Hello, everyone. Thank you for joining us today for the research section Critical Crosstalk titled Managing Child Care and Education During a Pandemic Without Losing Your Research Career. My name is Collin Maurer, and I'm a PGY-5 Pediatric Critical Care Fellow at the University of Texas Southwestern Children's Medical Center in Dallas, Texas. I'm very excited for the opportunity to be the moderator for this talk today. I'm joined by our two speakers, Dr. Lane Fall and Dr. Remy. Dr. Lane Fall is the Vice Chair of Inclusion, Diversity and Equity, an Associate Professor of Anesthesiology and Critical Care, and an Associate Professor of Epidemiology at the University of Pennsylvania. Dr. Remy is an NIH-funded physician scientist and Assistant Professor in the Department of Pediatrics and Internal Medicine at Washington University in St. Louis. Thank you both very much for speaking today. Recent literature has described specific challenges being faced by physician scientists during the pandemic, particularly related to balancing new obligations outside of the workplace with career advancement and research opportunities. These articles further discuss concerns that specific groups of physician scientists are being more heavily impacted by the recent changes in the fields of medicine, research, and our day-to-day lives. During this critical crosstalk, we aim to discuss the following, the demographics of the most vulnerable physician scientists during the pandemic, to gain a better understanding of the productivity gap between junior scientists with and without childcare and homeschooling obligations, and between junior scientists and tenured faculty without these obligations, and also to discuss potential solutions such as support for childcare and homeschooling, funding strategies, and considerations around faculty promotion. I would now like to turn the floor over to Dr. Lainfall and Dr. Remy to tell us more about themselves and how the pandemic has impacted their and their colleagues' research careers and roles. Dr. Lainfall, would you like to begin? Alan, thanks so much for the introduction. As you mentioned, I'm faculty at the University of Pennsylvania. I'm an anesthesiologist and a surgical intensivist, and in addition to my role as a vice chair for inclusion, diversity, and equity for my department, I'm also the disaster preparedness officer, so it's been pretty busy this last year. I'm an implementation scientist, and the work that I do, my scholarship sits at the intersection of patient safety, quality, qualitative research, mixed methods research, really trying to bridge the evidence-to-practice gap in acute care. I am married to a very kind and very generous man who is not in medicine, and that will become more important as we have the discussion later, and I'm also the mother to two school-aged girls aged seven and ten. As I think about what the pandemic has done for my own research, really it's brought it to a standstill. All of our data collection, which was based in acute care settings, had to stop, understandably, because we were focused on taking care of patients who were affected by COVID. We were focused on building and maintaining capacity for patient care, and we were having to change our workflow significantly, and so research had to take a back burner because our research wasn't directly related to COVID. I watched as my colleagues' labs were stopped, and for my basic science colleagues, some of their reagents were redeployed, some of their personnel were redeployed. My whole team had to work remotely, and so we were able to continue data analyses, but we couldn't, as I mentioned, collect new data. And on top of all of it, I was fortunate enough to get my first R01, which was great, but then I had to start the R01 during a pandemic, and so convening a new team, coming up with new study procedures all remotely was pretty difficult. Everything was slowed down and made more awkward by the pandemic. From a leadership perspective, I've had to think about what the pandemic has meant for researchers in my own institution. Specifically, I've had to think about how to advocate for junior researchers. At our own institution, we initially created a mechanism so that people who were on a clock or a ladder track could apply for an extension, a tenure clock extension, but we quickly realized that even that was too much of an impediment to folks, and so we rallied for or lobbied for the university to make that extension automatic, which they did. So it's great to know at our institution that no one's going to be penalized for productivity slowdowns related to COVID, but they don't have to take the extension if they don't want to, so hopefully it will just be something that's helpful to them. Another thing that I've been concerned about is with maintaining the fragile pipeline of underrepresented minority researchers and female researchers, and especially as I think about what it takes to be a successful junior researcher, usually you're working with and relying on students and other folks who are rotating through who are learning how to do research, but they don't cost quite as much, which is really important when you're first starting off your career. And we had to shut down all of our research apprenticeship programs with COVID, which meant that this important pipeline of researchers was unavailable for our junior researchers, and it also meant that those students didn't have crucial exposure to research, and