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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Crucible of Crisis</title><author><name sortKey="Sinha, Shashank S" sort="Sinha, Shashank S" uniqKey="Sinha S" first="Shashank S." last="Sinha">Shashank S. Sinha</name><affiliation><nlm:aff id="aff1">Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia</nlm:aff></affiliation></author><author><name sortKey="Sharma, Garima" sort="Sharma, Garima" uniqKey="Sharma G" first="Garima" last="Sharma">Garima Sharma</name><affiliation><nlm:aff id="aff2">Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, Baltimore, Maryland</nlm:aff></affiliation></author><author><name sortKey="Cullen, Michael W" sort="Cullen, Michael W" uniqKey="Cullen M" first="Michael W." last="Cullen">Michael W. Cullen</name><affiliation><nlm:aff id="aff3">Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7183288</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183288</idno><idno type="RBID">PMC:7183288</idno><idno type="doi">10.1016/j.jacc.2020.04.012</idno><idno type="pmid">NONE</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000367</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000367</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Crucible of Crisis</title><author><name sortKey="Sinha, Shashank S" sort="Sinha, Shashank S" uniqKey="Sinha S" first="Shashank S." last="Sinha">Shashank S. Sinha</name><affiliation><nlm:aff id="aff1">Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia</nlm:aff></affiliation></author><author><name sortKey="Sharma, Garima" sort="Sharma, Garima" uniqKey="Sharma G" first="Garima" last="Sharma">Garima Sharma</name><affiliation><nlm:aff id="aff2">Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, Baltimore, Maryland</nlm:aff></affiliation></author><author><name sortKey="Cullen, Michael W" sort="Cullen, Michael W" uniqKey="Cullen M" first="Michael W." last="Cullen">Michael W. Cullen</name><affiliation><nlm:aff id="aff3">Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the American College of Cardiology</title><idno type="ISSN">0735-1097</idno><idno type="eISSN">1558-3597</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bonow, R O" uniqKey="Bonow R">R.O. Bonow</name></author><author><name sortKey="Fonarow, G C" uniqKey="Fonarow G">G.C. Fonarow</name></author><author><name sortKey="O Ara, P T" uniqKey="O Ara P">P.T. O’Gara</name></author><author><name sortKey="Yancy, C W" uniqKey="Yancy C">C.W. Yancy</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Defilippis, E M" uniqKey="Defilippis E">E.M. DeFilippis</name></author><author><name sortKey="Stefanescu Schmidt, A C" uniqKey="Stefanescu Schmidt A">A.C. Stefanescu Schmidt</name></author><author><name sortKey="Reza, N" uniqKey="Reza N">N. Reza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Omer, S B" uniqKey="Omer S">S.B. Omer</name></author><author><name sortKey="Malani, P" uniqKey="Malani P">P. Malani</name></author><author><name sortKey="Del Rio, C" uniqKey="Del Rio C">C. del Rio</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Almarzooq, Z" uniqKey="Almarzooq Z">Z. Almarzooq</name></author><author><name sortKey="Lopes, M" uniqKey="Lopes M">M. Lopes</name></author><author><name sortKey="Kochar, A" uniqKey="Kochar A">A. Kochar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yong, C" uniqKey="Yong C">C. Yong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hawking, S" uniqKey="Hawking S">S. Hawking</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="editorial"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Am Coll Cardiol</journal-id><journal-id journal-id-type="iso-abbrev">J. Am. Coll. Cardiol</journal-id><journal-title-group><journal-title>Journal of the American College of Cardiology</journal-title></journal-title-group><issn pub-type="ppub">0735-1097</issn><issn pub-type="epub">1558-3597</issn><publisher><publisher-name>by the American College of Cardiology Foundation. Published by Elsevier.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7183288</article-id><article-id pub-id-type="publisher-id">S0735-1097(20)34914-7</article-id><article-id pub-id-type="doi">10.1016/j.jacc.2020.04.012</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The Crucible of Crisis</article-title><subtitle>Fellows’-in-Training and Early Career Cardiologists’ Responses to the COVID-19 Pandemic</subtitle></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Sinha</surname><given-names>Shashank S.</given-names></name><degrees>MD, MSc.</degrees><email>shashank.sinha@inova.org</email><ext-link ext-link-type="uri" xlink:href="https://twitter.com/ShashankSinhaMD">@ShashankSinhaMD</ext-link><xref rid="aff1" ref-type="aff">a</xref><xref rid="cor1" ref-type="corresp">∗</xref></contrib><contrib contrib-type="author" id="au2"><name><surname>Sharma</surname><given-names>Garima</given-names></name><degrees>MD</degrees><ext-link ext-link-type="uri" xlink:href="https://twitter.com/GarimaVSharmaMD">@GarimaVSharmaMD</ext-link><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au3"><name><surname>Cullen</surname><given-names>Michael W.