The COVID-19 pandemic has altered approaches to anesthesiology education by shifting educational paradigms. This vision paper discusses pre-COVID-19 educational methodologies and best evidence, adaptations required under COVID-19 and evidence for these modifications and suggests future directions for anesthesiology education.Learning management systems provide structure to online learning. They have been increasingly utilized to improve access to didactic materials asynchronously. Despite some historic reservations, the pandemic has necessitated a rapid uptake across programs. Commercially available systems offer a wide range of peer-reviewed curricular options.The flipped classroom promotes learning foundational knowledge prior to teaching sessions with a focus on application during structured didactics. There is growing evidence that this approach is preferred by learners and may increase knowledge gain. The flipped classroom works well with learning management systems to disseminate focused pre-class work. Care must be taken to keep virtual sessions interactive.Simulation, already used in anesthesiology, has been critical in preparation for the care of COVID-19 patients. Multidisciplinary, in-situ simulations allow for rapid dissemination of new team workflows. Physical distancing and reduced availability of providers have required more sessions. Early pandemic decreases in operating volumes have allowed for this; future planning will have to incorporate smaller groups, sanitizing of equipment, and attention to use of personal protective equipment.Effective technical skills training requires instruction to mastery levels, use of deliberate practice, and high-quality feedback. Reduced sizes of skills training workshops and approaches for feedback that are not in-person will be required.Mock oral and OSCE examinations allow for training and assessment of competencies often not addressed otherwise. They provide formative and summative data and objective measurements of ACGME Milestones. They also allow for preparation for the ABA APPLIED examination. Adaptations to teleconferencing or videoconferencing can allow for continued use.Benefits of teaching in this new era include enhanced availability of asynchronous learning and opportunities to apply universal, expert-driven curricula. Burdens include decreased social interactions and potential need for an increased amount of smaller, live sessions.Acquiring learning management systems and holding more frequent simulation and skills sessions with fewer learners may increase cost. With the increasing dependency on multimedia and technology support for teaching and learning, one important focus of educational research is on the development and evaluation of strategies that reduce extraneous processing and manage essential and generative processing in virtual learning environments. Collaboration to identify and implement best practices has the potential to improve education for all learners.

Educating Anesthesiologists During the Coronavirus Disease 2019 Pandemic and Beyond.

Background: Obstetrics and Gynaecology (O&G) is an evolving specialty that encompasses women's health at its core The COVID-19 pandemic has caused significant patient care challenges, however simultaneously it has resulted in the interruption of clinical training and cessation of all elective work Our primary aim was to assess the impact of the pandemic on the experiences of O&G trainees Methods: An email invite was sent to all 127 O&G trainees in Kent, Surrey and Sussex (KSS), inviting them to participate in an anonymous 33-question survey The survey data was collected and analysed over a 4-week period Results: Of the 127 trainees sent the survey, 87 responded (69%) 39% and 75% of trainees agreed that the pandemic had a negative impact on their overall physical and mental wellbeing respectively 43% agreed that the COVID-19 pandemic had adversely affected their obstetric training experience whilst almost all trainees stated a significant negative impact on benign gynaecology surgical training Reassuringly, over 80% were positive they would recover from the negative impacts of COVID-19 Conclusions: It is evident that COVID-19 has impacted O&G trainees in several ways Whilst we face uncertain times, we must firstly ensure the physical and mental well-being of all trainees It is encouraging that non-emergency consultations and benign surgery are being restarted nationwide and whilst this will inevitably help with re-booting surgical training, we must also think "outside" the box and utilise other modes of teaching and training to safeguard learning whilst mitigating against the negative impacts of subsequent waves

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The impact of COVID-19 on obstetrics and gynaecology trainees;how do we move on?

The educational and psychological impact of the COVID-19 pandemic on medical students: A descriptive survey at the American University of Beirut.

Background This study aimed to measure the levels of anxiety and burnout among healthcare workers, including attending physicians, residents, and nurses in intensive care units during the coronavirus disease 2019 (COVID-19) pandemic. Methods This is a cross-sectional survey analysis of healthcare workers in our institution. Data were collected on demographic variables, COVID-19 symptoms and test, disease status, anxiety level (assessed by the Beck Anxiety Inventory), and burnout level (measured by the Maslach Burnout Inventory). Subscales of the burnout inventory were evaluated separately. Results A total of 104 participants completed the survey. Attending physicians, residents, and nurses constituted 25%, 33.7%, and 41.3% of the cohort, respectively. In comparison to untested participants, those tested for COVID-19 had a lower mean age (p = 0.02), higher emotional exhaustion and depersonalization scores (p = 0.001, 0.004, respectively), and lower personal accomplishment scores (p = 0.004). Furthermore, moderate to severe anxiety was observed more frequently in tested participants than untested ones (p = 0.022). Moderate or severe anxiety was seen in 23.1% of the attending physicians, 54.3% of the residents, and 48.8% of the nurses (p = 0.038). Emotional exhaustion, personal accomplishment, and depersonalization scores differed depending on the position of the healthcare workers (p = 0.034, 0.001, 0.004, respectively). Conclusion This study revealed higher levels of anxiety and burnout in younger healthcare workers and those tested for COVID-19, which mainly included residents and nurses. The reasons for these observations should be further investigated to protect their mental health.

Anxiety and burnout in anesthetists and intensive care unit nurses during the COVID-19 pandemic: a cross-sectional study.

PURPOSE OF REVIEW: The recent global pandemic has dramatically altered the anaesthesiology educational landscape in unexpected ways. It is important that we pause to learn from this crisis. RECENT FINDINGS: Most resident trainees actively caring for COVID-19 patients present with probable or subclinical finding of post-traumatic stress disorder. Anaesthesia resident training programmes evolved to continue the mission of anaesthesia education in the face of institutional restrictions and evolving clinical crises. SUMMARY: The recent global COVID-19 pandemic has illustrated how external stressors can cause significant disruption to traditional medical education pathways. Resilience to external disruptive forces in anaesthesia education include a willingness of leadership to understand the problem, flexibility in adapting to the needs of learners and instructors in the face of key challenges, deployment of technology and innovation-minded solution-finding where appropriate, and attention to Maslow's hierarchy of needs. VIDEO ABSTRACT: http://links.lww.com/COAN/A77.

Graduate medical education in anaesthesiology and COVID-19: lessons learned from a global pandemic.

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. Work-related 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 well-being and mental health. In response, anaesthetists have developed innovations in teaching and trainee support. New technologies support trainer-trainee 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.

Caitlynn J. Miller

Papers

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