November 28, 2025 • 36 mins
This week we go back in time to 2020 to delve into the topic of fellow wellness and review a work from the Boston Children's group on fellow fears and stressors when beginning their training. Are there patterns amongst the fellow concerns that can be identified and used to inform interventions to help allay these fears and reduce the stress? We speak with Dr. David Brown, Associate Professor of Pediatrics, Harvard Medical School and also Dr. Tony Pastor who was then the ACHD Fellow at Boston Children's Hospital/Brigham and Women's Hospital about their thoughts on fellow fears and stressors as well as fellow (and doctor) wellness.
doi: 10.1007/s00246-019-02276-z.
doi: 10.1007/s00246-019-02276-z.
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Episode Transcript
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Speaker 1 (00:00):
Hello everybody. This is rob Past, the host of the
(00:02):
Pdhart podcast. This week we go back five years in
time to review an important episode on fellowship, specifically the
stresses of first year fellows and how we might alleviate these.
I hope everybody enjoys this episode. I'll see you back
next week with a brand new episode. Welcome to Pdiheart
(00:35):
Pediatric Cardiology Today. My name is doctor Robert Pass and
I'm the host of this program. I am Professor of
Pediatrics at the Icon School of Medicine at Mount Sinai,
where I am the chief of Pediatric Cardiology. Thank you
very much for joining me this week for our one
hundred and thirtieth episode of the podcast. I hope everybody
last week had an opportunity to listen to our conversation
with Assistant Professor of Pediatrics, Kanaka mat Thor, about a
(00:58):
recent paper she author third on the topic of the
risks of analoprol in the single ventrical patient. For those
of you with an interest in the infants with single
ventrical trial or infants in general who are having single
ventrical palliation and the role of ACE inhibitors, I'd strongly
recommend you to take a listen to last week's episode
one hundred and twenty nine. As I say every week,
(01:19):
if you'd like to reach out to me, it's easy
to reach me. My email is pdheart at gmail dot com.
This week we move on to the world of Cardiology
fellowship and we'll be reviewing an interesting paper entitled Fears
and Stressors of Trainees starting Fellowship in Pediatric Cardiology. The
first author of this work is David Brown and the
(01:39):
senior author is Elizabeth Bloom, and the authors all come
from Boston Children's Hospital, Department of Cardiology in Boston, Massachusetts.
When we've done reviewing this paper, doctor David Brown will
sit down with us to discuss this important paper. Therefore,
let's move straight on to this article and then our
discussion with doctor Brown. This week's work starts by explaining
(02:00):
that moderate amounts of stress have been shown to enhance learning,
but sustained levels of high stress can lead to burnout
and what the authors describe as moral distress. The authors
explain that burnout can decrease work effectiveness and creates a
feeling of low personal worth and emotional exhaustion, and they
make the important statement that the rates of burnout depression, suicide,
(02:22):
substance abuse, and relationship difficulties in physicians is higher than
in other fields, particularly during postgraduate medical training. They then
explain that most studies of people in training are performed
in resident physicians, but that burnout amongst trainees can increase
medical errors and worsen patient care. They then posit that
the stresses on the pediatric cardiology fellow are likely even
(02:44):
higher than other medical fields because of the very high
acuity of patients cared for and so the authors state
that quote in order to develop interventions to support fellowship
trainees in pediatric cardiology, we sought to categorize our fellow's
perceived stressors at the us onset of their training. The
authors explained that all incoming fellows at their program over
(03:05):
a seven year period from twenty twelve to twenty nineteen
were asked to anonymously write down the answer to the
question what are your fears for the coming year. This
was an open question with no expectations or suggestions for
a total number of responses, and this question was asked
in the first week of their fellowship during a fellow
month long boot camp. They looked at the individual fellows
(03:27):
answers and also the group in aggregate. The authors also
had demographic information about each fellow from their fellowship application.
A qualitative analysis of the fellow's answers was performed, and
both the percent of fellows reporting a given fear as
well as the overall distribution of fears in each category
were analyzed. Some fears were placed in a thematic code,
(03:48):
and if a fellow had more than one fear in
the same thematic code, they were reported as having the
fear only once and add to the results. There were
basically five main areas of what the author's term codes
of thematic fears that the fellows expressed, and these were
first fellowship career responsibilities, which were seen in eighty three
percent of the respondents, and this included such things as
(04:10):
worries about increased clinical ode, clinical skill, worries, boards, and research.
The second most common fear was failure or disappointment fears,
which were seen in seventy eight percent of the respondents,
and this included such things as fear of failing in
so called imposter syndrome. The third most common was personal
life fears, seen in seventy four percent of the respondents,
(04:33):
and this was mostly either worries about personal relationships or
work life balance. The fourth most common fear was emotional
exhaustion fears, which were seen in sixty one percent of respondents,
and this mostly was fear of regret or burnout. And finally,
the fifth most common area were new hospital fears, seen
(04:53):
in thirty six percent of the incoming fellows, and these
were mostly worries or fears about finances, professional lif relationships,
and the adjustment to a new hospital system. Overall, the
most common specific fears for incoming fellows, seen in over
fifty percent of them, were first increased clinical responsibility seen
in sixty five percent, second imposter syndrome seen in sixty
(05:16):
two percent, and finally burnout seen in fifty eight percent
of respondents to this question. The authors speak of the
fact that over the seven year time period, the fears
offered were largely unchanged, with fears regarding fellowship and career
responsibilities always coming out as the most common fear in
all but two years, in which it was the second
most common fear. Interestingly, in one year twenty sixteen, the
(05:40):
fellows submitted their answers to this fear question two weeks
into the boot camp, rather than the first day or two,
and this time the percentage with this fear of fellowship
or career responsibilities was markedly lower at fifty percent, compared
to an average of eighty nine percent seen in the
other five years in which it was the first choice
and in which the fellows answered this question in the
(06:01):
first day or two of their fellowship. When the authors
looked at all three hundred and seventy eight reported fears
over the seven years that were submitted, and they looked
at the categories, career and fellowship, responsibilities were still number one,
with thirty four percent falling into this category, with the
next most common category being personal life, followed by failure
(06:21):
or disappointment, emotional exhaustion, and finally, least commonly new hospital environment. Overall,
the most commonly reported fear by any respondent after analysis
into the codes by frequency was again increased clinical responsibility,
followed by fears about imposter syndrome, and finally burnout. In
their discussion, the authors stated and I quote in this
(06:45):
qualitative analysis of reported first year pediatric cardiology fellows fears
at the onset of their training, we found that five
most common themes emerged over eighty percent of fellows reported
fears concerning fellowship career responsibilities as the most common respons
but importantly, a majority of respondents had fears about emotional exhaustion, failure, disappointment,
(07:06):
and personal life. A minority of respondents reported fears concerning
a new hospital environment. When considering individual responses divided by
qualitative analysis into codes, fellow's most commonly reported fears related
to clinical responsibility, imposter syndrome, and burnout as the most
commonly reported individual fears. An important specifically mentioned fear categorized
(07:28):
undo clinical responsibility was the fear of harming a patient.