so we're trying to figure out ways to maintain that pipeline so that we don't a few years from now end up in an even worse position than we are right now with respect to representation in STEM fields. So there's been a lot to think about. I think that we're on the way out, and we've had a lot of creative thoughts about how to support people, but there's going to be a lot more sequelae from this moving forward, so I'm happy to be a part of this panel. I'm happy for us to have a rousing discussion about how to support folks, and I appreciate the opportunity to be able to talk with you all. Great. Thank you, Dr. Lanefall. Dr. Remy? Thank you, and great to hear from Dr. Lanefall, and certainly thank you, Dr. Maurer, for the introduction. So I'm a physician scientist at Washington University. I'm an adult and pediatric critical care physician, and I wear a number of different hats, including I'm the basic science and translational section leader of the research section for SSCM, as well as the leader of immunology section for the pediatric acute lung and sepsis investigators, blood net group, and some other hats I wear in national and international task forces now in COVID. So prior to the pandemic, I've been supported by KO8 through NIGMS, and my lab actually studies how red blood cells lyse and cause immune dysregulation and sepsis and other related diseases. And in fact, my planned R01 submission was this past fall. And once the pandemic occurred, I unfortunately, in many ways, got called into action as an adult and pediatric intensivist to do a number of different things that not only were related to bench work, but were also related to some of the other things that I do, including global health and public health based off my previous work at the NIH and other locations. And so when the pandemic started in March and in April, I spent about two, two and a half months specifically in our COVID ICU. And I should tell you that I'm blessed with a wonderful spouse who's in this conference today, as well as four children, a set of twins, an eight year old and a set of twins that are six years old and a three year old. And at the time we had two dogs. And so we started our pandemic this way. And during that timeframe, I was in the COVID unit for the first two and a half months. But during that time, I was fortunate that I was able to pivot my research after talking to my program officer, specifically into making my laboratory and collaborating with my colleague Richard Hotchkiss's laboratory into COVID labs. And so for the months while I was taking care of patients, I would literally drive from different hospitals in our hospital system and pick up samples. Because we had stayed home orders, I did not have coordinators or anybody to consent. I did all the consenting, a lot of the regulatory documentation, brought the samples to the lab, we ran and processed them. And then I would head off to a number of different task forces across the globe, trying to give some advice specifically on how to take care of adults in pediatric ICU settings. And then would sleep for, you know, four hours a day and go back and do this all the next day. And members of my laboratory were forced to stay home. Two members actually had to leave the lab specifically in time because they were going to medical school. Our students that we had already had scheduled for the summertime for bench, which were four students already, unfortunately could not come into the laboratory. And so we were forced to get really creative on how we did our bench research and translational work specifically, using different unique opportunities with different personnel configurations, including me pairing up with some collaborators. Now, in this whole pandemic, as I mentioned, my R01 was to be submitted last fall. And some of the key and crucial information that I was hoping to put into that with the proteomic data has been delayed until 2021. Promotions, including my own, were put on hold. And a number of other things that were certainly going to be very relevant for me to move in advance forward in my research career were certainly delayed. But on the same respect, by adapting and to the current conditions with COVID disease, I was able to certainly be able to remain productive in my research endeavors and able to marry a lot of the immunologic readouts that I use in sepsis into COVID. And fortunately, myself and my colleagues have published now over 12 manuscripts in COVID since the pandemic. And we continue to publish, which I think has been great, because it just demonstrates that being able to be adaptable and collaborate are one ways, especially in a tough pandemic, that you're able to move forward. I'm excited to talk on this conference today and certainly able to at least tell you a little bit about some of the things that I've had to endure. But I think more importantly, I've been so fortunate with my ability to move forward with my research career under these circumstances, frankly, because I've had a spouse who's really picked up the lion's share of a lot of the work at home. But it doesn't negate the fact that I still have to be cognizant of a number of staff members that also have similar struggles. And we've had to make certainly adaptations to make sure that when we did have a comeback to work order at our university, that we could certainly accommodate virtual learning and other such things so that we can continue to allow everyone to at least be