key: cord-0876936-69wya3he
authors: Saygin, Didem; Lin, Jean; Rolle, Noelle A; Mamut, Mary
title: Report of the ACR Fellows‐in‐Training Subcommittee: Experiences of Rheumatology Fellows early in the COVID‐19 Pandemic
date: 2022-04-04
journal: Arthritis Rheumatol
DOI: 10.1002/art.42135
sha: f81efc22cd8c00102e0f844c526d178d006b585c
doc_id: 876936
cord_uid: 69wya3he

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The rapid spread of coronavirus disease 2019 (COVID-19) created challenges and uncertainty for rheumatology trainees. Many fellowship programs were forced to rapidly implement innovat ive methods to educate trainees while also attempting to safely maintain high quality patient care (1) .

How COVID-19 and these changes impacted trainee's well-being, and education were unclear.

To understand the early experiences of adult and pediatric rheumatology fellows during the COVID-19 pandemic, an anonymous electronic survey was created by ACR Fellows-in-Training (FIT) Subcommittee Members, and distributed to adult and pediatric rheumatology fellows-intraining via e-mail on 6/2/2020 and closed on 6/8/2020 by ACR. Early in the pandemic it was unclear how programs were addressing COVID's impact on fellowship training. Thus, the survey was rapidly distributed and closed in order to gain a snapshot into how COVID initially impacted fellowship education in order to generate discussion for fellow townhall and ACR sessions. The survey questions assessed how the pandemic effected three key areas: learning, patient care, and trainee resiliency. All questions were asked in multiple-choice format allowing respondents to select all the answer options that apply except for coping mechanisms and topics for town hall discussion, which were open-ended questions. Return of the survey indicated participant consent.

In total, 132 out of 722 (18.2%) US rheumatology fellows completed the survey (45% in the 1 st year, 43.6% in 2 nd year, 9.4% in the 3 rd year of their fellowship training). As seen in table 1, the three most commonly selected areas of concern included the impact of COVID-19 on their education, their physical health and safety as a clinician, and the rheumatology job market. For education, 51.2% of respondents reported that the in-person didactics became completely virtual and 91.4% reported that their clinics were changed to telemedicine or a hybrid of telemedicine and in-person.

The most commonly reported coping mechanisms included exercise, family and colleague support, and reading. The most commonly suggested topic for a virtual town hall was impact of the pandemic on rheumatology job market with specific concerns about hiring freeze, virtual job interviews, and salary negotiation. The next most requested topic was optimizing telemedic ine appointments, i.e., conducting virtual physical exams, ensuring thorough evaluation, and enhancing the telehealth visit experience for both patients and physicians. This is one of the first national reports focusing on experiences of rheumatology fellows early during the COVID-19 pandemic. The survey uncovered that the majority of FIT training was interrupted by the pandemic and highlighted that rheumatology FITs' main concerns centered around education and physical health. These results have the potential to meaningfully impact the fellowship training environments by addressing these FIT specific needs and concerns. Our survey has certain limitations. First, since the response rate was 18.2% and included only U.S. fellowship programs, it may not reflect the experience of trainees at large. Next, our results capture the experience of FITs during the early stages of the pandemic with a potential response bias. Thus, the survey may not fully reflect the current experiences of all the trainees. Based on these results, fellowship programs should maximize the resources to address concerns regarding education and physical safety of FITs. As there was a mixed impact of COVID 19 on fellow education and clinical responsibilities, program leadership can use the fellow concerns to guide and individualize rheumatology didactics and clinics to maximize learning opportunities for fellows. As there is uncertainty and interest in the future of rheumatology practice, programs and conferences should have sessions specifically addressing best telemedicine practices and job search during pandemic. Follow up studies are crucial to best understand the evolving needs of the rheumatology fellows during these unprecedented times. Table 1 . Areas of concern reported by rheumatology fellows, effect of pandemic on fellow education, and format of fellow clinics during the early phases of the COVID-19 pandemic.

Areas of concern as a result of COVID-19 pandemic (n=132) Education 72.6% Physical health and safety as a clinician 71.8% Impact on the rheumatology job market 69.2% Potential changes to how rheumatologists will practice medicine in the future (telemedicine) 

Telemedicine in Adult Rheumatology: In Practice and In Training