Impact of COVID-19 on post graduate medical education and training

Medical Knowledge Acquisition during a Pandemic: Pediatric Subspecialty in-Training Examination and Board Certification Exam Passing Rate

OBJECTIVE

The COVID-19 pandemic resulted in training programs restructuring their curricula. Fellowship programs are required to monitor each fellow's training progress through a combination of formal evaluations, competency tracking, and measures of knowledge acquisition. The American Board of Pediatrics administers subspecialty in-training examinations (SITE) to pediatric fellowship trainees annually and board certification exams at the completion of the fellowship. The objective of this study was to compare SITE scores and certification exam passing rates before and during the pandemic.

METHODS

In this retrospective observational study, we collected summative data on SITE scores and certification exam passing rates for all pediatric subspecialties from 2018 to 2022. Trends over time were assessed using analysis of variance (ANOVA) analysis to test for trends across years within one group and t-test analysis to compare groups before and during the pandemic.

RESULTS

Data were obtained from 14 pediatric subspecialties. Comparing prepandemic to pandemic scores, Infectious Diseases, Cardiology, and Critical Care Medicine saw statistically significant decreases in SITE scores. Conversely, Child Abuse and Emergency Medicine saw increases in SITE scores. Emergency Medicine saw a statistically significant increase in certification exam passing rates, while Gastroenterology and Pulmonology saw decreases in exam passing rates.

CONCLUSIONS

The COVID-19 pandemic resulted in restructuring didactics and clinical care based on the needs of the hospital. There were also societal changes affecting patients and trainees. Subspecialty programs with declining scores and certification exam passing rates may need to assess their educational and clinical programs and adapt to the needs of trainees' learning edges.

Critical care medicine training in the age of COVID-19

CONTEXT

The COVID-19 pandemic caused the largest disruption to graduate medical education in modern history. The danger associated with SARS-CoV-2 necessitated a paradigm shift regarding the fundamental approach to the education of medical residents and fellows. Whereas prior work has examined the effect of the pandemic on residents' experiences during training, the effect of the pandemic on academic performance of critical care medicine (CCM) fellows is not well understood.

OBJECTIVES

This study examined the relationship between CCM fellow's lived experiences during the COVID-19 pandemic and performance on in-training examinations.

METHODS

This mixed-methods study consisted of a quantitative retrospective analysis of critical care fellows' in-training examination scores and a qualitative, interview-based phenomenological examination of fellows' experiences during the pandemic while training in a single large academic hospital in the American Midwest. Quantitative: Prepandemic (2019 and 2020) and intrapandemic (2021 and 2022) in-training examination scores were analyzed utilizing an independent samples t test to determine whether a significant change occurred during the pandemic. Qualitative: Individual semi-structured interviews were conducted with CCM fellows exploring their lived experiences during the pandemic and their perception of the effect on their academic performance. Transcribed interviews were analyzed for thematic patterns. These themes were coded and categorized, and subcategories were developed as indicated during the analysis. The identified codes were then analyzed for thematic connections and apparent patterns. Relationships between themes and categories were analyzed. This process was continued until a coherent picture could be assembled from the data to answer the research questions. Analysis was performed from a phenomenological perspective with an emphasis on interpretation of the data from the participants' perspectives.

RESULTS

Quantitative: Fifty-one in-training examination scores from 2019 to 2022 were obtained for analysis. Scores from 2019 to 2020 were grouped as prepandemic scores, while scores from 2021 to 2022 were grouped as intrapandemic scores. Twenty-four prepandemic and 27 intrapandemic scores were included in the final analysis. A significant difference was found between mean total prepandemic and intrapandemic in-service examination scores (t 49=2.64, p=0.01), with mean intrapandemic scores being 4.5 points lower than prepandemic scores (95 % CI, 1.08-7.92). Qualitative: Interviews were conducted with eight CCM fellows. Thematic analysis of the qualitative interviews revealed three main themes: psychosocial/emotional effects, effects on training, and effects on health. The factors that most effected participants' perceptions of their training were burnout, isolation, increased workload, decreased bedside teaching, decreased formal academic training opportunities, decreased procedural experience, a lack of an external reference point for normal training in CCM, fear of spreading COVID-19, and neglect of personal health during the pandemic.

CONCLUSIONS

In-training examination scores decreased significantly during the COVID-19 pandemic for CCM fellows in this study. The fellows in this study reported perceived effects of the pandemic on their psychosocial/emotional well-being, medical training, and health.

Impact of the COVID-19 Pandemic on Medical Education during Inpatient Internal Medicine Rounds

OBJECTIVES

Inpatient rounding is a foundational component of medical education in academic hospitals. The coronavirus 2019 (COVID-19) pandemic disrupted traditional inpatient rounding practices. The objectives of this study were to describe how Internal Medicine inpatient team rounding changed because of COVID-19-related precautions and the effect of these changes on education during rounds.

