and a great role model and mentor as well.
• 30:20
  SPEAKER_01: And with that, some very wise words of wisdom from Dr.
• 30:23
  SPEAKER_01: Carolie Estelle.
• 30:25
  SPEAKER_01: Carolie, thank you for speaking with me today and sharing your perspectives and experiences.
• 30:29
  SPEAKER_00: Thank you for having me and for developing the idea behind this discussion.
• 30:34
  SPEAKER_00: Also, we want to give a sincere thank you from Shay and to all healthcare personnel for everything you're doing to respond to COVID-19.
• 30:45
  SPEAKER_01: This podcast can be accessed on Shay's Online Education Center, Learning CE, under the Rapid Response Program.
• 30:52
  SPEAKER_01: You will also find additional resources such as the recorded webinars, Healthcare Facility Outbreak Preparedness, and SHAY COVID-19 Town Halls, as well as the additional podcast series, COVID-19 update, What We Know Now, which is released every Thursday.
• 31:09
  SPEAKER_01: We conclude this episode of the Allies and Infection Prevention Podcast Series.
• 31:13
  SPEAKER_01: Thank you for tuning in.