Novel Changes in Resident Education during a Pandemic: Strategies and Approaches to Maximize Residency Education and Safety

THIEME Original Research SPECIAL ARTICLE COVID -19 Novel Changes in Resident Education during a Pandemic: Strategies and Approaches to Maximize Residency Education and Safety Jared Johnson1, Michael T. Chung1, Jeffrey Hotaling1 Michael A. Carron1 1 Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States 2 Division of Neurotology/Skull Base Surgery, Michigan Ear Institute, Farmington Hills, MI, United States Eleanor Y. Chan1,2 Ho-Sheng Lin1 Address for correspondence Michael T. Chung, MD, Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, 4201 St. Antoine, 5E-UHC, Detroit, MI 48201, United States (e-mail: ). Int Arch Otorhinolaryngol 2020;24(3):267–271. Abstract Keywords ► COVID-19 ► pandemic ► resident education ► strategies Introduction The COVID-19 pandemic has led to a reduction in surgical and clinical volume, which has altered the traditional training experience of the otolaryngology resident. Objective To describe the strategies we utilized to maximize resident education as well as ensure patient and staff safety during the pandemic. Methods We developed a system that emphasized three key elements. First and foremost, patient care remained the core priority. Next, clinical duties were restructured to avoid unnecessary exposure of residents. The third component was ensuring continuation of resident education and maximizing learning experiences. Results To implement these key elements, our residency divided up our five hospitals into three functional groups based on geographical location and clinical volume. Each team works for three days at their assigned location before being replaced by the next three-person team at our two busiest sites. Resident teams are kept completely separate from each other, so that they do not interact with those working at other sites. Conclusions Despite the daily challenges encountered as we navigate through the COVID-19 pandemic, our otolaryngology residency program has been able to establish a suitable balance between maintenance of resident safety and well-being without compromise to patient care. Introduction The novel coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented and sudden changes within our world over the past few months. Even as the Centers for Disease Control and Prevention (CDC) advocates “shelter in place,” “social distancing” and adherence to meticulous personal hygiene, COVID-19 has proven to be highly transmissible,  Authors contributed equally to this manuscript. received May 28, 2020 accepted June 3, 2020 DOI https://doi.org/ 10.1055/s-0040-1714147. ISSN 1809-9777. and has swiftly spread throughout our country.1–3 With the rapid rise in the number of confirmed COVID-19 cases, the burden imparted on the healthcare system has been unparalleled in the last century. This strain on healthcare delivery has led to numerous changes in the usual day-to-day operations, including the cancellation of all surgical cases except for those that are considered essential, emergent, or cancer-related.4–6 Clinic schedules have been severely reduced to include only urgent patients who need to be seen in a time sensitive manner, Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 267 268 Novel Changes in Resident Education (COVID19) Johnson et al. while telemedicine has swiftly usurped the traditional face-toface doctor to patient encounter. The conventional otolaryngology residency education involves a balance of surgical training in the operating theater, patient encounters in clinic, academic time in the form of didactic lectures and self-study. The reduction in surgical and clinical volume has altered the residency experience, and has required novel approaches to make up for these lost opportunities. As a residency training program, considering the health and well-being of residents is of utmost importance. Ensuring resident safety and limiting unnecessary exposure to COVID-19 is critical, as those who are infected and symptomatic must be quarantined according to CDC guidelines.7 Infected residents pose a risk to fellow residents and staff whom they work closely with, and thus appropriate precautions must be taken to avoid propagating infection to other members of the residency, which can have detrimental effects on the ability of the department to deliver patient care.7,8 Additionally, infected medical professionals pose a risk to patients they interact with, thus causing further potential endangerment to those we are tasked to care for, and worsening the dissemination of disease. Our otolaryngology residency serves downtown Detroit and its surrounding communities, which have been particularly hard hit by COVID-19, and thus, developing effective and reliable mechanisms to keep our residents, staff and patients safe during this time has been paramount.9 The present paper describes our strategies and techniques utilized to maximize resident education as well as ensure patient and staff safety during the COVID-19 pandemic. Methods Residency programs across all medical and surgical specialties currently find themselves in a complicated predicament, and are forced to maintain some level of normalcy in a situation which could have never been truly anticipated or prepared for.10 As our department considered contingency plans, we identified three unifying key elements that guided our decisions. First, patient care was to remain the top priority, and all members of the clinical team expressed that this could not be compromised, especially under such critical circumstances. Second, resident safety and well-being had to be preserved at all times, and clinical duties were reorganized to ensure minimization of unnecessary exposure to COVID-19 patients. Last but not least, substantial effort was made to ensure continuity of resident education and learning opportunities during the pandemic despite the overall reduction of surgical and clinic volume. The present study was deemed by the authors to be exempt from institutional review board review at (XXX blinded for review process XXX) Wayne State University according to institutional policy. Results To implement the key elements described above, our residency resorted to a five-team approach divided among three practice sites. At our program, we cover multiple hospitals including a International Archives of Otorhinolaryngology Vol. 24(3) No. 3/2020 tertiary referral freestanding cancer center, two American College of Surgeon (ACS) designated Level 1 Trauma Centers, a smaller community hospital, and a Veterans Affairs (VA) hospital. We divided up the five hospitals into three functional groups based on geographical location and clinical volume. The 2 busiest hospital groups were each assigned 2 different teams consisting of three residents (PGY-4/5, PGY-2/3, PGY-1/2). The least busy group was assigned a team of two (...truncated)