Impact of the COVID-19 pandemic on interventional cardiology training in the United States

Abstract

Objectives: We sought to determine the effect of COVID-19 related reduction in elective cardiac procedures and acute coronary syndrome presentations on interventional cardiology (IC) training.

Background: The COVID-19 pandemic has significantly disrupted healthcare in the United States, including cardiovascular services. The impact of COVID-19 on IC fellow training in the United States has not been assessed.

Methods: The Society for Cardiovascular Angiography and Interventions (SCAI) surveyed IC fellows training in both accredited and advanced non-accredited programs, as well as their program directors (PD).

Results: Responses were received from 135 IC fellows and 152 PD. All respondents noted reductions in procedural volumes beginning in March 2020. At that time, only 43% of IC fellows had performed >250 PCI. If restrictions were lifted by May 15, 2020 78% of IC fellows believed they would perform >250 PCI, but fell to only 70% if restrictions persisted until the end of the academic year. 49% of IC fellows felt that their procedural competency was impaired by COVID-19, while 97% of PD believed that IC fellows would be procedurally competent at the end of their training. Most IC fellows (65%) noted increased stress at work and at home, and many felt that job searches and/or existing offers were adversely affected by the pandemic.

Conclusion: The COVID-19 pandemic has substantially affected IC training in the United States, with many fellows at risk of not satisfying current program procedural requirements. These observations support a move to review current IC program requirements and develop mitigation strategies to supplement gaps in education related to reduced procedural volume.

Keywords: competency; coronavirus; interventional cardiology; medical education; procedure volume; training.

FIGURE 1

Distribution of responding fellows by respondents' geographic region and program metropolitan area size. (a) Geographic distribution of United States regions for fellow respondents, showing that most responses are from the Northeast United States. (b) Distribution of respondents by the metropolitan area population size. Most respondents are from areas with populations >500,000 people [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Impact of the Covid‐19 pandemic on actual and expected PCI Volume. Distribution of reported and anticipated PCI volume of respondents (IC fellows). As of March 1st, 2020, most fellows had not yet reached 250 PCI (57%). If restrictions were to remain in place only 71% of fellows anticipated reaching 250 PCI by the end of the training year. However, if restrictions were lifted on May 1st, 78% anticipated reaching 250 PCI. (Legend: <200 PCI, 201–250 PCI, >250 PCI)

FIGURE 3

Fellow redeployment duties during pandemic (n = 24). A total of 24 fellows reported being redeployed as a result of COVID‐19 pandemic related changes in healthcare operations. Fellows were most likely to be redeployed to the work in an intensive care unit (79%) setting or medical floor (46%), with some fellows being asked to serve as cardiology attendings (17%)

FIGURE 4

Fellow reported effect on procedural competency as a result of Covid‐19 Pandemic. Half of the responding fellows reported that there is no change in their perceived procedural competency as a result of the COVID‐19 pandemic, but 47% of fellows (n = 40) reported that they feel less competent as a result of changes to procedural volume during the pandemic. A small minority of respondents (3%) reported that they will feel more competent as a result of the pandemic [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 5

Fellow reported ability to reach 250 Cardiovascular Interventions and Confidence Regarding Interventional Cardiology Board Certification. The majority of fellows (79%) reported that they would reach 250 cardiovascular interventions by the end of training despite restrictions related to the COVID‐19 pandemic, but 21% did not believe they could achieve that number of interventions (a) Despite this, only 3% of fellows believed that the pandemic would affect their ability to achieve a passing score on the ABIM Interventional Cardiology certification exam (b) [Color figure can be viewed at wileyonlinelibrary.com]