The authors then explained that most of the fears reported
in this paper were consistent with prior research in this
field in resident trainees, and they speak of how a
new fellowship can involve significant life transition and change in
responsibility and a need to rapidly adapt to new systems
and expectations that can result in tremendous stress. They explain
(07:51):
how this sort of anxiety and fear can lead to burnout,
which can substantially affect quality of care and trainee quality
of life. The authors explained that given the high percentage
of fears regarding responsibility in a Cardiology fellowship from all
of the critical illness they're exposed to. They write that
they feel it is essential that training programs ensure that
fellows have adequate training in communication, palliative care, and clinicians
(08:14):
support resources. They speak of how many of the fellows
had a fear of harming a patient or imposter syndrome,
and how they are difficult to address but are treatable,
and they wonder if intimate, small group sessions that directly
acknowledge and address these two issues can improve adjustment and
acclamation to fellowship. They re mention the fact that the
fellows who answered this question after two weeks of boot
(08:36):
camp seem to have substantially less fear and believe that
the boot camp was the reason, and they wonder if
crisis management training episodes might also be useful. They also
mention how wellness programs are almost universally available, but not
all residents are aware of these. However, they do mention
that there is little research on what interventions of this
nature are truly most effective for supporting the mental health
(08:58):
of trainees, and similarly no research on the effectiveness in
dealing with these issues through boot camps. The Boston Group
has responded to the wellness issue by establishing a wellness
faculty member and ensuring engagement and access to a curriculum
of wellness. But again they acknowledge that there is no
evidence of this positively impacting on wellness of the fellows,
(09:18):
and so they conclude the stress is reported by incoming
pediatric carneology fellows are similar to those that impact residents.
Similar to first year residents, beginning fellows have fears of
inadequacy in their new position, as well as fears over
their ability to manage the increased clinical responsibilities in work hours. However,
fellows face additional fears over their career choice and responsibilities
(09:41):
that new residents do not. Their increased clinical responsibilities placed
them in positions where they may feel more directly responsible
for clinical outcomes of their patients, including the fear of
directly harming patients. While taking on increasing responsibility is critical
for their learning and growth towards independent practice, it is
very important for training programs to be aware of some
(10:01):
of these specific fears and to provide adequate support for
the fellows in the early months of training, developing interventions
designed to assist our fellows in managing both their new
responsibilities and their other stressors is an important focus for
all pediatric cardiology training programs. Well, I think this was
a very important work because of its focus on the
fellow in cardiology, who's largely left out of most of
(10:24):
our research, but hopefully not for much longer. Fellowship in
cardiology is a very difficult path, and anyone listening who's
been a cardiology fellow, I am sure as an agreement.
Speaker 2 (10:34):
With that statement.
Speaker 1 (10:35):
But why is that? Well? I think in large part
it's because of exactly what these authors mention, which is
the fairly substantial uptick in complexity and severity of illness
that were all forced to manage in a very rapid fashion.
I know that for me it was a major adjustment.
It was exciting and thrilling at times, but also very scary,
and I still look back upon certain cardiac arrests or
(10:56):
challenging situations that were profoundly stressful. However, I also honestly
recall having curses hurled at me with some regularity by
some faculty, and I think we would all agree that
this was not helpful, was unhealthy and probably wrong. Thankfully,
the days of cursing at fellows and yelling ranting and
raving are over and in truth, we were far too
(11:17):
late to figure this out. In cardiology, the process of
hazing of our fellows was cruel, and I'm pleased to
see these efforts by the Boston team to rectify this.
I am hopeful more research of this nature's performed to
figure out how we can all be more supportive of
our fellows, which can obviously only have a positive impact
on patient care, fellow learning, and fellow wellness. At this time,
(11:39):
I think it would make sense to speak with the
authors of this paper in order to glean some more
insights into this important work. Treating us now is doctor
David Brown, who's Associate Professor of Pediatrics at Harvard Medical
School as well as the director of Fellowship Training in
the Department of Cardiology at Boston Children's Hospital. Doctor Brown
received his undergraduate degree from William's College and medical degree
(11:59):
from Harvard Medical School, completing his residency in pediatrics and
fellowship in cardiology, both at Boston Children's Hospital. He is
a non invasive imager who specializes mostly in eco cardiography,
and he also attends on the Impatient Cardiology Awards at
Boston Children's Hospital. Doctor Brown has been quoted as stating
that quote working with our amazing trainees is one of
(12:20):
the great joys of my career. Therefore, it is no
surprise that he authored this week's work. Let's welcome doctor
Brown to the podcast to discuss this week's work. Welcome
doctor Brown. I'm here now with David Brown. David, thank
you very much for joining us this week on the podcast.
Speaker 3 (12:35):
Rob It's such an honor to be on the podcast.
Thank you so much for asking me to do it.
Speaker 1 (12:39):
Appreciate it. David very much enjoyed this work offline. When
we were discussing this work, you explained to me that
the paper has generated a fair bit of discussion between
the faculty at Children's Boston and the present day fellows,
some of whom were respondents to the questions regarding fellowship
that you studied in this work. I'm wondering if you
(12:59):
might want to share with the audience some of the
issues that have been raised or discussed with the fellows
since the time that you published this important work.
Speaker 3 (13:06):
Yeah, thank you, Robert. I'd like to say that we
learned a really important lesson doing this particular project. At
its core, this paper is really a compilation if you will,
in fears and stressors reported by new fellows at our
program that were gathered as part of a course on
humanism and professionalism that we've been running. We didn't really
(13:30):
conceive of this from the beginning or carry it out
as something that would one day be written up and
shared more broadly. It was the years went by, and
we continue to see the reported fears and stressors remaining
remarkably constant over and over thematically that we thought it
was really important to the field, to trainees, and to
(13:52):
the people who train fellows around the country to share
that experience so that programs could start to think about
them and develop strategy Jesus interventions to really improve and
help support our new trainees. And while this is what
I would call educational quality improvement research, it went through
(14:13):
all of our traditional reviews here, including Scientific Review Committee,
the hospital's RRB, and we have given a full waiver
of consent for participants. If you read the paper, you'll
note it's completely anonymous. It's over an eight years experience
sixty four fellows. But in retrospect, given the nature of
(14:35):
what we were dealing with personally and emotionally, we really
should have circled back to everyone who participated and let
them know that we were planning on writing it up
and sharing it more broadly. Yes, So since that time,
we've had some really good constructive conversations, not only with
(14:56):
regard to this about how important it is and educational
research to have a collaboration in that research with the
trainees you're studying, but also very importantly, and relating to
the themes of this particular manuscript, how could we use
this to forge a head in our own program and
make some real progress on addressing the issues of wellness
(15:18):
and burnout and really trying to improve that across the program.
Speaker 4 (15:24):
Yeah.
Speaker 1 (15:24):
Yeah, well that came screaming through on the paper, and
that's in fact why I thought it was such an
important paper to review this week. You know, David, fears
of increased responsibility, as you said, was remarkably consistent and
highly prevalent amongst the fellows, and it really didn't seem
to change almost at all over the entire time period,
(15:46):
even though you have instituted a number of things to
try and address this. I'm wondering if you had any
thoughts about why this particular fear, which was the most
prevalent one didn't really change or improve with time.
