Pathology Trainee Redeployment and Education During the COVID-19 Pandemic: An Institutional Experience

Abstract

Pathology training programs throughout the United States have endured unprecedented challenges dealing with the ongoing coronavirus disease 2019 pandemic. At Houston Methodist Hospital, the Department of Pathology and Genomic Medicine planned and executed a trainee-oriented, stepwise emergency response. The focus was on optimizing workflows among areas of both clinical and anatomic pathology, maintaining an excellent educational experience, and minimizing trainee exposure to coronavirus disease 2019. During the first phase of the response, trainees were divided into 2 groups: one working on-site and the other working remotely. With the progression of the pandemic, all trainees were called back on-site and further redeployed within our department to meet the significantly increased workload demands of our clinical laboratory services. Adjustments to trainee educational activities included, among others, the organization of a daily coronavirus disease 2019 virtual seminar series. This series served to facilitate communication between faculty, laboratory managers, and trainees. Moreover, it became a forum for trainees to provide updates on individual service workflows and volumes, ongoing projects and research, as well as literature reviews on coronavirus disease 2019-related topics. From our program's experience, redeploying pathology trainees within our department during the coronavirus disease 2019 pandemic resulted in optimization of patient care while ensuring trainee safety, and importantly, helped to maintain continuous high-quality education through active involvement in unique learning opportunities.

Keywords: coronavirus disease 2019 pandemic; graduate medical education during coronavirus disease 2019; pathology education during coronavirus disease 2019; pathology trainee redeployment; redeployment during coronavirus disease 2019.

Figure 1.

A (top), This figure depicts several epidemic curves showing the number of coronavirus disease 2019 (COVID-19) cases and related deaths within the United States (white and light gray colors, respectively) and within Harris County, Texas (dark gray and black colors, respectively) over the timeline of trainee redeployment.^, A (bottom), Line graph depicting the number of overall trainees on anatomic pathology and clinical pathology services during COVID-19 redeployment in our department. Compared to standard operations, a majority of our trainees were assigned to clinical pathology rotations rather than anatomic pathology. B, Table shows the specific dates and actions occurring before and during the various phases of trainee redeployment at our institution.

Figure 2.

Sankey plots with hierarchical layouts are shown, highlighting the changes in trainee rotation distribution within both clinical and anatomic pathology (CP/AP) services over the phases of our training program’s redeployment during the coronavirus disease 2019 (COVID-19) pandemic. In summary, the overall reduction in surgical procedures allowed for the intradepartmental redeployment of approximately half of our trainees on AP services to CP services. Specifically, the distribution of residents to AP and CP services shifted from 13 residents on AP services and 6 residents on CP services before and during phase 1, to 3 residents on AP services and 16 residents on CP services during phase 2. Distribution of fellows on AP and CP services remained relatively stable, with only one fellow shifting from AP to CP during this time.

Figure 3.

Line graphs depicting the changes in surgical pathology (A), neuropathology (B), nongynecological cytology (C), gynecological cytology (D) case volumes with the onset of the coronavirus disease 2019 (COVID-19) pandemic, including the months of January through May 2020. Case volumes for each service from the same time period in 2019 are also shown. Autopsy cases during the months of January through May 2020 were compared to the median number of cases performed during the years 2017 to 2019 over the same period (E, left panel). The percent of pneumonia and/or acute lung injury (eg, acute, resolving diffuse alveolar damage) findings in autopsy cases performed from January to May 2020, compared to the median number of cases with these findings performed during the same period of the years 2017 to 2019 is shown (E, right panel). For each group, the percentage of cases with pneumonia or acute lung injury findings was determined based on all autopsies performed in that time frame with lung tissue available for examination. Cases with incidental and intravascular pathologies only (eg, small vessel thrombi), but no alveolar pathologies, were not included as positive findings. For January to May 2017 to 2019, the average percentage of positive cases is shown (43.2%), reflecting an expected rate of these pathologies at our institution in the pre-COVID-19 period. For January to May 2020, this rate was 54.2%, emphasizing the need for caution in autopsy performance, even with negative COVID-19 testing.

Figure 4.

Specimen triage and distribution of the analytic workflow for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular diagnostic testing performed on various RT-PCR platforms in the molecular diagnostics laboratory at Houston Methodist Hospital. Locations of various instruments within 5 separate laboratory areas are denoted by (Lab #). (*) RNA extraction platforms include EZ1 advanced XL (Qiagen) and qiasymphony SP (Qiagen). (†) SARS-CoV-2 RT-PCR assay platforms include (1) ABI 7500 fastdx (Applied Biosystems), (2) panther fusion (Hologic, Inc), (3) genexpert infinity (Cepheid) and genexpert Dx GX-IV (Cepheid), and (4) filmarray 2.0 (BioFire Defense, LLC). BAL indicates bronchoalveolar lavage; LP, labor pool personnel; MT, medical technologist; NP, nasopharyngeal; RT-PCR, reverse transcription polymerase chain reaction.

Figure 5.

Flowchart depicting changes in the transfusion medicine services and workflow during the coronavirus disease 2019 (COVID-19) pandemic. Routine services including blood bank, therapeutic apheresis, and donor center continued operations and were staffed by 1 to 2 trainees involved in prospective blood utilization reviews and supervision/management of apheresis patients and blood donors. With the initiation of an in-house COVID-19 convalescent plasma trial, our services required a significant diversion of transfusion medicine personnel and resources, with 3 additional trainees redeployed to assist. Their duties included triaging, screening, and collecting clinical information from plasma donors, donor recruitment, and research activities such as aggregation and analysis of data.