METHODS

During February to March 2021, we conducted four virtual focus groups with medical and physician assistant students, interns, upper-level residents, and attending physicians at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, and designed a codebook to categorize focus group commentary.

RESULTS

Focus groups revealed that students believed that certain physical-distancing measures in place early on during the pandemic were ineffective and significantly limited their ability to evaluate patients in person. Residents described increased stress levels related to potential severe acute respiratory-coronavirus 2 exposure and limited time at the bedside, which affected their confidence with clinical assessments. Rounding-team fragmentation precluded the entire team learning from all of the patients on the team's census. Loss of intrateam camaraderie impaired the development of comfortable learning environments.

CONCLUSIONS

This study evaluated Internal Medicine team member focus groups to describe how the COVID-19 pandemic affected medical education during rounds. Academic teaching programs can adapt the findings from this study to address and prevent pandemic-related gaps in medical education during rounds now and during future potential disruptions to medical education.

Is Virtual Learning Here to Stay? A Multispecialty Survey of Residents, Fellows, and Faculty

The transition to virtual learning during the coronavirus disease 2019 pandemic marks a paradigm shift in graduate medical education (GME). From June to September 2021, we conducted a dual-center, multispecialty survey of residents, fellows, and faculty members to determine overall perceptions about virtual learning and assess its benefits, drawbacks, and future role in GME. We discovered a mainly positive view of virtual education among trainees (138/207, 0.67, 95% CI 0.59-0.73) and faculty (180/278, 0.65, 0.59-0.70). Large group sessions, such as didactic lectures, grand rounds, and national conferences, were ranked best-suited for the virtual environment, whereas small groups and procedural training were the lowest ranked. Major benefits and drawbacks to virtual learning was identified. A hybrid approach, combining in-person and virtual sessions, was the preferred format among trainees (167/207, 0.81, 0.75-0.86) and faculty (229/278, 0.82, 0.77-0.87). Virtual learning offers a valuable educational experience that should be retained in postpandemic GME curriculums.

Online Sports Medicine Fellowship Education: The Genesis of a National Program and Year-1 Analysis

ABSTRACT

The COVID-19 pandemic has created numerous challenges in all walks of life. One such challenge was the strain and subsequent effects on medical education, including the elimination of in-person learning opportunities. Consequently, in March of 2020, a nationwide Sports Medicine fellowship online education series was developed. Presentations were available for live and recorded viewing. Over the course of the 2020-2021 academic year, 38 presentations were offered, covering 45 topics. Live viewership totaled nearly 1600 through the year, while views of recorded lecture reached nearly 34,000. There was no statistical difference in the number of viewers for musculoskeletal versus nonmusculoskeletal topics in either the live (46.50 ± 35.37 vs. 43.38 ± 27.28 viewers, respectively; P = 0.77) or recorded formats (843.60 ± 337.66 vs 876.67 ± 624.70 viewers, respectively; P = 0.85). This article presents the novel approach to sports medicine education by the American Medical Society for Sports Medicine in the 2020-2021 academic year through the genesis the National Online Fellowship Education Program along with analyses of viewership data.

Impact of COVID-19 pandemic on rheumatology trainees: an online survey

To assess the impact of the COVID-19 pandemic on the training of rheumatology trainees. We conducted an observational cross-sectional study using an online survey-based questionnaire sent to rheumatology trainees in India. Rheumatology trainees from India, including DM/DNB residents and fellows, were included. A total of 78 trainees from 24 institutes in 12 states participated in the study. An overwhelming majority of residents (84%) felt COVID-19 Pandemic Negatively impacted their residency and their Physical (65%), Mental (74%) and Social well-being (80%); 79% of trainees felt burnt out. Majority of trainees felt the pandemic negatively impacted their training with clinical teaching (91%), Clinical examination skills (74%), current (80%) and future (70%) research opportunities suffering during the pandemic. Most had significant reduction in the overall footfall (72%) of patients in rheumatology including OPD (77%) and indoor (67%) admissions along with academics (35%), procedures (66%) and exposure to musculoskeletal ultrasound (71%). Almost 60% and 40% of trainees had OPDs, and indoor admissions stopped during COVID-19 pandemic of these 20% had OPDs, and Admissions closed for more than 6 months. 85% of participants had one or the other psychological symptoms with almost half experiencing anxiety (44%), low mood (47%) or lack of sleep (41%). We found The COVID-19 Pandemic has significantly affected the physical, social and mental well-being of Rheumatology trainees. Academic and clinical training reduced, current and future Research became difficult, disruptions in OPDs and Admissions, recurrent COVID postings and reduction in patient footfall, procedures and MSK-US have been detrimental to trainees.