Speaker 3 (15:59):
It's a great question. So among the fears that we
group thematically under that broadheading would be things like the
fear of harming a patient or being afraid that you're
really not up to par to handle the clinical demands
of your new job. And I think a large part
(16:19):
of that stems from the very demanding nature of pediatric
cardiology and what we do. We deal with a really
high patient acuity population. There's a lot of morbidity, there's
some mortality, and I think for most of us it
really is a big step up from general pediatrics training.
I would also keep in mind that the session that
(16:41):
we're describing in the paper was for the vast majority
of fellows done really on arrival. It's that first week
of orientation, so it generally would be before any of
the interventions we've developed here could have affected things, and
it's described in the paper a one month introductory boot
(17:04):
camp like rotation for our new first years. A huge
component of that that's really meant to address the increased
responsibility aspect has been simulation training. We have several really
high fidelity simulations that are built into that experience. That
we really think are important in helping people feel that
(17:26):
they can manage their new job and that they are
really up to the task and meant to be here.
So an important limitation of the study that we're talking
about is that we didn't we didn't do or describe
any post testing. And I will mention that an important
(17:47):
part of the humanism course that we've tried to do
is to circle back at the end of the first
year of training and just have a reflection on you know,
here's what you were worried about when you can came in.
What do you think of that now and how has
that has that changed over time? And if so, how
(18:08):
and what are your thoughts on that. So that's something
that we think is really important, but we're really at
this point haven't explored and certainly haven't described.
Speaker 1 (18:16):
Yeah. Well, I certainly would say that almost anybody who's
ever been a cardiology fellow can identify with those fears.
Certainly I had those fears when I started at Boston
Children's But then again, I had Krishna Kumar and Betsy
Bloom in my year. So anybody who saw those two
would certainly suffer from imposter syndrome with those types of
(18:38):
awesome fellows that I was working with.
Speaker 3 (18:41):
That true.
Speaker 1 (18:41):
I wanted to ask David if you were able to
identify any differences in response to this question between those
fellows who were Children's Hospital of Boston residence and those
from the outside. This question is particularly interesting to me
because I have to say I was always very fearful
as being a resident who was not originally being a
(19:03):
fellow who was not originally from Boston. That was a
concern of mine when I was a fellow. I'm wondering
if this was identifiable.
Speaker 5 (19:13):
You know.
Speaker 3 (19:14):
The short answer to question is no, we didn't look
at that. We did when we did our analysis. We
completely anonymized it, so I didn't really know who was
who or where they had trained when we did our
thematic analysis. You could certainly go back and do that.
It's been my observation and this program director here for
(19:35):
nine years now that I do think adjustment to a
program like this one is sometimes easier for those who
already know the hospital, maybe have spent a little time
in the department of cardiology, maybe know some of the faculty.
I think some of that adjustment is a little easier
being from the home program. But I think when you
think about some of those basic fears, though, that we're
(19:59):
reported so common, that the fear of hurting someone, the
fear of not being up to par for the job,
or feeling a little bit like an imposter. I think
those things are pretty universal, and I suspect they're not
much different whether you train at Boston Children's or a
very small latency program.
Speaker 1 (20:20):
Yeah, I think you're probably right about that. You know,
you've alluded to this a few times, and you mentioned
it in the paper, the wellness curriculum that you have
for the fellows in Boston. I'm wondering if you might
be able to explain a little bit to us what
this curriculum actually includes, and if you're in any fashion
(20:42):
studying the impact that this type of work has had
on the fellows in reducing these stresses.
Speaker 3 (20:48):
Yeah, thank you. I would say that the wellness curriculum
here was extremely rudimentary in FIR several years, consisted mostly
of a quarterly happy but rich really aspired to, with
the help of my current fellows, really aspire to be
that up and make it a much more interesting and
(21:14):
important part of working here. So I've actually got a
group of fellows with the representatives from each year in
the program who've done amazing work on as part of
our Fellowship Wellness Committee, and I've invited one of them
to really speak to the audience about what they've come
(21:34):
up with in terms of initiatives here.
Speaker 1 (21:36):
Okay, Well, for those in the audience at this moment,
which is four forty five on Wednesday, we're not yet
certain if we're going to be able to have that
fellow on. I'm hoping we will, but obviously you'll know
before the end of this podcast whether we were able
to snag Tony for a few moments to talk about it,
But if not, then we'll try to include it in
(21:57):
a future podcast for sure. Well, David, I can't thank
you enough for joining me this week. I'm going to
finish up this interview with the last question which I
sometimes ask of authors, and that is, as the author
of this work, what do you believe is the single
most important finding of this work?
Speaker 3 (22:14):
Well, I would say one of the biggest lessons that
I take away is really not that earth shattering. If
you think back to your first experience as a medical
student or a brand new intern, or even for those
of us who have faculty jobs. That first day as
a faculty member. It's that's here that it's so common.
(22:37):
You aren't ready for what you're being asked to do,
and you're really worried. The demands of the job are
maybe more than you're ready for, and even if you
can do it, you're worried about what kind of toll
that's going to take on your own personal and emotional
well being. I'd say that these are really important. I
think they're incredibly important to address. I think they're universal,
(23:02):
and I think as programs and for program directors in
the audience, I think we have to really do the
hard work of trying to develop initial experiences and initiative
that kind address some of those early in training. And
I think if we can do that and take some
steps in that direction, I think we're going to have happier,
(23:27):
more productive, better adjusted trainees and future faculty.
Speaker 1 (23:32):
Well. I certainly agree with that, and I think for
those young people in the audience listening to this conversation,
this fear never leaves you, and at every level of
your career, you have a similar fear as you move
up the ladder, as it were. And so there's an
important message in this paper not only for cardiology fellows,
(23:53):
but for everybody in our fields. David, I can't thank
you enough. I know you're very busy this week. All
of us know that we're getting ready to interview all
of our fellows, and David, being the head of the fellowship,
is super busy. But I really can't thank you enough
for making a few minutes in your week to speak
with us about it. And I want to congratulate you
your co authors on this really important work.
Speaker 3 (24:14):
Thank you so much. I've been such a pleasure, pleasure,
take care.
Speaker 1 (24:17):
Thank you here. Well, if you've been listening, you know
that I mentioned the possibility of having doctor Tony Pastor,
who's presently the Adult with Congenital Heart Disease Fellow at
Harvard Medical School, join us. Tony is joining us. He's
a graduate of Johns Hopkins University for his undergraduate training,
and he completed medical school and residency at Baylor College
of Medicine, where he was also the Internal Medicine Chief
(24:39):
Resident at Baylor in Houston, Texas. He completed his pediatric
cardiology training at Boston Children's and as I mentioned, he's
presently the ACCHD Fellow in that wonderful program. I'm excited
to get a fellow's perspective on the stresses that cardiology
fellows feel and also to speak with us about the
wellness program for fellows that he is spearheading. Welcome doctor
(24:59):
Paster to the podcast. All right, I'm here now with
Tony Pastor. Tony, thank you very much for joining us.
For those in the audience, doctor Pastor is actually on vacation,
but he was kind enough to speak with us from
his break, so of course I'm not helping his wellness
at all, but thank you very much for joining us
this week.
