Introduction
Even in the best of times, providing excellent resident education involves many challenges. Ensuring outstanding surgical care while training residents in surgery, maintaining appropriate balance between service and education, and designing a graduated experience that allows a natural transition of trainees from Resident to Faculty are some of the baseline conundrums faced by all surgical training programs. The introduction of the global COVID-19 pandemic has disrupted our practices and added additional dimensions to these challenges.
As Educators, our first step in responding to this pandemic must be to understand its potential areas of impact on our trainees. Hands-on surgical exposure for trainees has been dramatically curtailed by a decreased volume of surgical procedures. On March 23rd, the American Academy of Otolaryngology – Head and Neck Surgery officially recommended limiting patient interactions to “time-sensitive and emergent problems” and resident surveys demonstrate that, during the same time frame, nearly all programs surveyed had enacted policy changes to decrease COVID-19 spread1,2. Additionally, risk of infection restrictions on personal protective equipment (PPE) can limit operating room participation to only essential personnel.
The role of the head and neck surgeon and trainees with whom we work, however, extends beyond the operating room. Much of the risk we face is presented during inpatient management and consultations. Training and patient care in this environment presents a different set of challenges. The “routine” examinations and procedures that make up much of the daily life of a resident now require a careful assessment of risk to trainees, faculty, and staff. Medicine is a team sport and we also face the risk of infecting each other. Early results from contact tracing of infected health care workers at our institution demonstrate that transmission between health care providers is almost as likely as transmission from patients3. Many clinics have started using telehealth for initial ambulatory visits and limiting the people in the room during clinic assessments to mitigate ambulatory risk, but in-hospital consultations remain a source of concern.
The COVID-19 pandemic required restructuring of faculty and resident assignments to protect the safety of healthcare workers and patients alike. In this paper, we describe the creation and implementation of guidelines delineating resident and faculty responsibilities in accordance with safety mandates to reduce the risk (to providers, other health care workers, and patients) while preserving resident education.