engaged in the research that we were conducting. Great. Thank you both very much for those introductions. I was hoping to move on to our first topic. You had both have touched on this briefly in your introductions, but I thought we could get into it a little bit more specifically. The field of medicine and those conducting research in the STEM fields was recently, as I mentioned, described as having barriers to entry and advancement, specifically for women and minorities, and that these barriers have been exacerbated during the pandemic. Have either of you observed the pandemic having a larger impact on a specific group of physician scientists? And if so, who, how, and why do you think that group has been more affected? Dr. Lainfall, would you like to start? Sure. Yeah, I mean, I think this is a real thing. Whether it's related to societal expectations or gender norms, there are a lot of responsibilities that both women and underrepresented minorities bring with them to their professional life, and the pandemic has only exacerbated that. When we think about women who typically bear the brunt of home care, so whether that's child care, elder care, household duties, in general, women tend to do more of that. And I realize this frame is a little bit heterosexist, so I apologize for that. But in general, women do a lot of domestic work, and so that hasn't changed with COVID. It's actually gotten a bit worse. And I think about taking care of my own kids, and my husband does a lot of it, but we have all become teachers. I think we're all really appreciative of what teachers do now, but we've all had to help with homework and virtual learning. And, you know, your kids don't necessarily understand that you're writing a paper, or you're doing an analysis, or you're on a conference call. They just know that their Zoom dropped off, or they need help with something. And so every single interruption, every single new duty, slows you down a bit and pulls you back. And it's not that what you're now being called to do isn't important, but in an academic world that expects you to continue to be productive, it's very hard to continue firing on all cylinders when you have new expectations. And so I've certainly seen women affected by that. In terms of underrepresented minorities, in particular, you know, I'm a Black woman. That's the frame I tend to think about. And so we've had to deal not just with the pandemic related to COVID, but an epidemic, and some would say a pandemic of racism and inequality and injustice. And so the year that we've finished, 2020, has extra weight. And so it's not just extra duties related to COVID. It's that the emotional experience of being a professional in this environment is really, really hard. And so it can be difficult to continue plugging along in a system that feels like is not set up for your success. Specifically, I talked about the pipeline issues as well, and thinking about how to support folks who still need a lot of institutional help, whether that's that they need workers who are usually at the intern or student stage, or they are the students or interns themselves who aren't now able to access research experiences. I do think the pandemic has had a lopsided impact on some of these folks. Great, thank you so much. Dr. Remy, did you have anything to add? No, I mean, I agree with what Dr. Lien-Paul is saying, and certainly don't disagree with her sentiments. I do think that there are some other aspects, I think, to consider in such a pandemic such as COVID specifically because it disproportionately provided an opportunity for all of us critical care folks to have to be at the bedside a lot of times to take care of a number of patients, especially with surging capacity. And if you think about those that are physician scientists specifically that are in the formative years of either their jump from their T award to a K award or a K award to an R01 award, those folks are generally going to be junior faculty members who are on the younger side of their careers. And if you also think about the people that were in some ways kept away from patients, many of those are the practitioners that are much older, older than age 65, at least in the beginning of the pandemic. And so if you think about the poll, now you've got a poll where you've got younger physician scientists who are preferentially disproportionately being allocated to the ICUs at a greater scale and also have to forge their junior faculty and research time in a way that's at least a little bit difficult to maintain moving forward based off of that. Now, I would say some other things that I think are kind of, to me, are quite interesting. One thing I think is interesting to me is that, separate from the pandemic, this is probably an odd way to say this and separate from research, and I'm a workaholic, so it's probably not fair for me to say this, but I think that the pandemic in some ways has unearthed a number of different skill sets that are certainly important for young faculty and people that are involved and engaged in productive research. Some of them include time management and adaptability, but the other factor, and this may be completely devoid of science, which is perhaps with a lot of the stay-at-home and virtual interactions and meetings, which seemingly have become exhausting because it seems like you're on 17 more meetings now a day than you ever were, and getting work done is actually exceedingly difficult, especially if