**7. GME implementations pertaining to the COVID-19 pandemic**

The response of the ACGME and related GME programs has been rapid and robust to avoid an abrupt deterioration in the educational experiences of postdoctoral training that is of the utmost importance to develop adept practitioners. This response has been aimed at numerous stages of medical education, extending from forgoing ACGME activities regarding accreditation of training programs to the preferment of telemedicine and virtual video conferencing to continue instructive endeavors [21]. Regardless of the stage of response, the commonality among said responses subsists in adequately addressing the preservation of the trainee's educational experience derived from the appropriate medical management of patients using an attentive albeit cautious approach. Remarkably, this approach has had the inherent ability to be altered in relation to the uncertainty to the COVID-19 pandemic.

In an attempt to assure proper patient care and mitigate institutional challenges imposed by the COVID-19 pandemic, the ACGME delayed the direct surveyal of sites including accreditation and clinical learning environment review (CLER) [22]. The ACGME has deferred the assessment of a post-doctoral trainee's proficiency to the program director and Clinical Competency Committee (CCC) because of the adversely affected compulsory volume of patients evaluated in inpatient and

outpatient settings in addition to the reassignment of trainees to assist in the medical management of COVID-19 patients [21]. Likewise, the ACGME deferred the determination of a trainees capability to practice medicine unsupervised, indicated through completion of their residency training program, because of rotation resignment [21]. The ACGME and corresponding GME programs have increasingly implemented telemedicine including the redefining of "direct supervision" as the supervising physician and/or patient not being physically present with the trainee, consequential of concurrent patient care by the supervising physician and trainee through telecommunication [23]. The transition of post-doctoral training from in-person education to telecommunication for educational instruction has required innovative implementation to diminish the disruption to medical education delivery and sense of comradery that comes from socialization. Irrespective of the integral role of telecommunication in patient encounters or in-person conferences, adherence to 80 hours of clinical and education work per week, the maximum of every third day call and the minimum of one day per seven days free of clinical duties approximated over four weeks, including the reception of appropriate training regarding PPE, is compulsory to preserve proper work-hour restraints and oversight [23].

The transfiguration of GME policies and procedures in the setting of adverse clinical conditions imposed by the present pandemic has concentrated on trainee well-being to contest physician burnout. The ACGME has created coalitions with the National Academy of Medicine (NAM) to create the 'Action Collaborative on Clinician Well-Being and Resilience' in addition to promotion of their 'AWARE' program to promote well-being, mitigate the adverse effects of psychosocial stressors encountered in training and prevent burnout by-and-large [21]. Particular to the COVID-19 pandemic, the 'Well-Being in the Time of COVID-19' guidebook contains responses to illness and death due to COVID-19 by incorporating six strategies to promote well-being including: optimizing a challenging working and learning environment, promoting connectedness, building skills and mindsets, providing virtual resources for well-being support, identifying and assisting residents and fellows in distress and delivering coordinated crisis planning and management [24].

Numerous institutions have implemented Stanford's WellMD Initiative to disseminate positive transformations at the GME level. Created in 2015, this initiative discusses a culture of wellness including behaviors, attitudes and values that promote self-care, organizational responsibility regarding value of time and energy in clinical practice and personal resilience regarding behaviors and attitudes that contribute to personal well-being [25]. Initiatives like the aforementioned have advocated for added examinations of different interventions to diminish the extensiveness of burnout in the healthcare setting. A 2017 study by Busireddy et al. illustrated that a reasonable decrease in ACGME duty hours improved emotional exhaustion and burnout, evident by 42% lower odds of the percentage of residents reporting high levels of emotional exhaustion (OR = 0.59; 95% confidence interval 0.45–0.79; P < 0.001) [26]. A 2019 study by Spinelli et al. illustrated that interventions predicated on mindfulness possessed moderate effect on anxiety (Hedge's g = 0.47), depression (0.41), psychological distress (0.46) and stress (0.52) [27]. Small to moderate effects were present for burnout (0.26) and well-being (0.32) [27]. Therefore, there is substantiating evidence that cognitive and behavioral interventions on personal and institutional levels ideally lessen the severity of trainee burnout. An abundance of GME programs have adopted the application of wellness interventions into their curricula like St. Luke's University Health Network lifestyle medicine. Lifestyle medicine integrates positive transformation in an individual's nutrition, physical activity and coping mechanisms to lessen the precipitating and perpetuating factors that worsen physician burnout (**Figure 4**).

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

**Figure 4.** *The Stanford wellness framework as adapted from Stanford medicine et al. [28].*
