The Neglect of Educational Issues During the COVID-19 Pandemic.

Dear Editor,

The authors would like to thank Orhurhu et al. [1] for their commentary on our multi-organizational review on pain management best practices during COVID-19 [2] and particularly for their astute comments on the effect of the pandemic on the psychological health of pain medicine fellows. The findings of Orhurhu and colleagues in their informal survey of 16 current pain medicine fellows bring to light numerous important issues, including the pervasive and unforeseen consequences of this public health crisis.

Many of the issues cited by Orhurhu and colleagues are unfortunate, yet (in some respects) inevitable consequences of the pandemic (deployment to other areas, uncertainty with the job market, reduced volume of procedures, hiring freezes by many practices), while others might be remediable by better leadership (e.g., mixed messages across and within institutions, lack of consistent guidelines regarding testing). However, there are certain issues that can and should be addressed by institutional, program, and educational leadership, including assurances regarding graduation, the availability of personal protective equipment, and providing resources to address anxiety levels. In a recent survey sent to 100 Accreditation Council for Graduate Medical Education (ACGME)–accredited pain medicine fellowship program directors, Kohan et al. [3] found that approximately one-third reported that their fellows were experiencing high or very high levels of stress, but only slightly over half had division-specific strategies in place to deal with it.

In an attempt to address these critically unmet needs, the Association of Pain Program Directors recently published a comprehensive two-part series [4, 5] addressing several key issues that could potentially contribute to high levels of stress including how the ACGME will deal with potential gaps in training, strategies to promote wellness, detailed approaches to optimize job satisfaction, and a call to develop postgraduation mentorship programs to facilitate the successful transition to an independent work life. The availability of pragmatic approaches to manage career and personal stressors associated with the COVID-19 pandemic is important because studies have found that biased attention to threat, rather than the actual threat itself (which is often manageable), has the greatest impact on psychological well-being during crises [6].

In summary, the letter by Orhurhu and colleagues [1] provides keen insight into a subject that has received little attention thus far during the pandemic (<0.5% of publications on COVID-19 address educational issues) [3]. Awareness of this problem is the first step in addressing it.