you've got a bench or a translational research project, but taking that all aside, there may be a ray of light through this whole pandemic, which is maybe we all need to spend a little more time at home, and maybe we need to alter the way that we actually approach the way that we work. I mean, a lot of our European colleagues certainly don't kill themselves the way that we work, some 70, 80, 90 hours a week, and maybe there's an opportunity where we have a hybrid model post-pandemic where many of us, in fact, some parts of the week, in fact, stay at home, and even if our children are at school, but at least get some work done at home and be there for our children in the morning or in the afternoons or our spouses in other ways. So, I think that there's some other lessons from this pandemic that, in fact, may make you more productive because a lot of us have probably been running on empty probably pre- pandemic for too long. Just a different way that I think about this. Dr. Remy, I think those are great points, and something I want to add to amplify that is, you know, thinking about who is able to do work in this new way of working. We, in our department, recently just hired someone who said, I need to work from home two days per week, and pre-pandemic, it would have been a non-starter. We would have said, oh, I'm sorry, that's, you know, we can't hire you, and now we go, okay, everyone does that. That's fine, as long as we see you occasionally, and so I'm really interested in seeing how that opens up possibilities for people, and I'm excited to see what that means for efforts to include a broader group of folks to work with us. Brilliant. I totally agree. That was great. Thank you both very much. I think, you know, you both touched on some things that your institutions are doing, or that you have done to help overcome this issue. Is there anything in particular that your institutions or you have done that you found to be very successful that you could share with the group, or anything you think we could be doing better to help overcome these barriers, specifically for these groups of physician-scientists? Dr. Remy? Hmm. Well, I was going to ask Dr. Leinfeld, because I think she's got some unique perspectives on this, which I think are actually really helpful. I think for this, for us in the pandemic, at this institution at least, a nice thing for the research group is that they've been quite transparent about allowing us to understand when certain personnel would be let back to work, but also giving us the flexibility, as mentioned, to allow some individuals to certainly work from home. And I'll be honest with you, you know, if you think about it, we've got folks that travel an hour to work each way. And the idea that for two hours that they don't have to travel, and that for someone in my lab could spend just one hour not traveling, and actually will be making figures, but then have that hour to themselves also and have some flexibility, I think it actually provides a level of productivity that's a little bit different than I would have expected pre-pandemic. Now, I need folks at the bench side to be able to do the assays. They can't do those things from home. But I think that it provides the opportunity really for translational research to be done in a different fashion. And the other thing I would mention is at least, you know, I was fortunate that I got grant funding during the COVID pandemic, and I have an R01 that I'm a co-PI on. I did actually get separate from my primary focus, is that it allowed me to really branch out and collaborate with a number of different individuals that I never would have actually collaborated with. And if nothing more, you know, doing a lot of global health and working in Africa and South America, I've been using Zoom since 2015, whereas a number of my colleagues have never used Zoom before this pandemic. And I would say that one thing that's been really quite interesting is that a lot of the spheres or silos, if you will, of the work that previously many of us have done have been opened up. And a lot of us are interacting with other colleagues across the globe in a much different fashion that I think is going to provide a different way for us to conduct team science. And I think that that's unique. I think that's actually, that's a win through this pandemic, even though we've endured such tragedy. Absolutely. Dr. Leopold, did you have anything to add? Sure. So our institution has also similarly set expectations about what types of work are acceptable to do from home, which I think is really useful. And taking the default of we expect you to do most of your work from home, I think is very useful unless you do have to be at the bench side or at the bedside or for some other reason come in. But resetting those expectations I think is useful. There are a few other things I think that institutions can do to support scholars. One is to make sure that everyone has the tools available to them that they need. And so whether that's making sure that you have free access to Zoom, our institution actually has too many video conferencing platforms that they give us access to, but it's a good problem to have. They make sure we have access to cloud storage. And for those of us who need to remote into our desktops, they make it easy for that to happen. They make it easy for us to get into a VPN so that we can get into clinical systems if we need to from home. And for those of us who need specialized