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.