</given-names></name><degrees>MD</degrees><ext-link ext-link-type="uri" xlink:href="https://twitter.com/mwcullen">@mwcullen</ext-link><xref rid="aff3" ref-type="aff">c</xref></contrib><aff id="aff1"><label>a</label>Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia</aff><aff id="aff2"><label>b</label>Division of Cardiology, The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, Baltimore, Maryland</aff><aff id="aff3"><label>c</label>Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota</aff></contrib-group><author-notes><corresp id="cor1"><label>∗</label><bold>Address for correspondence:</bold> Dr. Shashank S. Sinha, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, Virginia 22042. <email>shashank.sinha@inova.org</email><ext-link ext-link-type="uri" xlink:href="https://twitter.com/ShashankSinhaMD">@ShashankSinhaMD</ext-link></corresp></author-notes><pub-date pub-type="pmc-release"><day>25</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>25</day><month>4</month><year>2020</year></pub-date><permissions><copyright-statement>© 2020 by the American College of Cardiology Foundation. Published by Elsevier.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder>American College of Cardiology Foundation</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><related-article related-article-type="commentary-article" id="d32e173" ext-link-type="doi" xlink:href="10.1016/j.jacc.2020.04.014"></related-article><related-article related-article-type="commentary-article" id="d32e176" ext-link-type="doi" xlink:href="10.1016/j.jacc.2020.04.013"></related-article><related-article related-article-type="commentary-article" id="d32e179" ext-link-type="doi" xlink:href="10.1016/j.jacc.2020.04.015"></related-article></article-meta></front><body><p id="p0010"><disp-quote><p>The only constant in life is change.</p><attrib>—Heraclitus of Ephesus</attrib></disp-quote></p><p id="p0015">The coronavirus disease 2019 (COVID-19) is a global pandemic resulting from an acute viral illness that can manifest as severe derangements of the respiratory, cardiac, and immune systems (<xref rid="bib1" ref-type="bibr">1</xref>). Many patients presenting with acute complications of COVID-19, especially those with underlying cardiovascular comorbidities, have succumbed to its devastating morbidity and mortality (<xref rid="bib1" ref-type="bibr">1</xref>). As of April 6, 2020, >1.2 million COVID-19 cases have been reported worldwide, resulting in nearly 70,000 deaths globally (<xref rid="bib2" ref-type="bibr">2</xref>). The COVID-19 pandemic has also resulted in a cataclysmic stress on our health care system, organizational structure, and health care workforce. It has abruptly and adversely impacted the cardiology fellows-in-training (FIT) and early career (EC) cardiovascular professional community. Given the critical need for rapid assimilation and dissemination of knowledge regarding COVID-19, the <italic>Journal</italic> is pleased to share with our FIT-EC readership a series of insightful perspectives from courageous members of our community. We herein provide a brief introduction to this collection and posit questions for readers to consider as they peruse these papers.</p><p id="p0020">From an FIT perspective, Drs. DeFilippis, Stefanescu Schmidt, and Reza share a compelling commentary on how the cardiovascular educational community can support FITs during the COVID-19 pandemic (<xref rid="bib3" ref-type="bibr">3</xref>). As the authors eloquently discuss, despite the changes deemed necessary due to the pandemic, many FIT educational modalities abound. These include experiential learning, online simulations, virtual procedural experience, telemedicine, and remote education (<xref rid="bib3" ref-type="bibr">3</xref>); however, several challenges persist. For example, the social and physical distancing imperative (<xref rid="bib4" ref-type="bibr">4</xref>) has catalyzed a significant transformation of traditional inpatient team structures, including FIT roles and responsibilities. How should FITs contribute meaningfully to inpatient clinical care during this COVID-19 era? Besides supporting direct bedside participation in the care of cardiac intensive care and intermediate care units, to which other inpatient cardiovascular and noncardiovascular services should programs now assign FITs? Given the very real risks of exposure, how can FITs protect themselves and fulfill their professional and educational responsibilities? From a procedural standpoint, many health systems have deferred elective procedures; consequently, FITs are receiving diminished exposure to critical hands-on, interactive, and supervised experiences performing invasive procedures. It does not seem fair that these FITs should be penalized for not fulfilling all major Accreditation Council of Graduate Medical Education (ACGME) milestones. How then should training programs restructure their