equipment, they've made allowances to either bring that equipment from work to home or in some cases to purchase equipment for use at home. So they're really trying to make sure that they set up the conditions to be productive. Additionally, I mentioned the tenure clock extensions. So those extensions apply to anyone who's on the standing faculty, anyone who's on a ladder track, which I think is very useful. And then for those researchers who have been financially impacted by the pandemic because their lab had to shut down and they had to sacrifice animals or they had to have reagents redeployed, the university has established a fund for them to make them whole, which I think is really important. So if the institution is in a position to help mitigate some of the financial losses related to the pandemic, I think that's a very important mechanism to help support researchers that are in a vulnerable stage of their career. Colin, just one more point, and it's separate really from the institutional level, but I think it's an underscored point that many junior faculty members that are at least in their formative years of getting funded or are currently in K's or R's, and perhaps, you know, I worked for the NIH for five years and probably didn't realize it until I got into the extramural world this much, but speaking to your program officer is invaluable. The NIH and other funding mechanisms out there have specifically have a way to be able to discuss if there's a delay, if you can't actually get your animals, your transgenics, if you can't get reagents, if you need to push or have a no-cost extension to your grant. I would say that for me and for many of my colleagues, this has been invaluable because it takes a little bit of that pressure off that my funding is just sitting there, it's not being used and it's going to expire with a year and a half left on this grant. What the heck can we do from here? I think that talking to your program officer at the NIH or whatever mechanism you may have through DOD or HQR or anything else is paramount actually for success, especially during such a time period. That's great. Thank you both very much. Moving on to our second topic that we'd like to cover today, particularly pertaining to the closing of schools and daycares during the pandemic. With this, many of our colleagues have had to seek alternative options for childcare and or take on more of that role themselves. And unfortunately, we've seen this translate into a lower number of manuscript submissions and lower overall academic productivity as described in the recent literature. Could you both touch on a little bit how this specific issue has impacted you and your colleagues? Dr. Landfall, we can start with you. Sure. So it's interesting that you cite the decrease in productivity and the decrease in manuscripts. I think we're actually seeing a bimodal distribution. I think some people are really productive right now. And I look at them and I go, how are you doing that? Because there are some folks that maybe don't have childcare responsibilities and they don't have clinical responsibilities and they can't go to the office. And so they just write. And I'm glad that they're able to do that. I am not one of those people. So my productivity in terms of manuscripts specifically has definitely fallen with the pandemic. I've had to do disaster preparedness work. I've had more clinical work. I've had new projects start. And so the thing I haven't had time to do is write. And I think what I've had to do and what I encourage doing is giving myself a little bit of grace and giving our colleagues some grace and understanding that a career evolves over a lifetime and that this year, while there may be a little bit of a dip, it'll be okay in the long run. Now, I say that from a position of privilege, meaning that I've been promoted already. And so that dip is probably not gonna be, it's not gonna hurt me the same way it might someone who's right in the run-up to promotion. But I do think that we need our institutions to insulate folks that are in vulnerable positions. But specifically what I've had to deal with is my kids being in and out of school. And I will tell you the spring, there was not a lot of learning happening. It was keep them alive and make sure their teachers see them occasionally. We're doing better in the fall, but it's still not great. And I still get Zoom bombed by my children, except when I lock the door to make sure they don't come in, which I do have to do sometimes, but I try not to do too much. And I think we make do with what we can. Some folks have nannies. I don't have a nanny or a babysitter. Some folks have family. Some folks have TV. I think we're all just trying to make our way through. Great, thank you so much. Dr. Remy, do you have anything to add? I think that person on my Zoom screen that's below me probably will add more because she did this in a way that allowed me to become more productive. In fact, I was able to publish a ton during this and also provide a lot of clinical care. And it's interesting because I think in this whole pandemic, oh, a light just went out on me, that's weird. They shut the lights out on me. So I think for this pandemic, for me, frankly, I think figuring out ways to get those folks that have helped me in manuscript preparations and other academic pursuits specifically, such as our statisticians and people that are working from home, I think it's an understanding that