Speaker 4 (25:18):
Thanks. I'm happy to be here.
Speaker 1 (25:19):
Pleasure you know, Tony. Offline, David Brown and I discussed
this work and he explained to me that when the
paper was first out, it generated a little bit of
discussion between the faculty at Boston Children's as well as
the present day fellows, some of whom were some of
the respondents to the question regarding fellowship that was studied
(25:40):
in this work. I'm wondering if you might share with
the audience some of the issues that were raised or
discussed with the fellows since the time that the work
was published.
Speaker 4 (25:49):
Yeah, I think when the paper first came out when
we first saw it sort of and across our institution,
I think a lot of the fellows and previous fellows
felt a little upset about the fact that we didn't
know that the paper was being published. And at the
(26:10):
time when we had these sort of sessions with doctor
Bloom collecting, you know, talking about our fears, we felt
like these were sort of safe spaces and worked totally
going to know that this was going to end up
being data for submission for a research project. So, you know,
many of the fellows talked amongst ourselves, we talked to
(26:32):
former current faculty who are now former fellows and decided
to bring up the issue to the administration, and we
talked to Dave Brown, we talked to Betty Bloom and
appropriately so they they held a bunch of town halls
that we could express, you know, our issues with the
fact that we felt like our trust had been violated,
and I think overall it was a very positive experience
(26:56):
and both sides sort of like learned from from everything
that had occurred because of this publication. And you know,
Dave had presented to the fellows like what can we
do to sort of make your fellowship better? And that's
where you know, the idea of the Wellness Committee came
about and sort of in a direct response to the
(27:20):
controversy of this paper coming out.
Speaker 2 (27:22):
I see, I see.
Speaker 1 (27:23):
Well. Actually I was very interested to hear a little
bit about the Wellness Committee. David hinted to us in
his interview which is preceding this interview on the podcast
this week, that you had spearheaded with other fellows this
curriculum and program. I'm wondering sort of what it is
that you're doing as part of this committee and whether
(27:46):
or not you've actually started to measure the impact or
noticed any impact on the fellows since you've incorporated this
into their lives.
Speaker 5 (27:55):
Yeah. I know.
Speaker 4 (27:57):
It's so funny because if you would have asked us,
what are our idea was their curriculum was a couple
of months ago, it would be completely different due to
the COVID pandemic. So initially Dave had recruited two fellows
from every class so that we could all be equally represented.
So the initial class was myself, Dave, Karen, Emily Addison
(28:17):
Raid and Marie Helene, and we didn't need the assessment
initially and found actually a lot of low hanging fruit
that could sort of improve jellowship wellness in general. But
then COVID nineteen hit and we suddenly readdressed sort of
you know, what our goals were for the committee, because
(28:40):
what we found that was lacking the most and what
was sort of destroying everyone's well being during the pandemic
was a lack of social interaction and the lack of
just coming together as a community again the sort of
we're all in this together culture that we sort of
pride ourselves to Boston children, and it was hard to
(29:01):
do that over zoom or you know, in the very
few conferences that we had together. So we abandoned our
initial goals and then just decided to launch a Zoom
based curriculum. It's even harder to call it a curriculum.
It was mostly social events where I think the initial
one was wine Nights with doctor Sanders, who's the director
(29:24):
of our cardiac registry and also wine cronus here just
like an all around nice guy also, and they became
so popular that the faculty actually really wanted to join them,
and so it evolved into these every Friday night we
were having Zoom based social events with the faculty and
the Fellows and it I mean in so many levels
(29:46):
it brought our community together, but it was also just
nice to just forget about the stressors of work, you know,
COVID nineteen, everything that we're all experiencing and just come
together with our coworkers and see each other in our
home homes and just laugh for an hour or so.
Speaker 6 (30:02):
And this was all via zoom.
Speaker 4 (30:05):
This was all Zoom based, It was all Fellow driven.
It was done with no funding. We just we just
came together and and did it via Zoom and and
we we did this for about like three months. And
it wasn't just the wine nights. We had like trivia
night that Emily and Dave had spent hours sort of preparing,
(30:26):
and we had teams. The Fellow team won.
Speaker 1 (30:28):
By the way.
Speaker 4 (30:29):
So yeah, we and in terms of like you know,
measuring our outcomes, we this is sort of the initial
class of our Wellness Committee. And going forward, we've actually
gone decided that we're probably going to do like a
pre and post survey of our interventions. But I think
at the time when we were doing this, we just
(30:52):
find it. We just saw a need and and said, hey,
we need to do something to kind of make everyone
a little happier.
Speaker 1 (31:00):
Yeah, well, I think we could all use a little
bit of that. And it's really nice to hear these ideas.
I'm sure people listening are going to try and think
about how they can incorporate this idea into their own
practice and their own programs. Tony, I really can't thank
you enough again, thank you very much for sharing with
us the fellows perspective of this, and also for sharing
(31:23):
with us some wonderful ideas that you and your colleagues
have come up with in Boston. As a former Boston Fellow,
I can tell you it really sounds wonderful to hear
how much people are paying attention to the wellness of
the Fellows. That's a wonderful thing and yet another example
of how Boston has been leading the way always in
cardiology and now in training as well.
Speaker 4 (31:43):
Yeah, of course I appreciate it, and I and thank
you for talking.
Speaker 3 (31:47):
To me today.
Speaker 2 (31:48):
It's real pleasure. Thank you.
Speaker 1 (31:49):
Well.
Speaker 2 (31:50):
I think we've learned a great deal this week about
the efforts made in Boston to help the Fellows by
first identifying what it is that's worrying them when they begin.
I think any form of YELLO listening this week can
likely well identify with all of the concerns of the
fellows in Boston, and I'm not surprised that the worries
did not change much over the timeframe of seven years
in this study. For I think, at least for me,
(32:12):
the same worries were mine nearly thirty years ago when
I started at that same institution. I think we all
learned a lot about the wellness attempts being made by
doctor Pastor and his co fellows, and certainly there is
something to learn for all of us in these efforts.
We all devote so much of our lives to our
patients and patient families, and this certainly takes a very
serious toll on all of us in many different ways.
(32:34):
And efforts like those by doctor Brown and doctor Bloom
to identify the stresses for our fellows, and efforts by
doctor Pastor to address the stress finding ways to release
some of the strain associated with working so hard taking
care of our patients are good first steps towards reducing
anxiety and strain for all. I'm most appreciative of doctor
(32:55):
Brown and doctor Pastor for sharing with us their time
this week. I hope you enjoyed our conversation as much
as I did.
Speaker 1 (33:02):
To conclude this replay of episode one hundred and thirty
from twenty twenty, we hear the magnificent tenor Franco Correlli
singing an aria for which he was justly famous, the
famous Nessundorma from Puccini's Torondot. Though today we associate this
aria with the great Luciano Pavarotti from his three tenor concerts,
(33:23):
prior to that time, Correlli was known throughout the world
as the greatest exponent of the role coof in this opera.
And I'm sure you'll understand why would you hear this
nineteen sixties recording. Thank you very much for joining me
for this replay episode, and thanks once again to Doctor
Pastor and doctor Brown.
Speaker 6 (33:41):
I hope I'll have a good week ahead.
