**1. Introduction**

A pandemic, by definition, is an epidemic of an infectious disease that has progressed across a large region, for instance multiple continents, affecting a substantial number of people [1]. COVID-19 is caused by an infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain, initially isolated from individuals with pneumonia and a constellation of acute respiratory signs/symptoms signs and symptoms in Wuhan, China in December 2019 [2]. Signs and symptoms include: fever (71%), cough (80%), fatigue (62%), muscle aches (61%), headache (46%) and shortness of breath (43%) in addition to loss of taste or smell (32%) [2]. Approximately 93% of patients encountered a triad of signs/symptoms including fever, cough and shortness of breath [3].

Initially, COVID-19 was identified in the United States in January 2020 and in March 2020, the World Health Organization (WHO) affirmed COVID-19 as a pandemic [3]. About one year after the initial identification, approximately 92.7 million individuals have been diagnosed as having COVID-19 worldwide [4]. As of January 2021, approximately 2 million individuals have succumbed to COVID-19 worldwide [4]. Prior to the COVID-19 pandemic, the 2009 Influenza A (H1N1) pandemic infected approximately 1.4 billion individuals worldwide and killed approximately 575,000 of said individuals [5]. The 2014 Ebola Virus Disease (EVD) pandemic infected approximately 28,656 and killed approximately 11,325 of said individuals [6]. In contrast, these figures pertaining to previous noteworthy pandemics that were ultimately restrained, illustrate that the present pandemic is unparalleled, particularly pertaining to mortality.

The pandemic incited a considerable response regarding cautionary and counteractive measures by both state and federal administrations to address an uptick in incidence including legislation like the Coronavirus Aid, Relief and Economic Security (CARES) Act and the Coronavirus Preparedness and Response Supplemental Appropriations Act [7]. At \$2 trillion and \$8.3 billion respectively, they were to help expand assessment for COVID-19, vaccine research and PPI procurement [7]. This legislation, particularly the CARES Act, allocated monetary reimbursement to the American public and provided supplemental unemployment payments subsequent to imposed quarantines throughout the country. Aside from legislation, partnerships among constituents of the Department of Health and Human Services (HHS) including: Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Biomedical Advances Research and Development Authority (BARDA) and the Department of Defense (DoD) donned Operation Warp Speed in May 2020, in a concerted attempt to develop 300 million doses of efficacious FDA approved vaccines available by January 2021 [1]. As of January 2021, the FDA has approved two vaccines for emergency use to battle the pandemic: co-developed Pfizer-BioNTech and Moderna [8]. Additionally, Operation Warp Speed has been integral in promoting the use of alternative therapeutics against COVID-19 like FDA-approved REGN-COV2, a combination of monoclonal antibodies casirivimab and imdevimab [1].

## **2. Methodology**

Several studies have assessed the association among the COVID-19 pandemic, the pervasiveness of adverse psychosocial stressors encountered by trainees and the detrimental effects on the trainee's well-being regarding GME. Resultantly, these studies indicate that it is imperative to perpetuate the transfiguration of procedures and policies through the Accreditation Council for Graduate Medical Education (ACGME) and subsequent GME constituents of respective residency training programs, as a means to address the negative impact the COVID-19 pandemic has had on post-doctoral training. Prior to the COVID-19 pandemic, there were a plethora of studies that examined physician well-being and welfare including the prevalence of physical and emotional exhaustion that exacerbates burnout, using reliable psychological assessments like the Maslach Burnout Inventory. Nonetheless, the predominance of said studies disregard the post-doctoral trainee population,

#### *The Impact of Coronavirus Disease 2019 (COVID-19) on Graduate Medical Education (GME)… DOI: http://dx.doi.org/10.5772/intechopen.96764*

particularly throughout a pandemic that poses personal and professional challenges to a previously susceptible practitioner population.

A website search engine was used to assist in the selection of an assortment of studies examining the negative implications the COVID-19 pandemic has had on post-doctoral training pertaining to the prevalence of physician burnout. Scholarly sources such as the National Library of Medicine, particularly the National Institutes of Health, including peer-reviewed literature catalogs like PubMed were used. Keywords used were burnout related to intern, resident, residency, fellow and COVID-19. Additionally, the keywords welfare and wellbeing were used in relation to the previous specifiers pertaining to post-doctoral trainees. Inclusion criteria included: studies about physician burnout including at least one of its primary symptoms (emotional exhaustion, depersonalization or decrease in personal satisfaction), studies composed using the English language, studies that illustrate empirical results using reliable instruments to measure instances of burnout like the Maslach Burnout Inventory, more specifically the Maslach Burnout Inventory – Human Services Survey for Medical Personnel (MBI-HSS MP) and studies that examined a patient population primarily comprised of post-doctoral trainees (i.e. residents and/or fellows). Exclusion criteria included: studies composed using a non-English language, studies possessing no preset criteria pertaining to physician burnout, studies that disregard the examination of burnout related to residents and/or fellows.