they may not have the same response time that I may have because they're juggling 13 other things at home. And so that's been a little bit challenging at times, but there's the level of understanding and adaptability that certainly you've got to take into it. And it means that I have to, frankly, provide a better data set for them and do things that make it a little bit easier for them to do their jobs. And maybe that's something that perhaps now I've learned post pandemic when we get there, hopefully in March and April, that will actually streamline productivity for everyone in a different fashion. But I'm not the right one to answer, even though I wear a lot of different hats and I'm also a city council member and have had to deal with this in a public policy and public health perspective. Most of my work has frankly been outside of the house. And so I've been really fortunate that I have a spouse who frankly has been working 24 seven since the beginning of the pandemic. And I get some relief every now and then in a call room. So she's the one probably that can answer this better than me. Great, well, I think this is a perfect time to ask Dr. Remy's wife, Alison. Thank you so much for joining us today. This is an often overlooked, but obviously very important topic. How has the pandemic and the increased workload and things like that impacted you and your role and overall your life? Well, thank you for having me. I very much appreciate it. I will say first of all, that I have a very supportive husband who had already been supportive in my decision to stay home a few years ago. I'm a clinical social worker. So I have over 10 years of experience working in hospitals. So I understand the clinical side of things. And for our family, we decided that it worked better for us. So I was already at home. So fortunately, when things started kind of getting canceled or postponed or, all right, time to try teaching your children at home, I was already here. We don't have a nanny or babysitters or family here. So for the most part, it was pretty much me and my computer and my tablet and emails back and forth to our wonderful teachers who were really nice and supportive online of us. Our oldest is eight. So she was finishing up second grade last year and our twins are six. So they were finishing up kindergarten. And then our little guy who's now three, who unfortunately knows how to use the tablet really well because trying to juggle the kindergartners and the second grader with the little guy was, you know, a little bit difficult at times. So it's been very interesting. And I think Dr. Lane-Falls said it really well with just trying to give yourself a little bit of grace as well as everyone else, because you kind of just have to figure out what works for you and your family and figure out how to just get through this time period. Great. Thank you so much for sharing. I really appreciate it. Either of you have anything else you wanted to add on this topic? I guess my next big question is, where do you see this, how do you see this impacting the long-term career of these physician scientists being, having their research and things like that impacted right now? Where do you see the field of STEM and the research in that field going? Do you think that we'll have less of a certain group of physician scientists in this field 10 years down the road because of the pandemic? Will people be less inclined to join the field because of some of the barriers that they face? Dr. Remy, if you wouldn't mind sharing your thoughts. I think they're at the surface, seems like that could be an inherent risk. I may answer this a little bit different. I actually think that Dr. Lienfall hit it right on the head. I think that the opportunity to provide opportunities for individuals who could actually now be engaged in certain aspects of research and be able to do so remotely, I think is only potentially a strength actually that will enhance a lot of the research that's being done. And I think that the ability to do things at home, whether you're caring for ill parents or you've got a child needs in the morning for school and in the afternoon or other things, or you've got other endeavors that you are involved with, I frankly think the ability to work remotely really adds this whole new dimension and provides accessibility to individuals who previously would have never applied for positions in the first place or would have been denied at the surface. So I think that it's actually going to potentially open the doors for some individuals in STEM. On the other hand, I don't want to underscore but continue to make the same point. I think that if you look at the way funding mechanisms work, the funders are funding those who are working collaboratively and are working in multidimensional and dimensions, meaning you've got to have different people from different labs or different institutions or different disciplines working on a specific area of focus because that at least allows them not just to spread the wealth of the funds, but it allows for a collaborative approach that we think is probably delivering stronger science. And so I think that the pandemic in some ways has actually highlighted that. And as us as intensivists are in critical care, who have been able to see a lot of the tragedy associated with this COVID pandemic across a number of different spectrums, we've also been actively engaged in actually helping derive how we conduct business, both