Maslow identified 5 fundamental human needs: physiological, safety, belonging, esteem, and self-actualization.2 We modified Maslow's framework to identify the needs of trainees during the COVID-19 pandemic (Table 1 ). Table 1 shows examples of potential interventions to meet trainee well-being needs on the program, institution, and extrainstitutional level.
Table 1 Examples of Potential Interventions to Address Resident/Fellow Wellness Needs Using Maslow's Need Framework During COVID-19 Pandemic
Adapted Maslow Need Theme Categories Examples of Potential Interventions
Extrainstitutional Institutional Department/Program
Physiologic Food Food while working Extra money on meal cards Provide meals while in hospital/clinic
Food at home Community-provided meals to health care workers Hospital-sponsored groceriesGift cards for food-delivery servicesVolunteer network provide groceries Gift cards for food-delivery services
Sleep Sleep on-call ACGME work hour restrictions - pandemic status Additional call rooms
Respite lodging State/local lodging for health care workers Respite housing
Physical health COVID-19 screening and testing COVID-19 testing stations in community Illness screeningTemperature screeningSufficient expedited COVID-19 testingTrack COVID-19 exposure and testing Track COVID-19 exposure and testing
COVID-19 illness management Track sick residentsClinical monitoringOccupational healthIsolation policiesReturn to work criteria Track sick residentsCommunication about processesAdequate back-up systems
Mental health Mental health hotlines for health care workersWeb-based mindfulness resources On-call mental health providerOn-line telehealthEmployee and family assistance programDirector of trainee well-beingStress and resilience town halls and webinarsWeb-based meditation Screening for mental healthCentralized resource listDebriefing of teams - scheduled and as neededCheck-ins by Program Directors, chief residentsGroup discussions facilitated by mental health provider
Childcare State-supported daycare facilities for health care workersAssistance with paying for increased costs of childcare Institutional daycareVolunteer networkAffiliations with childcare agenciesAssistance with paying for increased costs of childcare Centralized resource listResident childcare sharingFlexible schedulingParenting/newborn elective
Safety Personal safety Personal protective equipment (PPE) ACGME requirements Adequate PPEPPE trainingInfection control training PPE trainingJust-in-time trainingAdherence to infection control
Accommodation of high risk individuals (pregnancy, immunocompromised, etc.) Institutional policies defining high-risk population Scheduling to accommodate high-risk individuals
Safety of family Short- and long-term housing (for COVID-19 exposure and positive)Shower near workDisinfection protocolScrubs for work Centralized information re: disinfection protocol and housingScrubs for work
Financial security Job insecurity (personal or spouse) Governmental subsidies Counseling about job alternatives
Additional expenses Paid leave of absenceChildcare subsidy
Schedule and patient care responsibilities Vacation policySchedule for COVID-19 surge Short- and long- term schedules, including vacationCOVID-19 surge coverage
Sense of belonging Social support from colleagues APPD virtual events Virtual institutional and departmental town halls Group-based learning activitiesTown halls, meetingsGroup-based virtual social activities: games, competitions, happy hours, journalingEmail updates
Social support from friends and family Technology (ie, ZOOM Webex, etc.) to connect with friends and family
Esteem Appreciation by and for others Expressions of appreciation Community appreciation Additional compensationDepartmental appreciation Shout-outs, expressions of gratitude, virtual graduation, gift certificates
Self-identity as physician Engagement in meaningful activities Remote into rounds, electives, advocacy work, scholarship
Caring for adult patients Adequate supervision and teachingCommunication scripts Collaboration with Internal Medicine (IM), Med-Peds program leadership IM bootcamp, supervision by IM and Med-Peds facultyCommunication training
Self-actualization Mentoring Faculty mentoring program
Curriculum Structure and content ABP allowing PD to request waivers for graduating trainees Development of new curricula (eg, new rotations or electives, telehealth, web-based curricula)
Telehealth to promote physical distancing ACGME requirements for education, including telehealthCMS revising teaching attending rules for telehealth Institutional policies in regard to telehealth and traineesTelehealth equipment Training residents in telehealthTelehealth equipmentAppropriate supervision of residents with telehealth
Career development APPD and COPS resources and guidelines for application to residency and fellowship programs Virtual career mentoring by departmental chair, faculty, educational and program leaders Virtual career mentoring, facilitate networking, provide exposure to trainees’ fields of interest, support CV development
ACGME indicates Accreditation Council for Graduate Medical Education; APPD, Association of Pediatric Program Directors; ABP, American Board of Pediatrics; PD, program director; COPS, Council of Pediatric Subspecialties; and CV, curriculum vitae.