Speaker 5 (34:01):
So fast, not so for the.
Speaker 6 (34:12):
Person double.
Speaker 7 (34:21):
On y Arny Star refunny.
Speaker 3 (34:37):
So the sup.
Speaker 7 (35:11):
What of your ale sh shel Seal.
Speaker 5 (35:23):
Boggy mel all my note app be
Speaker 1 (36:03):
To me to
Hello everybody. This is rob Past, the host of the
(00:02):
Pdhart podcast. This week we go back five years in
time to review an important episode on fellowship, specifically the
stresses of first year fellows and how we might alleviate these.
I hope everybody enjoys this episode. I'll see you back
next week with a brand new episode. Welcome to Pdiheart
(00:35):
Pediatric Cardiology Today. My name is doctor Robert Pass and
I'm the host of this program. I am Professor of
Pediatrics at the Icon School of Medicine at Mount Sinai,
where I am the chief of Pediatric Cardiology. Thank you
very much for joining me this week for our one
hundred and thirtieth episode of the podcast. I hope everybody
last week had an opportunity to listen to our conversation
with Assistant Professor of Pediatrics, Kanaka mat Thor, about a
(00:58):
recent paper she author third on the topic of the
risks of analoprol in the single ventrical patient. For those
of you with an interest in the infants with single
ventrical trial or infants in general who are having single
ventrical palliation and the role of ACE inhibitors, I'd strongly
recommend you to take a listen to last week's episode
one hundred and twenty nine. As I say every week,
(01:19):
if you'd like to reach out to me, it's easy
to reach me. My email is pdheart at gmail dot com.
This week we move on to the world of Cardiology
fellowship and we'll be reviewing an interesting paper entitled Fears
and Stressors of Trainees starting Fellowship in Pediatric Cardiology. The
first author of this work is David Brown and the
(01:39):
senior author is Elizabeth Bloom, and the authors all come
from Boston Children's Hospital, Department of Cardiology in Boston, Massachusetts.
When we've done reviewing this paper, doctor David Brown will
sit down with us to discuss this important paper. Therefore,
let's move straight on to this article and then our
discussion with doctor Brown. This week's work starts by explaining
(02:00):
that moderate amounts of stress have been shown to enhance learning,
but sustained levels of high stress can lead to burnout
and what the authors describe as moral distress. The authors
explain that burnout can decrease work effectiveness and creates a
feeling of low personal worth and emotional exhaustion, and they
make the important statement that the rates of burnout depression, suicide,
(02:22):
substance abuse, and relationship difficulties in physicians is higher than
in other fields, particularly during postgraduate medical training. They then
explain that most studies of people in training are performed
in resident physicians, but that burnout amongst trainees can increase
medical errors and worsen patient care. They then posit that
the stresses on the pediatric cardiology fellow are likely even
(02:44):
higher than other medical fields because of the very high
acuity of patients cared for and so the authors state
that quote in order to develop interventions to support fellowship
trainees in pediatric cardiology, we sought to categorize our fellow's
perceived stressors at the us onset of their training. The
authors explained that all incoming fellows at their program over
(03:05):
a seven year period from twenty twelve to twenty nineteen
were asked to anonymously write down the answer to the
question what are your fears for the coming year. This
was an open question with no expectations or suggestions for
a total number of responses, and this question was asked
in the first week of their fellowship during a fellow
month long boot camp. They looked at the individual fellows
(03:27):
answers and also the group in aggregate. The authors also
had demographic information about each fellow from their fellowship application.
A qualitative analysis of the fellow's answers was performed, and
both the percent of fellows reporting a given fear as
well as the overall distribution of fears in each category
were analyzed. Some fears were placed in a thematic code,
(03:48):
and if a fellow had more than one fear in
the same thematic code, they were reported as having the
fear only once and add to the results. There were
basically five main areas of what the author's term codes
of thematic fears that the fellows expressed, and these were
first fellowship career responsibilities, which were seen in eighty three
percent of the respondents, and this included such things as
(04:10):
worries about increased clinical ode, clinical skill, worries, boards, and research.
The second most common fear was failure or disappointment fears,
which were seen in seventy eight percent of the respondents,
and this included such things as fear of failing in
so called imposter syndrome. The third most common was personal
life fears, seen in seventy four percent of the respondents,
(04:33):
and this was mostly either worries about personal relationships or
work life balance. The fourth most common fear was emotional
exhaustion fears, which were seen in sixty one percent of respondents,
and this mostly was fear of regret or burnout. And finally,
the fifth most common area were new hospital fears, seen
(04:53):
in thirty six percent of the incoming fellows, and these
were mostly worries or fears about finances, professional lif relationships,
and the adjustment to a new hospital system. Overall, the
most common specific fears for incoming fellows, seen in over
fifty percent of them, were first increased clinical responsibility seen
in sixty five percent, second imposter syndrome seen in sixty
(05:16):
two percent, and finally burnout seen in fifty eight percent
of respondents to this question. The authors speak of the
fact that over the seven year time period, the fears
offered were largely unchanged, with fears regarding fellowship and career
responsibilities always coming out as the most common fear in
all but two years, in which it was the second
most common fear. Interestingly, in one year twenty sixteen, the
(05:40):
fellows submitted their answers to this fear question two weeks
into the boot camp, rather than the first day or two,
and this time the percentage with this fear of fellowship
or career responsibilities was markedly lower at fifty percent, compared
to an average of eighty nine percent seen in the
other five years in which it was the first choice
and in which the fellows answered this question in the
(06:01):
first day or two of their fellowship. When the authors
looked at all three hundred and seventy eight reported fears
over the seven years that were submitted, and they looked
at the categories, career and fellowship, responsibilities were still number one,
with thirty four percent falling into this category, with the
next most common category being personal life, followed by failure
(06:21):
or disappointment, emotional exhaustion, and finally, least commonly new hospital environment. Overall,
the most commonly reported fear by any respondent after analysis
into the codes by frequency was again increased clinical responsibility,
followed by fears about imposter syndrome, and finally burnout. In
their discussion, the authors stated and I quote in this
(06:45):
qualitative analysis of reported first year pediatric cardiology fellows fears
at the onset of their training, we found that five
most common themes emerged over eighty percent of fellows reported
fears concerning fellowship career responsibilities as the most common respons
but importantly, a majority of respondents had fears about emotional exhaustion, failure, disappointment,
(07:06):
and personal life. A minority of respondents reported fears concerning
a new hospital environment. When considering individual responses divided by
qualitative analysis into codes, fellow's most commonly reported fears related
to clinical responsibility, imposter syndrome, and burnout as the most
commonly reported individual fears. An important specifically mentioned fear categorized
(07:28):
undo clinical responsibility was the fear of harming a patient.