in clinical fashion and the research world. And so I'm actually optimistic that this is actually going to stimulate and enhance the development of new researchers in this field and hopefully we'll continue those that are providing that STEM work right now to have them continue longevity in their current careers. Great, thank you. Dr. Leinfeld, did you have anything to add? Sure, so I'm glad that Dr. Remy mentioned the need for collaborative science and the need to have lots of disciplines. I know that we have physician scientists overrepresented, but I don't want to forget about our nurse scientists, colleagues, and all the other scientists from different disciplines that relate to critical care. I've actually been impressed by the amount of team science where we've been able to pull in lots of different members of our community. And I'm thinking about some work that we've done looking at how to improve the uptake of evidence-based practices as they relate to ARDS. And at our institution, we've been able to bring in not just nurse scientists, but respiratory therapists and lots of other people into our science. And so I'm hopeful to see that moving forward. But particularly as it relates to the pandemic, I hope that we maintain the zeal for science. I hope that we grow the pipeline, but I think that's going to take some active recovery of people that are vulnerable because there are going to be folks that are hurting, that already are hurting, and we need to reach out to them and try to support them so that we can keep them in the scientific enterprise. And so I'm thinking specifically of the groups we mentioned before, thinking of women, thinking of underrepresented minorities, but there are lots of folks who have met challenges during the pandemic. And if we don't look out for them, we may actually lose them from science, which is not what we want to see. And I think brilliant point certainly about bringing others to the table, because I think the ability to bring nurses, respiratory therapists and others engaged, especially remotely, because previously, unless those individuals were at work, they couldn't actually participate. And so now you've got the ability to bring others to the table to participate in a lot of different areas of research, I think in a translational fashion, I think that makes it stronger. But one thing I will also say is pre-pandemic, in our field specifically, both nurses, physicians, therapists, we've been talking a lot about burnout and a lot about how the impact of burnout in fact could impact clinical care. And I think that this concept certainly needs to be evaluated in the context of certainly burnout post-pandemic for those scientists and people that actually provide clinical work as well. Because I think there's a unique opportunity and hopefully not a missed opportunity that we evaluate the impact of exhaustion and fatigue, both mentally and physically from the conditions of such a pandemic upon not only productivity, but also overall wellbeing. Those are great points. One more thing I'll add is I've been impressed by the ability of people to build community over social media. And I think that could be one thing that actually keeps people in science. It's because you get to reality test a bit and you get to say, wait a minute, did that really happen? Why did that happen? Or what's going on? And you can share and build community with people who are very far away from you. And so I'm hopeful that that's a tool that may help us keep people in science. Great. Thank you both very much. Going back to the topic of childcare and homeschooling, anything like that, have there been any policies or helpful things that your institutions have done that you feel like were really beneficial to you and your colleagues? Any support that they offer that could be translated possibly to other institutions? Yeah, we've had a couple of things that I've found interesting. One is to create, to make it easier for people to get access to ad hoc childcare or ad hoc eldercare. And so if for some reason your school shut down and you weren't expecting it, or if your babysitter wasn't able to come in, we were able to connect people with online services so that they could get access to childcare, sometimes within an hour or two, which was phenomenal. Another resource is that we tried to create programming for kids, especially in the spring, just to keep them occupied. And so we would have virtual yoga and other sorts of things for kids. Parents and kids together could do their downward dog. And so we were just coming up with creative ways to build and sustain community that I think people found useful. That's fantastic. Dr. Remy, have you or Allison experienced anything through WashU that you felt was really helpful? Any policies or changes? We didn't access anything. I don't think specifically, as mentioned, we do have backup care for those needs. And frankly, we've not utilized it in this when we were at our previous employer, when we worked for the federal government, we did use it and actually worked quite well. I'm not sure what my colleagues have, if they've accessed that capability. We've been fortunate too, and our schools did close in early middle of March or so, or early April, but our children went back to school in the end of or middle of August and have been in school since then. And we've been fortunate that in our school, we've not seen a single case of transmission, even though we've been surging