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Tackling "Struggling" Infectious Disease Fellows: Public Health Watch

FEB 26, 2020 | BRIAN P. DUNLEAVY
Give infectious disease fellows a break.

Okay, the conclusions of a report published on February 18th by Open Forum Infectious Diseases may be more nuanced than that, and they are worthy of attention. It’s worth noting that the article, entitled “The Struggling Infectious Diseases Fellow: Remediation Challenges and Opportunities,” was written by representatives from some of the top ID training programs in the United States, and it was borne out of discussions in the Infectious Diseases Society of America’s Training Program Directors’ Committee meeting—on the theme of “Remediation of the Struggling Fellow”—during IDWeek 2018.

The authors of the paper did not respond to requests for comment on deadline. However, their article highlights the importance of identifying areas of the ID curriculum in which fellows may be struggling, and putting systems in place to provide support.

Perhaps not surprisingly, their report also addresses issues related to the “mental health” of fellows, specifically the issue of burnout—likely common given the academic/research/clinical obligations they need to balance. Last April, Contagion® covered a study designed to assess the scope of some of these problems within the infectious disease field, which was also published in Open Forum Infectious Diseases.

Spoiler alert: The sample size was admittedly small, but some 53% of young ID specialists met the criteria for burnout.

“When concern for mental health problems arises, program directors should openly, honestly, and sensitively broach such concerns with the fellow,” the authors of the more recent paper write. “Provision of support, confidential and comprehensive health screenings, and optimization of the practice environment are critical components of addressing these concerns. Some fellows may benefit from approaches including coaching, counseling, or peer support.”

They go on to list several “threats to ID fellow well-being,” including working with complex, often seriously ill patients; “feeling used or dismissed by faculty;” and “receiving inappropriate, repetitive, or unnecessary pages.” Some programs have observed that fellows may be deficient in time management, according to the authors, which can compound some of these problems.

Unfortunately, there is no one-size-fits-all solution to these issues, although some ID fellowship programs have taken steps to lessen the workload of their fellows, the authors note. That’s at least a start. Some programs, for example, have hired advanced practice providers to help offload consults, they add, while others have added administrative assistants and scribes to assist with nonclinical duties.

Even after providing fellows more time to learn, though, some programs are still finding “gaps” (our word) in medical knowledge and patient-care competency. “Role modeling” by a master clinician or supervising faculty can be used to address these gaps.

However, even murkier are effective ways to address fellows who demonstrate poor interpersonal communication skills—with both patients and colleagues—and/or lack professionalism. “As with other deficiencies, direct observation of conversations with patients, family members, and health care professionals is fundamental to understanding these shortcomings; standardized patient assessments or video-recorded patient interactions, if available, may also assist,” the authors write, adding that “remediating these deficiencies can feel daunting” to fellowship program directors.

To mitigate these concerns, the authors recommend using “a structured clinical observation and its accompanying skills checklist”—which they provide in an appendix—to help facilitate specific feedback on actionable items. The Academy of Communication in Healthcare also provides extensive online resources, they add.

Of course, we’re only touching on some of these issues here. However, what the authors of the Open Forum Infectious Diseases article accomplish—if nothing else (and trust us, they do that much and more)—is remind us that just as the practice of infectious disease as a specialty is challenging, so too is training young doctors to prepare them for it.

Frankly, we could all use a refresher on that now and then.
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