How Coronavirus Has Impacted the Training of Medical Residents

Just as the novel coronavirus pandemic has had a profound impact on almost every other aspect of life, it has also had a keen effect on otolaryngology resident training. While some otolaryngology residents have been reassigned to work in intensive care units or emergency departments to handle surging COVID-19 cases, others have experienced diminished opportunities to train in non-emergent otolaryngology areas due to halted elective surgeries and office visits from mid-March through May 2020.

But otolaryngology programs around the country were able to shift from didactic, in-person lectures to robust online sessions and focused hands-on surgical training in the areas that were available—generally head and neck cancer cases—to continue their residency training during the pandemic. The changes, experts say, offer valuable insights into the future of otolaryngology graduate education.

In lectures, we’ve really tried to focus on residents reviewing cases, with a review of surgical decision-making. While it isn’t an exact replacement for being in the OR, it is crucial to their development as surgeons. —Alexander Hillel, MD, Johns Hopkins Medicine

“I’ve never encountered any challenge to the system and to healthcare anywhere near as severe as what COVID-19 has done to us,” said Michael Ruckenstein, MD, professor, vice chairman, and residency program director of otorhinolaryngology–head and neck surgery at the Hospital of the University of Pennsylvania in Philadelphia. “We are all naïve in having to deal with this. The fact that residents experienced this event is an incredible education in and of itself. It’s very significant for the future because it’s likely that something like this will happen again during their careers. They’re part of the front line for intervention for COVID-19. They won’t get an exam on it, and I hope they never have to encounter it again, but if they do, they’ll have a real jump-start compared to what we had.”

Working and learning through the pandemic also brought a sense of unity, even while practicing the social distancing necessary to slow COVID-19’s spread. “There’s a recognition that we’re all in this together: as a world, a country, a state, the city of Baltimore, and the hospital we’re in,” said Alexander Hillel, MD, the residency program director and an associate professor in the department of otolaryngology–head and neck surgery at Johns Hopkins Medicine in Baltimore.

Training Challenges

In March, as the country began to shut down, residents’ schedules were affected based on where in the country they were located. “Some areas of the country were significantly more affected than others,” said Stacey Tutt Gray, MD, the vice chair of education, residency program director, and associate professor in the department of otolaryngology–head and neck surgery at Harvard Medical School, and the Sinus Center director at Massachusetts Eye and Ear in Boston. Across the country, many otolaryngology residents were reassigned to non-otolaryngology specialties, including ICU and medicine wards, to take care of patients with COVID-19. Elsewhere, she explained, “as the majority of elective otolaryngology care was put on hold, many programs changed the way rotations were structured. Residents continued to be involved with emergency otolaryngology cases and head and neck cancer care, but involvement in non-urgent otolaryngology cases and clinic was limited,” she said. “Due to concerns about higher-risk procedures that generated aerosols, most programs focused on ways to limit trainee exposure to COVID-19.”

As of June, “We’re now in the start of the recovery phase and focusing on ways to make up for lost time,” said Dr. Gray. “In terms of resident educational experience, it isn’t one size fits all. Depending on what rotations were missed, making up surgical and clinic time will be different. We’ll figure out how to regain that experience depending on where they were in their training.

“During this pause, most of the residents have been involved in a variety of activities, including completing research projects, writing opinion pieces, and catching up on studying,” she notes. “This has been a time to really focus on independent learning, and I think they’ve all taken advantage of the opportunity.”

At Hopkins, fewer elective surgeries has meant more time for otolaryngology residents to spend on didactics every day, with all of the faculty engaging in lectures daily, said Dr. Hillel. “In lectures, we’ve really tried to focus on residents reviewing cases, with a review of surgical decision-making. While it isn’t an exact replacement for being in the OR, it is crucial to their development as surgeons. We tried to encourage faculty to focus on surgical decision-making and developing the residents’ thought process,” he said. As elective surgeries return based on the Maryland governor’s guidelines, residents are assigned to cases on a weekly basis.

Graduate medical education is moving more toward competency-based training, rather than doing “20 specific procedures,” Dr. Gray said. “The key is individualizing the recovery plan for each resident and, as faculty, being able to gauge competency and comfort in those clinical areas.”