The opportunity for discussing the top patient safety risks over the years is a gift that will keep giving for awhile. While I will spend time on some of the most persistent and recurrent of safety issues, it is worth looking at many of the other topics as well. The concern about bringing new clinicians into practice is a new and very worrisome issue. When considering new clinicians this includes the spectrum of nurses, nurse practitioners, physician assistants, medical students graduating to residencies, and residents and fellows graduating to becoming attendings. The implications of these concerns is significant.
So let’s break down the concerns that ECRI has regarding this issue:
- First the good news – nurses and other graduates have great job opportunities compared to many other types of graduates with other degrees.
- Now the more worrisome news – and some of these concerns arise from several different forces:
- We are now seeing the “generation” of providers who were trained during COVID. For some, this may have meant that their normal education pathways were significantly disrupted. Classes were first cancelled and then done virtually. This is not to say that many lectures in medical schools or nursing schools were not already being streamed +/- recorded, they were. But these classes were often a hybrid with at least some audience and more targeted to an in person setting. There are different approaches and strategies to make sure you are engaging and educating students in an entirely virtual setting compared with the approach to in classroom teaching that may happen to allow the class to be streamed. Whether the changes needed to make the leap to completely virtual venues was ever done, or done well, is not clear. More on this later.
- These trainees may also have had, what we call clinical time, significantly interrupted. Whether you are a nurse, a medical student, a resident, or an individual training to be a Licensed Independent Practitioner (nurse practitioner, physician assistant), a good part of your growth is to move from the classroom to the bedside. This is where you start to put the things that are learned in a book/classroom, into practice on patients at the bedside. This is done under the supervision of teachers and trainers who are already experts in their areas. When COVID hit, this training was, disrupted, and sometimes outright cancelled. Some schools tried to integrate students and other trainees into telehealth interactions, yet even these educational opportunities were being thrown together in a chaotic environment with little thought to the needed educational outcomes. The concern was that students, who are paying for their education, should not be put in harm’s way as the pandemic was raging. Ethically, I think this was the right thing to do, but it did alter training in ways that may play out for years.
- Another group that was impacted by COVID are those that were further along in their training but still had not graduated into their final speciality areas. These are those were were in their residency or fellowship training. This group was generally expected to stay and treat COVID patients, but as hospitals and clinics closed their doors to routine surgeries and procedures, many people in their speciality training suddenly had no patients to treat. Even those who might normally take care of patients with infectious diseases, found that COVID was the ONLY thing they were dealing with as most other illnesses were not being admitted to hospitals unless they were critically ill (though this may have improved critical care skill sets in these residents). This change was prolonged and almost certainly impacted on the training of many young clinicians.
- Finally, even when trainees had patients to try and treat, their teachers and preceptors were sometimes overwhelmed with the care they were trying to deliver to patients with COVID. Medical staff were exhausted, frustrated, and sometimes terrified for themselves and their families.
So what does the literature suggest has happened to trainees during Covid? A few examples are below. There is certainly more, and perhaps additional research is currently underway.
- Interns’ perspectives on impacts of the COVID-19 pandemic on the medical school to residency transition
- The study explores how the COVID-19 pandemic impacted the transition from medical school to residency for PGY1 residents in the United States, emphasizing challenges faced, disruptions in training, and changes in desire to practice medicine.
- Key Takeaways:
- The pandemic adversely affected the connection with medical school communities and preparation for internship for PGY1 residents.
- Graduating medical students faced changes in scheduling for clinical experiences during the pandemic.
- Concerns about personal health, medical conditions, and childcare led to a decreased desire to practice medicine.
- Residents reported varied satisfaction levels regarding their ability to contribute to the COVID-19 response.
- Orientation for PGY1 residents included both virtual and in-person activities.
- Competence in using Personal Protective Equipment (PPE) varied among residents.
- Study findings highlight the need to monitor and support the experiences of medical students and new resident-physicians amidst ongoing pandemic uncertainties.
- Survey of Impact of the COVID-19 Crisis on Skill Decay Among Surgery and Anesthesia Residents. J of Surg Education. Vol 79. 2022
- This document is a report on a survey conducted to assess the impact of the COVID-19 pandemic on the technical skill decay among surgery and anesthesia residents. The study was conducted at two large academic medical centers in New York. The survey found that the pandemic had a significant impact on the training of residents, with a reduction in case volumes and a perceived decrease in technical skills. However, residents also gained experience in critical care skills through redeployment to COVID-19 intensive care units. The document highlights the need for longitudinal surveillance of trainees to evaluate the impact of reduced operative volume and redeployment on professional competency. It also suggests the use of simulation training and Entrustable Professional Activities (EPAs) as potential solutions to evaluate technical skill-based proficiency. The concerns of residents and faculty regarding training requirements and the assessment of competency are discussed, emphasizing the adaptability and resilience of residents and the importance of program flexibility in surgical education.
In Part 2 of this discussion implications of the above concerns and begin to explore possible way to address these vulnerabilities.