curricula? Some institutions may choose to declare pandemic emergency status. However, it is not entirely clear how program directors and clinical competency committees should evaluate which FITs may be ready to matriculate and which may require extensions of training. Perhaps one of the most formidable exercises for graduating FITs will be securing job placement. Many FITs may feel particularly disadvantaged as several institutions have implemented hiring freezes in the midst of this COVID-19 pandemic. Some employers have indicated there is no precedent to hire prospective candidates without an in-person interview taking place at some point during the recruitment process. Furthermore, the economic and financial impacts of the pandemic could linger long after the short-term stress on the health care system resolves, thereby hindering job search prospects for FITs. Unfortunately, no clear answers are readily available.</p><p id="p0025">In the next piece in this series, Drs. Almarzooq, Lopes, and Kochar embellish on the theme of virtual learning (<xref rid="bib5" ref-type="bibr">5</xref>). Cancellation or postponement of educational activities, including national professional society scientific meetings, institutional grand rounds, and departmental journal clubs, has inspired utilization of remote teleconferencing platforms (e.g., Zoom [Zoom Video Communications, San Jose, California], BlueJeans [BlueJeans Network, San Jose, California] WebEx [Cisco Webex, Milpitas, California], etc.) to permit FIT engagement in virtual teaching (<xref rid="bib3" ref-type="bibr">3</xref>). Dr. Almarzooq and colleagues specifically examine the development and implementation of virtual learning at their institution using Microsoft Teams (Microsoft Corporation, Redmond, Washington), which is similar to the aforementioned platforms in providing a collaborative environment through an integrated, secure, cloud-based system (<xref rid="bib5" ref-type="bibr">5</xref>). The platform these authors describe is quite versatile and has enabled FITs within their program to share and store articles in the cloud, collaborate on shared documents and projects, and participate in virtual conferences. The latter has been of particular interest, as it has enabled polling of FITs during virtual conferences and utilization of the chat box to promote discussion. Several sessions have been recorded and stored on the work cloud, empowering fellows engaged on the front lines to review important topics and content as their clinical obligations permit. Drs. Almarzooq and colleagues share several important lessons and insights that may be useful to other programs adopting virtual learning platforms (<xref rid="bib5" ref-type="bibr">5</xref>). We applaud training programs for rapidly adopting virtual learning as a potential strategy to maintain education in the era of social and physical distancing; however, the ultimate educational effectiveness of these virtual conferences compared to traditional live learning remains unproven, particularly in the current environment. We also wonder which of these innovative strategies will endure in the post-COVID-19 era. Ultimately, only time will tell.</p><p id="p0030">Finally, Dr. Celina Yong shares a thoughtful EC perspective on the myriad challenges the COVID-19 pandemic has imposed on the professional and personal lives of cardiologists (<xref rid="bib6" ref-type="bibr">6</xref>). She tackles an array of themes including reducing personal risk through a team-based approach, relying on community-based solutions to achieve the ever-elusive work-life balance, and transforming FIT education, among others (<xref rid="bib6" ref-type="bibr">6</xref>). This personal essay describes the poignant experience of an early career interventional cardiologist in a leadership role. What does one do if his or her hospital runs out of personal protective equipment? How does one responsibly and effectively leverage social media campaigns such as #GetMePPE on Twitter? How should FIT and EC professionals address pragmatic familial concerns, such as abrupt closure of child daycare programs? From a practical and safety standpoint, how does one make the difficult decision to have one’s parents, who may be elderly and most vulnerable, babysit one’s children? Do universally accepted decontamination protocols exist upon returning home from the hospital? Finally, how do we protect our senior faculty members who may be among the most experienced but also the most medically vulnerable to complications from COVID-19? These are but a few of the thought-provoking questions that Dr. Yong critically examines in her compelling personal essay (<xref rid="bib6" ref-type="bibr">6</xref>).