Whether it be discussing a novel therapy, a challenging diagnosis, grief over a patient’s death, or simply the best way to accomplish one’s career goals, being a part of a well-developed community is essential for every trainee. Fellowship (and really all medical training) is demanding, and having community helps provide moral, emotional, and intellectual support during these challenging times. One of the most important lessons learned from the COVID-19 pandemic is how vital other people are in our lives and how stress and anxiety can become heightened as isolation is more prevalent.

But, how do you build community during a pandemic? We won’t lie to you—it won’t be easy, and it won’t happen overnight. However, it is doable and critical to the wellness of our trainees. Thus, we would like to share five practical tips that will help build community within your programs.


1. Normalize the New Normal

Obviously, by their nature, the restrictions put in place to deal with the pandemic caused isolation and prevented some of the common activities that normally helped develop community. Looking back, we took for granted how much weekly gatherings at educational conferences were about more than just the didactic component. They were a time for co-fellows to see each other and bond over shared experiences. They were a time for senior and junior fellows to interact and learn from each other. They were a time for fellows and faculty to connect. Similarly, other program-derived activities like journal clubs, potlucks, and the yearly new-fellow welcoming party were all disrupted. Interacting outside of work was similarly tough.

With that, virtual conferences were made the new normal. While video platforms can be helpful, a big barrier remains that participation is less natural and, thus, just less frequent overall. As people were not always in places where they felt comfortable showing their background, cameras were more commonly off than on and so you still couldn’t always “see” your friends and colleagues. If the camera was on, fellows worried that there would be a surprise entrance of one of their loved ones such as a crying baby, child throwing a temper tantrum, or a cat jumping on the chair behind them. This fear may have resulted in less cameras being on, which then defeats the feeling of community that conferences often helped. For more on the impact of virtual conferences on trainees and education, check out this blog post by Dr. Koubek (https://apccmpdscholars.org/2021/04/20/virtually-the-same-a-fellows-reflections-on-a-transition-to-virtual-learning/).

Similarly, more demands were made of fellows’ time—to name a few, fellows had busier clinical schedules especially with the COVID surges, creation of a backup call system in case a co-fellow or themselves contracted COVID-19, and trying to attend virtual conferences all the while figuring out childcare AND dealing with virtual school or homeschooling.

We are in a different world now and programs should first acknowledge the above issues—the heightened stress should be called out and normalized. If a child comes into view of the camera, say hi. If a spouse has a question that needs an answer or if the dog needs to be let outside, then let them attend to those needs. With virtual platforms, we can easily pause or turn off the camera to tend to necessary tasks or duties as needed and then come back when able to join the rest of the conference. In the end, we are all human and need to find a balance between both home and work.


2. Conduct Regular Check-ins

Consider implementing weekly or bi-weekly meetings as a check-in with each other. At these meetings, you can discuss fun and exciting news in the trainee’s lives (examples could include birthdays, baby announcements, new hobbies, etc,) and areas where trainees are struggling by eliciting specific complaints or challenges that have caused or added to their stress. Everyone has a different level of stress and the key is to meet people at their moment. Additionally, these regular check-ins can help fellows keep informed and sift through the overwhelming amount of information. Transparency helps trainees feel some sort of control in the chaos of the world around them.

Another way to do this, would be for the program leadership to regularly communicate with fellows—this may be via text message, phones calls, or emails. Program leadership can ask fellows for their communication preferences. If there is a major increase in workload, then talk with the trainees to ensure they are up for the challenge.  If a trainee contracted COVID, then reach out to them daily. For more suggestions on how to help trainees that test positive for COVID, check out this blog post by Dr. Santhosh (https://apccmpdscholars.org/2021/08/30/12-tips-for-medical-education-leaders-when-your-trainee-tests-positive-for-covid-19/)


3. Get Outside and Moving

After vaccinations were readily available, many programs provided more opportunities for small outdoor gatherings. If you have the ability and weather permitting, meet with your trainees outside and enjoy lunch together. This is a great time to share daily stories. If possible, avoid talking about work and focus on life outside of work.

The creation of activity-specific interest groups could help build connections, healthy lifestyles, and wellness. One of our programs created a signup sheet via a Google document with a running list of interested participants in various activities, such as hiking, biking, tennis, skiing, etc. For these groups, both faculty and fellows were included so each can get to know one another on a more personal level.

This doesn’t have to be just PCCM specific. Other specialties and programs could be integrated to build community. Although you need to be mindful of any institution-specific restrictions on meetings.


4. Host Virtual Social Events

Although most of the educational conferences remain virtual, and fatigue from virtual platforms is very real, incorporation of virtual social events may be necessary depending on the time of year and state/institutional restrictions. Some options for virtual social events could include happy hours for fellows and faculty (utilize breakout groups to keep group sizes small to enhance discussion and engagement), trivia night (there are online sites that would host such an event, such as TriviaHub), game night (online gaming platforms, such as Game Night Out), or movie watching (through Netflix or other such streaming sources), and a book club with the goal of reading non-medical books.

If programs implement such activities, these should be optional for fellows without any pressure to attend. The goal of virtual social events is to have fun, but if fellows feel obligated to attend, then it could potentially add to their stress and burn out. Having these activities as optional events would allow fellows to attend as they can and based on their level of bandwidth.


5. Encourage Co-Fellow Engagement

The hardest connections have been for the 1st-year fellowship class given the start of their training occurred during the pandemic with significant restrictions and limitations on social events. One way to keep them connected could be through app-based texting services that allow for group texts, such as WhatsApp. Having these group chats can go a long way to maintaining connections.



According to Oxford Language, a community is “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.”  For anyone wondering how they can establish this within their own institution, we hope the above tips will help get you started. Remember that building community will take time, but it is worth the effort and investment, not only the trainees but faculty as well.


Hear Drs. Carmona, Lesko, De La Zerda, and Kelm discuss Community Building in fellowship training and strategies to enhance collaboration among trainees, staff and faculty on their APCCMPD Medical Educator Podcast.


Hugo Carmona, MD is an Assistant Professor of Medicine at the University of Washington in the Division of Pulmonary, Critical Care and Sleep Medicine. He also serves as an Associate Program Director for the PCCM Fellowship. He has interests in medical education research as it relates to professional identity formation and clinical interests in the care of patients with neuromuscular disease.
Melissa Lesko, DO is a Pulmonary and Critical Care physician and Associate Program Director at the NYU Langone Transplant Institute, cares for people who have lung conditions, including interstitial lung disease, advanced chronic obstructive pulmonary disease (COPD), advanced bronchiectasis, or pulmonary fibrosis, before and after lung transplantation.
David De La Zerda, MD is Assistant Professor of Medicine and Pulmonary and Critical Care Medicine Training Program Director at the University of Miami. His areas of interest include pulmonary arterial hypertension, critical care outcomes, and graduate medical education.
Diana Kelm, MD is an Assistant Professor of Medicine, Core Faculty for Pulmonary and Critical Care Medicine at Mayo Clinic in Rochester, MN and the Associate Program Director of the Pulmonary and Critical Care Medicine Fellowship Program. She received her medical degree from Texas A&M Health Science Center and completed residency, chief residency, and fellowship at Mayo Clinic. Her research is geared towards medical education with specific interests in procedural skills training, gender disparity, and interprofessional education.