Abstract
Keywords
Modified Maslow's Framework
Adapted Maslow Need | Theme | Categories | Examples of Potential Interventions | ||
---|---|---|---|---|---|
Extrainstitutional | Institutional | Department/Program | |||
Physiologic | Food | Food while working | Extra money on meal cards | Provide meals while in hospital/clinic | |
Food at home | Community-provided meals to health care workers | Hospital-sponsored groceries Gift cards for food-delivery services Volunteer network provide groceries | Gift cards for food-delivery services | ||
Sleep | Sleep on-call | ACGME work hour restrictions - pandemic status | Additional call rooms | ||
Respite lodging | State/local lodging for health care workers | Respite housing | |||
Physical health | COVID-19 screening and testing | COVID-19 testing stations in community | Illness screening Temperature screening Sufficient expedited COVID-19 testing Track COVID-19 exposure and testing | Track COVID-19 exposure and testing | |
COVID-19 illness management | Track sick residents Clinical monitoring Occupational health Isolation policies Return to work criteria | Track sick residents Communication about processes Adequate back-up systems | |||
Mental health | Mental health hotlines for health care workers Web-based mindfulness resources | On-call mental health provider On-line telehealth Employee and family assistance program Director of trainee well-being Stress and resilience town halls and webinars Web-based meditation | Screening for mental health Centralized resource list Debriefing of teams - scheduled and as needed Check-ins by Program Directors, chief residents Group discussions facilitated by mental health provider | ||
Childcare | State-supported daycare facilities for health care workers Assistance with paying for increased costs of childcare | Institutional daycare Volunteer network Affiliations with childcare agencies Assistance with paying for increased costs of childcare | Centralized resource list Resident childcare sharing Flexible scheduling Parenting/newborn elective | ||
Safety | Personal safety | Personal protective equipment (PPE) | ACGME requirements | Adequate PPE PPE training Infection control training | PPE training Just-in-time training Adherence to infection control |
Accommodation of high risk individuals (pregnancy, immunocompromised, etc.) | Institutional policies defining high-risk population | Scheduling to accommodate high-risk individuals | |||
Safety of family | Short- and long-term housing (for COVID-19 exposure and positive) Shower near work Disinfection protocol Scrubs for work | Centralized information re: disinfection protocol and housing Scrubs for work | |||
Financial security | Job insecurity (personal or spouse) | Governmental subsidies | Counseling about job alternatives | ||
Additional expenses | Paid leave of absence Childcare subsidy | ||||
Schedule and patient care responsibilities | Vacation policy Schedule for COVID-19 surge | Short- and long- term schedules, including vacation COVID-19 surge coverage | |||
Sense of belonging | Social support from colleagues | APPD virtual events | Virtual institutional and departmental town halls | Group-based learning activities Town halls, meetings Group-based virtual social activities: games, competitions, happy hours, journaling Email updates | |
Social support from friends and family | Technology (ie, ZOOM Webex, etc.) to connect with friends and family | ||||
Esteem | Appreciation by and for others | Expressions of appreciation | Community appreciation | Additional compensation Departmental appreciation | Shout-outs, expressions of gratitude, virtual graduation, gift certificates |
Self-identity as physician | Engagement in meaningful activities | Remote into rounds, electives, advocacy work, scholarship | |||
Caring for adult patients | Adequate supervision and teaching Communication scripts | Collaboration with Internal Medicine (IM), Med-Peds program leadership | IM bootcamp, supervision by IM and Med-Peds faculty Communication training | ||
Self-actualization | Mentoring | Faculty mentoring program | |||
Curriculum | Structure and content | ABP allowing PD to request waivers for graduating trainees | Development of new curricula (eg, new rotations or electives, telehealth, web-based curricula) | ||
Telehealth to promote physical distancing | ACGME requirements for education, including telehealth CMS revising teaching attending rules for telehealth | Institutional policies in regard to telehealth and trainees Telehealth equipment | Training residents in telehealth Telehealth equipment Appropriate supervision of residents with telehealth | ||
Career development | APPD and COPS resources and guidelines for application to residency and fellowship programs | Virtual career mentoring by departmental chair, faculty, educational and program leaders | Virtual career mentoring, facilitate networking, provide exposure to trainees’ fields of interest, support CV development |
Physiologic Needs
Food
Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements (Residency). ACGME approved major revision. 2018; effective: July 1, 2019. Available at:https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2019.pdf. Accessed June 24, 2020.
