Managing Resident Workforce and Education During the COVID-19 Pandemic

Abstract

Background: The novel coronavirus and associated Coronavirus Disease 2019 (COVID-19) is rapidly spreading throughout the world, with robust growth in the United States. Its drastic impact on the global population and international health care is swift, evolving, and unpredictable. The effects on orthopaedic surgery departments are predominantly indirect, with widespread cessation of all nonessential orthopaedic care. Although this is vital to the system-sustaining measures of isolation and resource reallocation, there is profound detriment to orthopaedic training programs. Methods: In the face of new pressures on the finite timeline on an orthopaedic residency, the Emory University School of Medicine Department of Orthopaedics has devised a 5-pronged strategy based on the following: (1) patient and provider safety, (2) uninterrupted necessary care, (3) system sustainability, (4) adaptability, and (5) preservation of vital leadership structures. Results: Our 5 tenants support a 2-team system, whereby the residents are divided into cycling “active-duty” and “working remotely” factions. In observation of the potential incubation period of viral symptoms, phase transitions occur every 2 weeks with strict adherence to team assignments. Intrateam redundancy can accommodate potential illness to ensure a stable unit of able residents. Active duty residents participate in in-person surgical encounters and virtual ambulatory encounters, whereas remotely working residents participate in daily video-conferenced faculty-lead, case-based didactics and pursue academic investigation, grant writing, and quality improvement projects. To sustain this, faculty and administrative 2-team systems are also in place to protect the leadership and decision-making components of the department. Conclusions: The novel coronavirus has decimated the United States healthcare system, with an unpredictable duration, magnitude, and variability. As collateral damage, orthopaedic residencies are faced with new challenges to provide care and educate residents in the face of safety, resource redistribution, and erosion of classic learning opportunities. Our adaptive approach aims to be a generalizable tactic to optimize our current landscape.

Development of clinical care guidelines for faculty and residents in the era of COVID‐19

“…In order to limit patient exposure and team risk, we introduced a team cohort approach: a rotating small-team approach designed for each clinical site in our residency program as described by other surgical subspecialties. 4 Each cohort team is prevented from physical interaction with the other teams and cover separate days in the hospital. Faculty-resident partnerships were assigned to limit interaction between department members but provide comprehensive coverage at each clinical site.…”

The Impact of COVID-19 pandemic on Obstetrics and Gynecology Residency Programs and perspectives on adaptive ways of training in Ethiopia

“…Hand in hand with ensuring adequate supply of PPEs, residency programs in the US divided resident task force into two groups and arranged resident rotations every fteen days. One group will be engaged in clinical activity and the second group will stay at home but will be involved in virtual teaching activities & consultations [9,10]. Naser et al reported experience of restructuring of general surgery residents during pandemics into three exclusive groups (inpatient, operative, and clinic) rotating weekly to practice appropriate physical distancing and reduce the possibility of transmission among residents [11].…”

“…Ethiopia has recorded its rst case in March and currently the number of infected people has escalated to more than 2000 [1]. The anticipated duration and impact of Covid-19 on the global population and international healthcare is swift, evolving, and unpredictable [2] In this unprecedented scenario, healthcare systems had to rapidly reshape their organization to cope with the emergency, aiming to optimize resources and minimize a further spread of the infection [3]. The daily responsibilities attributed to a resident demand a commitment to proper time management and the ability to prioritize tasks.…”

“…The daily responsibilities attributed to a resident demand a commitment to proper time management and the ability to prioritize tasks. Under the best of circumstances, there is a balance between clinical work, surgical training, didactics, and research [2]. The addition of a global catastrophe, such as the novel coronavirus/COVID-19 pandemic, disrupts this balance.…”

“…The addition of a global catastrophe, such as the novel coronavirus/COVID-19 pandemic, disrupts this balance. Maintaining a healthy resident workforce is critically important to patient care, but it is di cult for residents and other healthcare workers to minimize interpersonal contact and comply with 'social distancing' principle [2]. In addition, many clinicians had to dedicate part, if not all, of their practice to the management of COVID-19 patients [3,].…”