The first instinct Sakshi Dua, MD, had when the COVID-19 pandemic hit New York City was to shield the 18 Mount Sinai pulmonary and critical care medicine trainees under her purview from any contact with infected patients. But the swift progression of the crisis made it clear she would have to deploy them on the front lines of the battle.
“Our priority was ensuring trainee safety,” says Dr. Dua, Fellowship Director, and Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine), and Medical Education, at the Icahn School of Medicine at Mount Sinai. “Although we were stretched thin, we had faculty lead personal protective equipment training sessions, both in person and online; we implemented cross-disciplinary supervision; and we expanded the number of trainees they could supervise. We had just one trainee confirm positive for COVID-19, which is notable given that they were serving in our intensive care unit and performing invasive procedures.”
The efforts undertaken and lessons learned by Dr. Dua and her colleagues—enhancing team resilience, mitigating infection risk, and ensuring all needs are met—offer a template for other academic centers to follow in responding to the virus.
For Dr. Dua, the priority beyond ensuring trainee safety was addressing basic physiological needs such as nutrition, shelter, and transportation (see figure attached). The Mount Sinai Health System Boards of Trustees and other leaders secured hotel rooms, food, and car services, and Dr. Dua engaged friends and restaurant owners to supplement food donations.
“The accommodations were particularly welcome because, although our trainees are young and healthy, they were concerned they might be asymptomatic carriers and expose elderly relatives or other family members in their homes to the virus,” Dr. Dua says.
As COVID-19-related caseloads continued to rise, the master schedule of trainee rotations was swapped for flexible scheduling to address surges. But mandatory rest periods were maintained, as was educational programming, albeit with some changes. The daily schedule of content was reduced to twice-weekly sessions; faculty members who were not able to join the COVID-19 front lines due to pregnancy, age, or being immunocompromised were charged with developing lectures; and educational programming migrated online, facilitating trainee participation and anytime access through recorded content. “We saw a threefold increase in attendance and had more faculty joining in, which enriched the sessions,” Dr. Dua says. “As a result, we will continue to offer a hybrid of in-person, socially distanced, and online programming indefinitely.”
As Dr. Dua focused on trainee needs, Rachel Potter, LCSW, focused on the mental wellness of the department. A licensed clinical social worker at the Mount Sinai – National Jewish Health Respiratory Institute, Ms. Potter previously had been conducting monthly wellness groups for pulmonology and critical care fellows through the Office of Well-Being and Resilience. She pivoted to virtual weekly sessions tailored to fellows, attendings, and staff, supplemented by one-on-one sessions, personal emails to engage trainees, and informal in-person check-ins with faculty and staff. “We thought the group sessions would be popular due to isolation and social distancing, but we found that people were more comfortable talking about their experiences in the one-on-one sessions and the check-ins,” Ms. Potter says.
Although such interventions have proved vital during the pandemic, Ms. Potter has found them equally necessary in its wake. “When providers are in the midst of a health care crisis, their focus is on caring for others, and what they have been through only really hits them as things start to slow down,” she notes. “For that reason, I think supportive interventions are probably best in the lead-up to a pandemic such as COVID-19 and the phase immediately afterward.”
Looking back on the first wave of the pandemic, Dr. Dua and Ms. Potter have gained invaluable insights on the fundamentals for maintaining team health and well-being during a health care crisis. For Ms. Potter, they are having a dedicated person or team to lead mental wellness initiatives and ensuring everyone has ready access to resources to manage stress and anxiety. For Dr. Dua, it comes down to planning early, over-planning, and being ready to pivot as the situation evolves.
“A crisis such as this can bring out the best, or the worst, in people,” Dr. Dua says. “Based on what we have achieved at Mount Sinai, it brought out the best in us.”
Sakshi Dua, MD
Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine), and Medical Education
Rachel Potter, LCSW
Licensed clinical social worker at the Mount Sinai – National Jewish Health Respiratory Institute