</p><p id="p0035">In summary, these 3 publications in this COVID-19 series for the <italic>Journal’s</italic> FIT-EC section provide unique and valuable insights into the current pandemic. Changing times call for changing measures. While our health system, medical profession, and world economy have dramatically shifted in unprecedented ways within the last few weeks, the commitment, ingenuity, and dedication of our colleagues provide cautious optimism. The late great astrophysicist Stephen Hawking once said, “Intelligence is the ability to adapt to change.” These creative and intelligent solutions published in this series will inform our FIT-EC community during a time of grave uncertainty and heightened complexity. We applaud the authors for their contributions and look forward to learning from each other as we grapple with this crisis.</p><sec id="sec1"><title>Uncited Reference</title><p id="p0040"><xref rid="bib7" ref-type="bibr">7</xref>.</p></sec></body><back><ref-list id="cebib0010"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sref1"><person-group person-group-type="author"><name><surname>Bonow</surname><given-names>R.O.</given-names></name><name><surname>Fonarow</surname><given-names>G.C.</given-names></name><name><surname>O’Gara</surname><given-names>P.T.</given-names></name><name><surname>Yancy</surname><given-names>C.W.</given-names></name></person-group><article-title>Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality</article-title><source>JAMA Cardiol</source><year>2020 Mar 27</year><comment>[E-pub ahead of print]</comment></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="other" id="sref2"><person-group person-group-type="author"><collab>World Health Organization</collab></person-group><article-title>World Health Organization Coronavirus disease 2019 (COVID-19) Situation Report 77</article-title><comment>Available at:</comment><ext-link ext-link-type="uri" xlink:href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200406-sitrep-77-covid-19.pdf" id="intref0010">https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200406-sitrep-77-covid-19.pdf</ext-link></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="journal" id="sref3"><person-group person-group-type="author"><name><surname>DeFilippis</surname><given-names>E.M.</given-names></name><name><surname>Stefanescu Schmidt</surname><given-names>A.C.</given-names></name><name><surname>Reza</surname><given-names>N.</given-names></name></person-group><article-title>Adapting the educational environment for cardiovascular fellows-in-training during the COVID-19 pandemic</article-title><source>J Am Coll Cardiol</source><volume>75</volume><year>2020</year><comment>▪▪</comment></element-citation></ref><ref id="bib4"><label>4</label><element-citation publication-type="journal" id="sref4"><person-group person-group-type="author"><name><surname>Omer</surname><given-names>S.B.</given-names></name><name><surname>Malani</surname><given-names>P.</given-names></name><name><surname>del Rio</surname><given-names>C.</given-names></name></person-group><article-title>The COVID-19 pandemic in the US: a clinical update</article-title><source>JAMA</source><year>2020 April 6</year><comment>[E-pub ahead of print]</comment></element-citation></ref><ref id="bib5"><label>5</label><element-citation publication-type="journal" id="sref5"><person-group person-group-type="author"><name><surname>Almarzooq</surname><given-names>Z.</given-names></name><name><surname>Lopes</surname><given-names>M.</given-names></name><name><surname>Kochar</surname><given-names>A.</given-names></name></person-group><article-title>Virtual learning during the COVID-19 pandemic: a disruptive technology in graduate medical education</article-title><source>J Am Coll Cardiol</source><volume>75</volume><year>2020</year><comment>▪▪</comment></element-citation></ref><ref id="bib6"><label>6</label><element-citation publication-type="journal" id="sref6"><person-group person-group-type="author"><name><surname>Yong</surname><given-names>C.</given-names></name></person-group><article-title>COVID-19: the isolation that has brought us together</article-title><source>J Am Coll Cardiol</source><volume>75</volume><year>2020</year><comment>▪▪</comment></element-citation></ref><ref id="bib7"><label>7</label><element-citation publication-type="other" id="sref7"><person-group person-group-type="author"><name><surname>Hawking</surname><given-names>S.</given-names></name></person-group><comment>Available at:</comment><ext-link ext-link-type="uri" xlink:href="https://www.brainyquote.com/quotes/stephen_hawking_378304" id="intref0015">https://www.brainyquote.com/quotes/stephen_hawking_378304</ext-link></element-citation></ref></ref-list><fn-group><fn id="d32e185"><p id="ntpara0010">All authors have reported that they have no relationships relevant to the contents of this paper to disclose.</p></fn><fn id="d32e188"><p id="ntpara0015aa">The author attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the <italic>JACC</italic><ext-link ext-link-type="uri" xlink:href="http://www.onlinejacc.org/content/instructions-authors" id="interref1">author instructions page</ext-link>.</p></fn></fn-group></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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