The authors then explained that most of the fears reported
in this paper were consistent with prior research in this
field in resident trainees, and they speak of how a
new fellowship can involve significant life transition and change in
responsibility and a need to rapidly adapt to new systems
and expectations that can result in tremendous stress. They explain
(07:51):
how this sort of anxiety and fear can lead to burnout,
which can substantially affect quality of care and trainee quality
of life. The authors explained that given the high percentage
of fears regarding responsibility in a Cardiology fellowship from all
of the critical illness they're exposed to. They write that
they feel it is essential that training programs ensure that
fellows have adequate training in communication, palliative care, and clinicians
(08:14):
support resources. They speak of how many of the fellows
had a fear of harming a patient or imposter syndrome,
and how they are difficult to address but are treatable,
and they wonder if intimate, small group sessions that directly
acknowledge and address these two issues can improve adjustment and
acclamation to fellowship. They re mention the fact that the
fellows who answered this question after two weeks of boot
(08:36):
camp seem to have substantially less fear and believe that
the boot camp was the reason, and they wonder if
crisis management training episodes might also be useful. They also
mention how wellness programs are almost universally available, but not
all residents are aware of these. However, they do mention
that there is little research on what interventions of this
nature are truly most effective for supporting the mental health
(08:58):
of trainees, and similarly no research on the effectiveness in
dealing with these issues through boot camps. The Boston Group
has responded to the wellness issue by establishing a wellness
faculty member and ensuring engagement and access to a curriculum
of wellness. But again they acknowledge that there is no
evidence of this positively impacting on wellness of the fellows,
(09:18):
and so they conclude the stress is reported by incoming
pediatric carneology fellows are similar to those that impact residents.
Similar to first year residents, beginning fellows have fears of
inadequacy in their new position, as well as fears over
their ability to manage the increased clinical responsibilities in work hours. However,
fellows face additional fears over their career choice and responsibilities
(09:41):
that new residents do not. Their increased clinical responsibilities placed
them in positions where they may feel more directly responsible
for clinical outcomes of their patients, including the fear of
directly harming patients. While taking on increasing responsibility is critical
for their learning and growth towards independent practice, it is
very important for training programs to be aware of some
(10:01):
of these specific fears and to provide adequate support for
the fellows in the early months of training, developing interventions
designed to assist our fellows in managing both their new
responsibilities and their other stressors is an important focus for
all pediatric cardiology training programs. Well, I think this was
a very important work because of its focus on the
fellow in cardiology, who's largely left out of most of
(10:24):
our research, but hopefully not for much longer. Fellowship in
cardiology is a very difficult path, and anyone listening who's
been a cardiology fellow, I am sure as an agreement.
Speaker 2 (10:34):
With that statement.
Speaker 1 (10:35):
But why is that? Well? I think in large part
it's because of exactly what these authors mention, which is
the fairly substantial uptick in complexity and severity of illness
that were all forced to manage in a very rapid fashion.
I know that for me it was a major adjustment.
It was exciting and thrilling at times, but also very scary,
and I still look back upon certain cardiac arrests or
(10:56):
challenging situations that were profoundly stressful. However, I also honestly
recall having curses hurled at me with some regularity by
some faculty, and I think we would all agree that
this was not helpful, was unhealthy and probably wrong. Thankfully,
the days of cursing at fellows and yelling ranting and
raving are over and in truth, we were far too
(11:17):
late to figure this out. In cardiology, the process of
hazing of our fellows was cruel, and I'm pleased to
see these efforts by the Boston team to rectify this.
I am hopeful more research of this nature's performed to
figure out how we can all be more supportive of
our fellows, which can obviously only have a positive impact
on patient care, fellow learning, and fellow wellness. At this time,
(11:39):
I think it would make sense to speak with the
authors of this paper in order to glean some more
insights into this important work. Treating us now is doctor
David Brown, who's Associate Professor of Pediatrics at Harvard Medical
School as well as the director of Fellowship Training in
the Department of Cardiology at Boston Children's Hospital. Doctor Brown
received his undergraduate degree from William's College and medical degree
(11:59):
from Harvard Medical School, completing his residency in pediatrics and
fellowship in cardiology, both at Boston Children's Hospital. He is
a non invasive imager who specializes mostly in eco cardiography,
and he also attends on the Impatient Cardiology Awards at
Boston Children's Hospital. Doctor Brown has been quoted as stating
that quote working with our amazing trainees is one of
(12:20):
the great joys of my career. Therefore, it is no
surprise that he authored this week's work. Let's welcome doctor
Brown to the podcast to discuss this week's work. Welcome
doctor Brown. I'm here now with David Brown. David, thank
you very much for joining us this week on the podcast.
Speaker 3 (12:35):
Rob It's such an honor to be on the podcast.
Thank you so much for asking me to do it.
Speaker 1 (12:39):
Appreciate it. David very much enjoyed this work offline. When
we were discussing this work, you explained to me that
the paper has generated a fair bit of discussion between
the faculty at Children's Boston and the present day fellows,
some of whom were respondents to the questions regarding fellowship
that you studied in this work. I'm wondering if you
(12:59):
might want to share with the audience some of the
issues that have been raised or discussed with the fellows
since the time that you published this important work.
Speaker 3 (13:06):
Yeah, thank you, Robert. I'd like to say that we
learned a really important lesson doing this particular project. At
its core, this paper is really a compilation if you will,
in fears and stressors reported by new fellows at our
program that were gathered as part of a course on
humanism and professionalism that we've been running. We didn't really
(13:30):
conceive of this from the beginning or carry it out
as something that would one day be written up and
shared more broadly. It was the years went by, and
we continue to see the reported fears and stressors remaining
remarkably constant over and over thematically that we thought it
was really important to the field, to trainees, and to
(13:52):
the people who train fellows around the country to share
that experience so that programs could start to think about
them and develop strategy Jesus interventions to really improve and
help support our new trainees. And while this is what
I would call educational quality improvement research, it went through
(14:13):
all of our traditional reviews here, including Scientific Review Committee,
the hospital's RRB, and we have given a full waiver
of consent for participants. If you read the paper, you'll
note it's completely anonymous. It's over an eight years experience
sixty four fellows. But in retrospect, given the nature of
(14:35):
what we were dealing with personally and emotionally, we really
should have circled back to everyone who participated and let
them know that we were planning on writing it up
and sharing it more broadly. Yes, So since that time,
we've had some really good constructive conversations, not only with
(14:56):
regard to this about how important it is and educational
research to have a collaboration in that research with the
trainees you're studying, but also very importantly, and relating to
the themes of this particular manuscript, how could we use
this to forge a head in our own program and
make some real progress on addressing the issues of wellness
(15:18):
and burnout and really trying to improve that across the program.
Speaker 4 (15:24):
Yeah.
Speaker 1 (15:24):
Yeah, well that came screaming through on the paper, and
that's in fact why I thought it was such an
important paper to review this week. You know, David, fears
of increased responsibility, as you said, was remarkably consistent and
highly prevalent amongst the fellows, and it really didn't seem
to change almost at all over the entire time period,
(15:46):
even though you have instituted a number of things to
try and address this. I'm wondering if you had any
thoughts about why this particular fear, which was the most
prevalent one didn't really change or improve with time.
Speaker 3 (15:59):
It's a great question. So among the fears that we
group thematically under that broadheading would be things like the
fear of harming a patient or being afraid that you're
really not up to par to handle the clinical demands
of your new job. And I think a large part
(16:19):
of that stems from the very demanding nature of pediatric
cardiology and what we do. We deal with a really
high patient acuity population. There's a lot of morbidity, there's
some mortality, and I think for most of us it
really is a big step up from general pediatrics training.