quite high in the last couple of weeks, we've not seen that. So we've been fortunate from that perspective. Now, on my pediatric path, I've been actively involved in actually helping the kids get back into school because what I think is important for not only their own productivity, but certainly the sanity of their parents, especially whether it's when it's done safely. So a number of my colleagues have certainly been actively engaged in getting children into school and back to school, which I think is also impacted positively a lot of the work that their parents are conducting. Great, thank you. I think as we wrap up here, one thing that Dr. Rameau had mentioned is some of the skills that you think individuals can work on to help navigate these difficult times and some of the things they can focus on to possibly improve their productivity. And if you wouldn't mind touching on those again, possibly in a little bit more detail, I mean, you'd mentioned time management, adaptability, things like that. Is there anything else you're thinking of or would you be able to elaborate on that at all? I'll give you a couple because I can bloviate on this topic. So I do think time management is probably, even before this pandemic, one of the best skillsets that anyone can actually learn. I think that's important because you need to be able to schedule your time to be productive. And it means also building in when you've got unexpected interruptions such as children or other aspects, you've gotta be able to come back and be able to finish the tasks that you're setting yourself up to do. The second thing is being able to say no. This has been difficult for me. I can tell you as a COVID researcher now, the number of journals that have asked me, can you review these papers? You know, and they come on a frequent fashion and I've had to say no, and I worry, what is the impact going to be on my ability to publish in those journals or other things? But saying no is actually important because it protects your time to do the things that are most important for your productivity and advancement of both the science and your own academic career. I think adaptability, realizing that not everything's gonna be perfect and not everything is gonna be exactly the way that you anticipated, that's science, right? If you think about it, your study is never going to be done the same, you're gonna get results that you never would have expected, even though it differs from your hypothesis, your hypothesis might've been wrong and you actually have to follow where the data leads you. And so I think that that's an important skill that you need to certainly be a part of. And then the last thing I'll say just quickly is even though we're talking a lot about the ability to do things remotely, I do think that the underscored thing that most of us have seen in patient care specifically is how this pandemic has robbed us of our human interaction. And certainly we've seen that with individuals dying without their loved ones at the bedside and our professional relationship with them, whether it's a doctor, nurse or therapist certainly has been somewhat altered or changed, if you will. I think that our human interaction with our colleagues is really important. And so I would argue that once we get post this, after this pandemic, it's important for us to not always just be business only and find ways to at least work with our colleagues in a way that's pleasurable in a fashion that includes some social interactions. Because that I think really helps with burnout and I think certainly would improve productivity. Thank you, Dr. Lanefall. Do you have anything that you think people could be focusing on at this time, specifically fellows looking to take the next step in their career or others? Sure, so I think Dr. Remy's points were great. I would add two more. One is that you should know how to take care of yourself and that using the analogy of the airplane, when the masks drop down, you're supposed to put on your own mask first because you can't help other people unless you can breathe. Similarly, you should know what you need to do to recharge. And so for some people that's exercise, for some people that's meditation, for other people that's worship, it could be any number of things, but I think it's incumbent upon us to understand how to take care of ourselves. And the second is that I think we need to know when to ask for help. And intensivists especially and people who work in critical care, we are extraordinarily capable people used to dealing with anything. And even though we reach out for help amongst members of our teams, we still think of ourselves as super people. And so I think it's really important to understand when to reach out, when to say, I need a hand. And you never know where that help is gonna come from. And sometimes you'll be surprised with how your friends or your colleagues will rally to help you. Thank you. Well, thank you all three very much for joining us today. I think it's been a very productive discussion and provided people with a lot of different tools and possible implementations they can take back to their institutions that may help them and their colleagues. Do either of you have anything else you'd like to add before we close out this talk and open it up to comments and questions? Thanks so much for the time. It was a great discussion. Great, thank you so much. Thank you.

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