Sleep
Accreditation Council for Graduate Medical Education. Stage 3: pandemic emergency status guidance. 2020. Available at:https://www.acgme.org/COVID-19/Stage-3-PandemicEmergency-Status-Guidance. Accessed June 24, 2020.
Physical Health
Mental Health
Childcare
Safety
Personal Protective Equipment
Accreditation Council for Graduate Medical Education. Stage 3: pandemic emergency status guidance. 2020. Available at:https://www.acgme.org/COVID-19/Stage-3-PandemicEmergency-Status-Guidance. Accessed June 24, 2020.
High-Risk Conditions
Family Safety
Financial Insecurity
Routine Schedule
Sense of Belonging
Social Support From Program
Social Support From Families and Friends
Esteem Needs
Appreciation by and for Others
Self-Esteem
Self-Actualization
How to Lead Educational Change Using Kotter's 8-Step Change Management Framework
Kotter's 8 Steps to Leading Change | Examples of Leading Change During the COVID-19 Pandemic |
---|---|
| COVID-19 pandemic disrupts in-person direct patient care and education Trainee duration of training remains unchanged Public continues to expect graduation of competent physicians Strengths – Dedicated faculty interested in education, clinical care, and trainee wellness Weaknesses – Lack of telemedicine and tele-education Opportunities – Leverage telemedicine and tele-education to improve education for trainees Threats – Mandated physical distancing; ACGME and ABP requirements |
| Program leadership (program director, associate program directors, coordinators, chief residents) Chair, Designated Institutional Official Faculty Trainees |
| Keep trainees safe Deliver excellent patient care Educate our next generation of pediatricians Strategies: Leverage telemedicine and tele-education to deliver excellent patient care and educate our trainees while minimizing infection risk |
| Communicate frequently and regularly Use multiple communication modalities (email, teleconference, texts, postings, etc.) Create on-line repository of most up-to-date information Acknowledge plans evolve Be transparent about reasons behind changes |
| Empower faculty and trainees to engage in interactive distance learning modalities and telemedicine Provide faculty development in best practices for telemedicine and tele-education Install teleconferencing software, microphones and video cameras on existing computers Encourage members of guiding coalition to experiment with tele-education |
| Front-load didactic schedule with faculty willing to experiment with novel tele-education modalities Work closely with faculty to implement interactive remote teaching Recognize faculty who effectively utilize novel ways to engage learners with tele-education |
| Share best practices of how faculty engage with learners remotely Advocate for changes in your local institution Advocate within APPD, COPS, and COMSEP for flexibility for programs/trainees to meet ACGME, ABP, LCME requirements |
| Provide feedback to faculty about learner response to changes Develop faculty champions |
Establish a Sense of Urgency
Create a Guiding Coalition
Create a Shared Vision
Communicate the Vision
Empower Others to Act
Create Short-Term Wins
Consolidate Improvement
Institutionalize New Approaches
Conclusions
Acknowledgment
References
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- A theory of human motivation.Psychol Rev. 1943; 50: 370-396
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- Leading change: why transformation efforts fail.Harvard Business Rev. 2007;
Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements (Residency). ACGME approved major revision. 2018; effective: July 1, 2019. Available at:https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2019.pdf. Accessed June 24, 2020.
Accreditation Council for Graduate Medical Education. Stage 3: pandemic emergency status guidance. 2020. Available at:https://www.acgme.org/COVID-19/Stage-3-PandemicEmergency-Status-Guidance. Accessed June 24, 2020.
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Article info
Publication history
Footnotes
The authors have no conflicts of interest to disclose.