Perceptions of Occupational Risk and Changes in Clinical Practice of United States Vitreoretinal Surgery Fellows during the COVID-19 Pandemic

Abstract

Purpose: To assess perceptions of occupational risk and changes to clinical practice of ophthalmology trainees in the United States during the coronavirus disease 2019 (COVID-19) pandemic.

Design: An anonymous, nonvalidated, cross-sectional survey was conducted online. Data were collected from April 7 through 16, 2020.

Participants: Second-year U.S. vitreoretinal surgery fellows in two-year training programs were invited to participate.

Methods: Online survey.

Main outcome measures: Survey questions assessed policies guiding COVID-19 response, exposure to severe acute respiratory syndrome coronavirus 2, changes in clinical duties, and methods to reduce occupational risk, including availability of personal protective equipment (PPE).

Results: Completed responses were obtained from 62 of 87 eligible recipients (71.2% response rate). Training settings included academic (58.1%), hybrid academic/private practice (35.5%), and private practice only settings (6.5%). Overall, 19.4% of respondents reported an exposure to a COVID-19-positive patient, 14.5% reported self-quarantining due to possible exposure, and 11.3% reported being tested for COVID-19. In regards to PPE, N95 masks were available in the emergency room (n = 40 [64.5%]), office (n = 35 [56.5%]), and operating room (n = 35 [56.5%]) settings. Perceived comfort level with PPE recommendations was significantly associated with availability of an N95 respirator mask in the clinic (P < 0.001), emergency room (P < 0.001), or operating room (P = 0.002) settings. Additional risk mitigation methods outside of PPE were: reduction in patient volume (n = 62 [100%]), limiting patient companions (n = 59 [95.2%]), use of a screening process (n = 59 [95.2%]), use of a slit-lamp face shield (n = 57 [91.9%]), temperature screening of all persons entering clinical space (n = 34 [54.84%]), and placement of face mask on patients (n = 33 [53.2%]). Overall, 16.1% reported additional clinical duties within the scope of ophthalmology, and 3.2% reported being re-deployed to nonophthalmology services. 98.4% of respondents, 98.4% expected a reduction in surgical case volume. No respondents reported loss of employment or reduction in pay or benefits due to COVID-19.

Conclusions: Suspected or confirmed clinical exposure to COVID-19-positive patients occurred in approximately one fifth of trainee respondents. Perceived comfort level with PPE standards was significantly associated with N95 respirator mask availability. As surgical training programs grapple with the COVID-19 pandemic, analysis of trainees' concerns may inform development of mitigation strategies.

Figure 1

Bar graph showing the distribution of fellow responses during survey availability, April 7 through 16, 2020.

Figure 2

Bar graph showing the reported occupational risk of United States vitreoretinal surgery fellows during the coronavirus disease 2019 (COVID-19) pandemic, as of April 16, 2020.

Figure 3

Bar graph showing the risk mitigation strategies used by United States vitreoretinal surgery fellows during coronavirus disease 2019 (COVID-19), as of April 16, 2020.