I would also keep in mind that the session that
(16:41):
we're describing in the paper was for the vast majority
of fellows done really on arrival. It's that first week
of orientation, so it generally would be before any of
the interventions we've developed here could have affected things, and
it's described in the paper a one month introductory boot
(17:04):
camp like rotation for our new first years. A huge
component of that that's really meant to address the increased
responsibility aspect has been simulation training. We have several really
high fidelity simulations that are built into that experience. That
we really think are important in helping people feel that
(17:26):
they can manage their new job and that they are
really up to the task and meant to be here.
So an important limitation of the study that we're talking
about is that we didn't we didn't do or describe
any post testing. And I will mention that an important
(17:47):
part of the humanism course that we've tried to do
is to circle back at the end of the first
year of training and just have a reflection on you know,
here's what you were worried about when you can came in.
What do you think of that now and how has
that has that changed over time? And if so, how
(18:08):
and what are your thoughts on that. So that's something
that we think is really important, but we're really at
this point haven't explored and certainly haven't described.
Speaker 1 (18:16):
Yeah. Well, I certainly would say that almost anybody who's
ever been a cardiology fellow can identify with those fears.
Certainly I had those fears when I started at Boston
Children's But then again, I had Krishna Kumar and Betsy
Bloom in my year. So anybody who saw those two
would certainly suffer from imposter syndrome with those types of
(18:38):
awesome fellows that I was working with.
Speaker 3 (18:41):
That true.
Speaker 1 (18:41):
I wanted to ask David if you were able to
identify any differences in response to this question between those
fellows who were Children's Hospital of Boston residence and those
from the outside. This question is particularly interesting to me
because I have to say I was always very fearful
as being a resident who was not originally being a
(19:03):
fellow who was not originally from Boston. That was a
concern of mine when I was a fellow. I'm wondering
if this was identifiable.
Speaker 5 (19:13):
You know.
Speaker 3 (19:14):
The short answer to question is no, we didn't look
at that. We did when we did our analysis. We
completely anonymized it, so I didn't really know who was
who or where they had trained when we did our
thematic analysis. You could certainly go back and do that.
It's been my observation and this program director here for
(19:35):
nine years now that I do think adjustment to a
program like this one is sometimes easier for those who
already know the hospital, maybe have spent a little time
in the department of cardiology, maybe know some of the faculty.
I think some of that adjustment is a little easier
being from the home program. But I think when you
think about some of those basic fears, though, that we're
(19:59):
reported so common, that the fear of hurting someone, the
fear of not being up to par for the job,
or feeling a little bit like an imposter. I think
those things are pretty universal, and I suspect they're not
much different whether you train at Boston Children's or a
very small latency program.
Speaker 1 (20:20):
Yeah, I think you're probably right about that. You know,
you've alluded to this a few times, and you mentioned
it in the paper, the wellness curriculum that you have
for the fellows in Boston. I'm wondering if you might
be able to explain a little bit to us what
this curriculum actually includes, and if you're in any fashion
(20:42):
studying the impact that this type of work has had
on the fellows in reducing these stresses.
Speaker 3 (20:48):
Yeah, thank you. I would say that the wellness curriculum
here was extremely rudimentary in FIR several years, consisted mostly
of a quarterly happy but rich really aspired to, with
the help of my current fellows, really aspire to be
that up and make it a much more interesting and
(21:14):
important part of working here. So I've actually got a
group of fellows with the representatives from each year in
the program who've done amazing work on as part of
our Fellowship Wellness Committee, and I've invited one of them
to really speak to the audience about what they've come
(21:34):
up with in terms of initiatives here.
Speaker 1 (21:36):
Okay, Well, for those in the audience at this moment,
which is four forty five on Wednesday, we're not yet
certain if we're going to be able to have that
fellow on. I'm hoping we will, but obviously you'll know
before the end of this podcast whether we were able
to snag Tony for a few moments to talk about it,
But if not, then we'll try to include it in
(21:57):
a future podcast for sure. Well, David, I can't thank
you enough for joining me this week. I'm going to
finish up this interview with the last question which I
sometimes ask of authors, and that is, as the author
of this work, what do you believe is the single
most important finding of this work?
Speaker 3 (22:14):
Well, I would say one of the biggest lessons that
I take away is really not that earth shattering. If
you think back to your first experience as a medical
student or a brand new intern, or even for those
of us who have faculty jobs. That first day as
a faculty member. It's that's here that it's so common.
(22:37):
You aren't ready for what you're being asked to do,
and you're really worried. The demands of the job are
maybe more than you're ready for, and even if you
can do it, you're worried about what kind of toll
that's going to take on your own personal and emotional
well being. I'd say that these are really important. I
think they're incredibly important to address. I think they're universal,
(23:02):
and I think as programs and for program directors in
the audience, I think we have to really do the
hard work of trying to develop initial experiences and initiative
that kind address some of those early in training. And
I think if we can do that and take some
steps in that direction, I think we're going to have happier,
(23:27):
more productive, better adjusted trainees and future faculty.
Speaker 1 (23:32):
Well. I certainly agree with that, and I think for
those young people in the audience listening to this conversation,
this fear never leaves you, and at every level of
your career, you have a similar fear as you move
up the ladder, as it were. And so there's an
important message in this paper not only for cardiology fellows,
(23:53):
but for everybody in our fields. David, I can't thank
you enough. I know you're very busy this week. All
of us know that we're getting ready to interview all
of our fellows, and David, being the head of the fellowship,
is super busy. But I really can't thank you enough
for making a few minutes in your week to speak
with us about it. And I want to congratulate you
your co authors on this really important work.
Speaker 3 (24:14):
Thank you so much. I've been such a pleasure, pleasure,
take care.
Speaker 1 (24:17):
Thank you here. Well, if you've been listening, you know
that I mentioned the possibility of having doctor Tony Pastor,
who's presently the Adult with Congenital Heart Disease Fellow at
Harvard Medical School, join us. Tony is joining us. He's
a graduate of Johns Hopkins University for his undergraduate training,
and he completed medical school and residency at Baylor College
of Medicine, where he was also the Internal Medicine Chief
(24:39):
Resident at Baylor in Houston, Texas. He completed his pediatric
cardiology training at Boston Children's and as I mentioned, he's
presently the ACCHD Fellow in that wonderful program. I'm excited
to get a fellow's perspective on the stresses that cardiology
fellows feel and also to speak with us about the
wellness program for fellows that he is spearheading. Welcome doctor
(24:59):
Paster to the podcast. All right, I'm here now with
Tony Pastor. Tony, thank you very much for joining us.
For those in the audience, doctor Pastor is actually on vacation,
but he was kind enough to speak with us from
his break, so of course I'm not helping his wellness
at all, but thank you very much for joining us
this week.
Speaker 4 (25:18):
Thanks. I'm happy to be here.
Speaker 1 (25:19):
Pleasure you know, Tony. Offline, David Brown and I discussed
this work and he explained to me that when the
paper was first out, it generated a little bit of
discussion between the faculty at Boston Children's as well as
the present day fellows, some of whom were some of
the respondents to the question regarding fellowship that was studied
(25:40):
in this work. I'm wondering if you might share with
the audience some of the issues that were raised or
discussed with the fellows since the time that the work
was published.
