Table 1.

Challenges presented by COVID-19 pandemic

Maslow's hierarchy (the ‘d-needs’)	Didactic programme	Clinical responsibilities	Nonclinical work responsibilities	Assessment
Esteem	• Social isolation can make recognition and fulfilment challenging	• High mortality in COVID-19 ICU can lead to PTSD and low self-esteem	• Self-quarantine and social isolation has been shown to lead to mental distress [30].	• Cancellation of assessment examinations can challenge traditional modes of recognizing academic accomplishment.
Love/Belonging	• Team training and group learning reduced due to social distancing.	• Long work-hours and fear of transmitting virus caused social isolation from support groups and loved ones	• Separation from children and elderly parents needing care caused anxiety in trainees.	• Anxiety and depression can affect performance on tests
Safety	• Personal safety of residents endangered during certain clinical learning settings.	• Shortage of PPE threatened personal safety• Aerosol generating procedures threatened personal safety	• Increased social unrest and violence targeting minorities and communities of colour	• In-person convening for assessment examinations risks transmission of SARS-CoV-2.
Physiological	• Basic ‘d-needs’ unmet leading to sub-optimal support for learning environment.	• Contracting COVID-19 during clinical duties endangers health.• Fear of transmitting disease to loved ones necessitating isolation from loved ones at home	• Restaurant and grocery stores closure, limited hour openings of store not friendly to medical trainee work hours.• Shortage of essential items such as hand sanitizer.	• All trainees may not have access to devices and network capabilities for online assessments.• Basic ‘d-needs’ unmet leading to sub-optimal support for assessment of learning.