Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: Part I: Innovations in Pain Fellows’ Education, Research, Applicant Selection Process, Wellness, and ACGME Implementation During the COVID-19 Pandemic

Kohan, Lynn; Moeschler, Susan M.; Spektor, Boris; Przkora, René; Sobey, Christopher M.; Brancolini, Scott; Wahezi, Sayed E.; Anitescu, Magdalena

doi:10.1093/pm/pnaa168

Cited by 16 publications

(8 citation statements)

References 13 publications

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“…6 US directors of pain programmes have developed detailed guidance on adapting training. 7,8 Many countries have redeployed non-anaesthesia trainees to ICU, an unsettling and challenging time for those affected. 9 In Dublin, anaesthesia trainees supported redeployed peers from surgery and psychiatry introducing them to ICU in a safe and controlled manner.…”

Section: Teachingmentioning

confidence: 99%

Impact of the COVID-19 pandemic on anaesthesia trainees and their training

Sneyd

Mathoulin

O’Sullivan

et al. 2020

British Journal of Anaesthesia

109

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Coronavirus disease 2019 (COVID-19; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] has dislocated clinical services and postgraduate training. To better understand and to document these impacts, we contacted anaesthesia trainees and trainers across six continents and collated their experiences during the pandemic. All aspects of training programmes have been affected. Trainees report that reduced caseload, sub-specialty experience, and supervised procedures are impairing learning. Cancelled educational activities, postponed examinations, and altered rotations threaten progression through training. Job prospects and international opportunities are downgraded. Workrelated anxieties about provision of personal protective equipment, and risks to self and to colleagues are superimposed on concerns for family and friends and domestic disruption. These seismic changes have had consequences for wellbeing and mental health. In response, anaesthetists have developed innovations in teaching and trainee support. New technologies support traineretrainee interactions, with a focus on e-learning. National training bodies and medical regulators that specify training and oversee assessment of trainees and their progression have provided flexibility in their requirements. Within anaesthesia departments, support transcends grades and job titles with lessons for the future. Attention to wellness, awareness of mental health issues and multimodal support can attenuate but not eliminate trainee distress.

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Section: Teachingmentioning

confidence: 99%

Impact of the COVID-19 pandemic on anaesthesia trainees and their training

Sneyd

Mathoulin

O’Sullivan

et al. 2020

British Journal of Anaesthesia

109

View full text Add to dashboard Cite

show abstract

“…Among the more than 50,000 peer-reviewed articles that have been published since January 2020 on COVID-19 infection, only a handful have been devoted to how the disease affects pain, with nearly all focusing on logistical (eg, risk mitigation strategies and patient triage) and educational issues. [10][11][12] To date, there have been no major studies on pain manifestations caused by COVID-19 infection.…”

mentioning

confidence: 99%

Pain Manifestations of COVID-19 and Their Association With Mortality: A Multicenter Prospective Observational Study

Knox

Lee

Moon

et al. 2021

Mayo Clinic Proceedings

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Objectives To determine the prevalence and breakdown of pain complaints among COVID-19 patients admitted for non-pain symptoms, and the association between the presence of pain and ICU admission and death. Patients and Methods In this multi-center prospective study, data on the intensity and type of pain was collected on 169 patients with active SARS-CoV-2 infection at 2 teaching hospitals in the U.S. and Korea and on 8 patients with acute pain at another large teaching hospital between February 1, 2020 and June 15, 2020. Results Sixty-five (38.5%) of 169 patients reported an active pain condition. The most common pain complaints were headache (n=22, 30.1%), chest pain (n=17, 23.6%), spinal pain (n=18, 24.7%), myalgia (n=13, 18.1%), abdominal or pelvic pain (n=13, 17.8%), arthralgia (n=11, 15.3%), and generalized pain (n=9, 12.5%). Those reporting headache as their main complaint were less likely to require intensive care unit (ICU) admission (P = .003). Acetaminophen or NSAIDs were prescribed to 80.8%, opioids to 17.8%, adjuvants to 8.2% and ketamine to 5.5% of pain patients. When age ≥ 65 years and sex were controlled for in multivariable analysis, the absence of pain was associated with ICU admission (OR 2.92; 95% CI 1.42–6.28; P = .004) and death (OR 3.49; 95% CI 1.40–9.76; P = .01). Conclusions Acute pain is common during active COVID-19, and may affect multiple organ systems. Reasons why pain may be associated with reduced mortality include that an intense systemic stimulus (e.g. respiratory distress) might inhibit pain signals or that the catecholamine surge associated with severe respiratory distress might attenuate nociceptive signaling.

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“…5 Furthermore, before the pandemic, trainees often faced long hours, mistreatment at work, 19 and a burdensome electronic health record system [20][21][22] thought to contribute to high levels of burnout and depression. [23][24][25] With this study, we sought to understand the unique experience of trainees working and learning during the height of the pandemic at the Mount Sinai Hospital (MSH), an urban tertiary care hospital in New York City (NYC), the initial epicenter of the COVID- 8,11,26,27 with some focusing on specific GME populations, 15,16,[28][29][30][31][32][33] this study is the first to our knowledge to specifically evaluate the risk for psychopathology and burnout experienced by trainees during COVID-19 across specialties, and the occupational and personal correlates of such outcomes. By examining the relationship of work-related and personal factors with psychiatric symptoms and burnout, as well as assessing trainee worries and desired interventions, we hope to highlight opportunities for intervention and aid leaders in combating trainee distress during and after the crisis.…”

Section: Discussionmentioning

confidence: 99%