Speaker 4 (25:49):
Yeah, I think when the paper first came out when
we first saw it sort of and across our institution,
I think a lot of the fellows and previous fellows
felt a little upset about the fact that we didn't
know that the paper was being published. And at the
(26:10):
time when we had these sort of sessions with doctor
Bloom collecting, you know, talking about our fears, we felt
like these were sort of safe spaces and worked totally
going to know that this was going to end up
being data for submission for a research project. So, you know,
many of the fellows talked amongst ourselves, we talked to
(26:32):
former current faculty who are now former fellows and decided
to bring up the issue to the administration, and we
talked to Dave Brown, we talked to Betty Bloom and
appropriately so they they held a bunch of town halls
that we could express, you know, our issues with the
fact that we felt like our trust had been violated,
and I think overall it was a very positive experience
(26:56):
and both sides sort of like learned from from everything
that had occurred because of this publication. And you know,
Dave had presented to the fellows like what can we
do to sort of make your fellowship better? And that's
where you know, the idea of the Wellness Committee came
about and sort of in a direct response to the
(27:20):
controversy of this paper coming out.
Speaker 2 (27:22):
I see, I see.
Speaker 1 (27:23):
Well. Actually I was very interested to hear a little
bit about the Wellness Committee. David hinted to us in
his interview which is preceding this interview on the podcast
this week, that you had spearheaded with other fellows this
curriculum and program. I'm wondering sort of what it is
that you're doing as part of this committee and whether
(27:46):
or not you've actually started to measure the impact or
noticed any impact on the fellows since you've incorporated this
into their lives.
Speaker 5 (27:55):
Yeah. I know.
Speaker 4 (27:57):
It's so funny because if you would have asked us,
what are our idea was their curriculum was a couple
of months ago, it would be completely different due to
the COVID pandemic. So initially Dave had recruited two fellows
from every class so that we could all be equally represented.
So the initial class was myself, Dave, Karen, Emily Addison
(28:17):
Raid and Marie Helene, and we didn't need the assessment
initially and found actually a lot of low hanging fruit
that could sort of improve jellowship wellness in general. But
then COVID nineteen hit and we suddenly readdressed sort of
you know, what our goals were for the committee, because
(28:40):
what we found that was lacking the most and what
was sort of destroying everyone's well being during the pandemic
was a lack of social interaction and the lack of
just coming together as a community again the sort of
we're all in this together culture that we sort of
pride ourselves to Boston children, and it was hard to
(29:01):
do that over zoom or you know, in the very
few conferences that we had together. So we abandoned our
initial goals and then just decided to launch a Zoom
based curriculum. It's even harder to call it a curriculum.
It was mostly social events where I think the initial
one was wine Nights with doctor Sanders, who's the director
(29:24):
of our cardiac registry and also wine cronus here just
like an all around nice guy also, and they became
so popular that the faculty actually really wanted to join them,
and so it evolved into these every Friday night we
were having Zoom based social events with the faculty and
the Fellows and it I mean in so many levels
(29:46):
it brought our community together, but it was also just
nice to just forget about the stressors of work, you know,
COVID nineteen, everything that we're all experiencing and just come
together with our coworkers and see each other in our
home homes and just laugh for an hour or so.
Speaker 6 (30:02):
And this was all via zoom.
Speaker 4 (30:05):
This was all Zoom based, It was all Fellow driven.
It was done with no funding. We just we just
came together and and did it via Zoom and and
we we did this for about like three months. And
it wasn't just the wine nights. We had like trivia
night that Emily and Dave had spent hours sort of preparing,
(30:26):
and we had teams. The Fellow team won.
Speaker 1 (30:28):
By the way.
Speaker 4 (30:29):
So yeah, we and in terms of like you know,
measuring our outcomes, we this is sort of the initial
class of our Wellness Committee. And going forward, we've actually
gone decided that we're probably going to do like a
pre and post survey of our interventions. But I think
at the time when we were doing this, we just
(30:52):
find it. We just saw a need and and said, hey,
we need to do something to kind of make everyone
a little happier.
Speaker 1 (31:00):
Yeah, well, I think we could all use a little
bit of that. And it's really nice to hear these ideas.
I'm sure people listening are going to try and think
about how they can incorporate this idea into their own
practice and their own programs. Tony, I really can't thank
you enough again, thank you very much for sharing with
us the fellows perspective of this, and also for sharing
(31:23):
with us some wonderful ideas that you and your colleagues
have come up with in Boston. As a former Boston Fellow,
I can tell you it really sounds wonderful to hear
how much people are paying attention to the wellness of
the Fellows. That's a wonderful thing and yet another example
of how Boston has been leading the way always in
cardiology and now in training as well.
Speaker 4 (31:43):
Yeah, of course I appreciate it, and I and thank
you for talking.
Speaker 3 (31:47):
To me today.
Speaker 2 (31:48):
It's real pleasure. Thank you.
Speaker 1 (31:49):
Well.
Speaker 2 (31:50):
I think we've learned a great deal this week about
the efforts made in Boston to help the Fellows by
first identifying what it is that's worrying them when they begin.
I think any form of YELLO listening this week can
likely well identify with all of the concerns of the
fellows in Boston, and I'm not surprised that the worries
did not change much over the timeframe of seven years
in this study. For I think, at least for me,
(32:12):
the same worries were mine nearly thirty years ago when
I started at that same institution. I think we all
learned a lot about the wellness attempts being made by
doctor Pastor and his co fellows, and certainly there is
something to learn for all of us in these efforts.
We all devote so much of our lives to our
patients and patient families, and this certainly takes a very
serious toll on all of us in many different ways.
(32:34):
And efforts like those by doctor Brown and doctor Bloom
to identify the stresses for our fellows, and efforts by
doctor Pastor to address the stress finding ways to release
some of the strain associated with working so hard taking
care of our patients are good first steps towards reducing
anxiety and strain for all. I'm most appreciative of doctor
(32:55):
Brown and doctor Pastor for sharing with us their time
this week. I hope you enjoyed our conversation as much
as I did.
Speaker 1 (33:02):
To conclude this replay of episode one hundred and thirty
from twenty twenty, we hear the magnificent tenor Franco Correlli
singing an aria for which he was justly famous, the
famous Nessundorma from Puccini's Torondot. Though today we associate this
aria with the great Luciano Pavarotti from his three tenor concerts,
(33:23):
prior to that time, Correlli was known throughout the world
as the greatest exponent of the role coof in this opera.
And I'm sure you'll understand why would you hear this
nineteen sixties recording. Thank you very much for joining me
for this replay episode, and thanks once again to Doctor
Pastor and doctor Brown.
Speaker 6 (33:41):
I hope I'll have a good week ahead.
Speaker 5 (34:01):
So fast, not so for the.
Speaker 6 (34:12):
Person double.
Speaker 7 (34:21):
On y Arny Star refunny.
Speaker 3 (34:37):
So the sup.
Speaker 7 (35:11):
What of your ale sh shel Seal.
Speaker 5 (35:23):
Boggy mel all my note app be
Speaker 1 (36:03):
To me to
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