Impact of Pandemic Response on Training Experience of Anesthesiology Residents in an Academic Medical Center: A Retrospective Cohort Study

Abstract

Background The impact of the coronavirus disease 2019 (COVID-19) pandemic substantially altered operations at hospitals that support graduate medical education. We examined the impact of the pandemic on an anesthesiology training program with respect to overall case volume, subspecialty exposure, procedural skill experience, and approaches to airway management. Methods Data for this single center, retrospective cohort study came from an Institutional Review Board approved repository for clinical data. Date ranges were divided into the following phases in 2020: Pre-Pandemic (PP), Early Pandemic (EP), Recovery 1 (R1), and Recovery 2 (R2). All periods were compared to the same period from 2019 for case volume, anesthesia provider type, trainee exposure to Accreditation Council for Graduate Medical Education (ACGME) index case categories, airway technique, and patient variables. Results 15,087 cases were identified, with 5,598 (37.6%) in the PP phase, 1,570 (10.5%) in the EP phase, 1,451 (9.7%) in the R1 phase, and 6,269 (42.1%) in the R2 phase. There was a significant reduction in case volume during the EP phase compared to the corresponding period in 2019 (-55.3%; P < .001) that improved but did not return to baseline by the R2 phase (-17.6%; P < .001). ACGME required minimum cases were reduced during the EP phase compared to 2019 data for pediatric cases (age < 12 y, -72.1%; P < .001 and age < 3 y, -53.5%; P < .006) and cardiopulmonary bypass cases (52.3%, P < .003). Surgical subspecialty case volumes were significantly reduced in the EP phase except for transplant surgery. By the R2 phase, all subspecialty volumes had recovered except for plastic surgery (14.9 vs. 10.5 cases/week; P < .006) and surgical endoscopy (59.2 vs. 40 cases/week; P < .001). Use of video laryngoscopy (VL) and rapid sequence induction and intubation (RSII) also increased from the PP to the EP phase (24.6 vs. 79.6%; P < .001 and 10.3 vs. 52.3%; P < .001, respectively) and remained elevated into the R2 phase (35.2%; P < 0.001 and 23.1%; P < .001, respectively). Conclusions The COVID-19 pandemic produced significant changes in surgical case exposure for a relatively short period. The impact was short-lived, with sufficient remaining time to meet the annual ACGME program minimum case requirements and procedural experiences. The longer-term impact may be a shift towards the increased use of VL and RSII, which became more prevalent during the early phase of the pandemic.

Keywords: academic anesthesiology; accreditation council for graduate medical education (acgme); anesthesia residency; covid 19; procedure training.

Figure 1. Daily combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 7 January to 31 August for each year (right axis) shown with the 2020 daily Maryland in-hospital census for patients diagnosed with COVID-19 (X) and daily newly confirmed cases of COVID-19 (solid box) for the same period (left axis).

Daily combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 7 January to 31 August for each year (right axis) shown with the 2020 daily Maryland in-hospital census for patients diagnosed with COVID-19 (X) and daily newly confirmed cases of COVID-19 (solid box) for the same period (left axis). All points are shown as a seven-day moving average. Pandemic phases for 2020 are shown as shaded areas (PP: yellow; EP: orange; R1: red; R2: green). State of Maryland hospital census and daily confirmed cases adapted from https://data.imap.maryland.gov/datasets/mdcovid19-totalcurrentlyhospitalizedacuteandicu/explore and https://data.imap.maryland.gov/datasets/mdcovid19-totalcasesstatewide/explore. COVID-19, coronavirus disease 2019; EP: early pandemic phase; PP: pre-pandemic phase; R1: recovery 1 phase; R2: recovery 2 phase; STC: Shock Trauma Center; UMMC: University of Maryland Medical Center.

Figure 2. Weekly operative cases at UMMC for 2019 (solid line) and 2020 (dashed line) and STC for 2019 (X) and 2020 (solid box) from 1 January to 31 August for each year.

Weekly operative cases at UMMC for 2019 (solid line) and 2020 (dashed line) and STC for 2019 (Ï) and 2020 (n) from 1 January to 31 August for each year. Pandemic phases for 2020 are shown as shaded areas (PP: Yellow; EP: Orange; R1: Red; R2: Green). EP: Early Pandemic Phase; PP: Pre-Pandemic Phase; R1: Recovery 1 Phase; R2: Recovery 2 Phase; STC: Shock Trauma Center; UMMC: University of Maryland Medical Center.

Figure 3. Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for patients: A) age < 3 years and B) age < 12 years.

Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for patients: A) age < 3 years and B) age < 12 years. Age ranges reflect ACGME index case cutoffs for minimum case requirements. Pandemic phases for 2020 are shown as shaded areas (PP, Yellow; EP, Orange; R1, Red; R2, Green). ACGME: Accreditation Council for Graduate Medical Education; EP: Early Pandemic Phase; PP: Pre-Pandemic Phase; R1: Recovery 1 Phase; R2, Recovery 2 Phase; STC: Shock Trauma Center; UMMC: University of Maryland Medical Center.

Figure 4. Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for obstetric cases incorporating: A) cesarean and B) vaginal delivery.

Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for obstetric cases incorporating: A) cesarean and B) vaginal delivery. Cases meet the definition for ACGME index case requirements for obstetric case minimums. Pandemic phases for 2020 are shown as shaded areas (PP: Yellow; EP: Orange; R1: Red; R2: Green). ACGME: Accreditation Council for Graduate Medical Education; EP: Early Pandemic Phase; PP: Pre-Pandemic Phase; R1: Recovery 1 Phase; R2: Recovery 2 Phase; STC: Shock Trauma Center; UMMC: University of Maryland Medical Center.

Figure 5. Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for cases incorporating: A) lung isolation and B) cardiopulmonary bypass.

Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for cases incorporating: A) lung isolation and B) cardiopulmonary bypass. Cases meet the definition for ACGME index case requirements for cardiothoracic case minimum. Pandemic phases for 2020 are shown as shaded areas (PP: Yellow; EP: Orange; R1: Red; R2: Green). ACGME: Accreditation Council for Graduate Medical Education; EP: Early Pandemic Phase; PP: Pre-Pandemic Phase; R1: Recovery 1 Phase; R2: Recovery 2 Phase; STC: Shock Trauma Center; UMMC: University of Maryland Medical Center.

Figure 6. Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for the performance of regional anesthesia procedures.

Weekly combined operative cases at UMMC and STC for 2019 (solid line) and 2020 (dashed line) from 1 January to 31 August for each year for the performance of regional anesthesia procedures. Cases meet the definition for ACGME index case requirements for case minimums. Pandemic phases for 2020 are shown as shaded areas (PP: Yellow; EP: Orange; R1: Red; R2: Green). ACGME: Accreditation Council for Graduate Medical Education; EP: Early Pandemic Phase; PP: Pre-Pandemic Phase; R1: Recovery 1 Phase; R2: Recovery 2 Phase; STC: Shock Trauma Center; UMMC: University of Maryland Medical Center.