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The life-threatening risk of the COVID-19 pandemic has caused considerable mental health problems including anxiety, depression, and post-traumatic stress disorder in healthcare workers. 1,2 Although people respond to adversity and stress in various ways, there is evidence that people can positively change their perspectives and experience personal growth as a result of major life crisis or traumatic events. This process is known as post-traumatic growth (PTG) and was first described by Tedeschi and Calhoun in 1996. 3 PTG is characterized by positive adjustments that occur following severe traumatic experiences and includes five major aspects: forging stronger relationships with others, increased perception of personal strength, willingness to embrace new possibilities, deeper appreciation of life, and increased spirituality. 3 Since the COVID-19 pandemic, researchers have refocused their lens on assessing the PTG of front-line health care workers such as doctors and nurses. However, research to date has not investigated PTG in general surgery residents during the COVID-19 pandemic. As such, in December of 2020 we conducted an IRB-approved, multi-center survey of general surgery residents from four academic medical centers in Boston, MA. The survey consisted of 23-questions, including a modified Post-Traumatic Growth Inventory (PTGI) (supplement). 4 A total of 75 of 172 surveys were completed, for an overall response rate of 43.6%. Both female (46.7%) and male (53.3%) residents participated. The most positive COVID-19 related change reported by the surveyed general surgery residents was the feeling that they can rely on people in times of trouble, followed by increased compassion for others, greater sense of personal resilience, greater appreciation for their own life's value, greater sense of closeness with others and increased relationship efforts, changed priorities about what is important in life, increased willingness to express emotions and try to change situations that they are unsatisfied with, increased appreciation of each day, and appreciation of new opportunities (Fig. 1). Interestingly, our study showed that female residents reported greater growth than male residents in all components of the PTGI.

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Children who travel internationally to visit friends and relatives (VFRs) are at risk for travel-related illness, but underuse pretravel health services. Although primary care clinics can identify travelers and address pretravel health needs, to date, there are few published reports on effective primary care-based pretravel interventions. We developed a quality improvement initiative to increase traveler identification at a primary care clinic serving families that frequently travel to VFRs. Interventions included a screening question asked at all clinic visits, provider and staff training, travel fliers, and health recommendation sheets for families. Interventions were implemented during 2017 and 2018 peak travel seasons. Travel visit rates and characteristics during the intervention period were compared with pre-intervention baseline periods (April-August, 2015-16). Surveys with providers were conducted to assess disruptiveness of the interventions, and rates of duplicate travel visits were assessed. A total of 738 unique travel events were identified during peak travel seasons from 2015 to 2018, encompassing travel to 29 countries across five continents. Overall, there were 428 unique travel events (3.0% of all clinic visits) during peak seasons 2017-18, compared with 310 unique travel events (2.2% of all clinic visits) during peak seasons 2015-16 (rate ratio 1.34 [95% CI: 1.16-1.56], P < 0.001). None of the 18 healthcare providers or staff surveyed found new travel screening processes to be disruptive or bothersome. Implementation of a primary care-based multimodal travel screening and education initiative was associated with a significantly increased rate of travel visits.

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