COVID-19 Impact on Intern Exposure to Common Inpatient Diagnoses

Abstract

OBJECTIVE We sought to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical exposure of pediatric interns to common pediatric inpatient diagnoses. METHODS We analyzed electronic medical record data to compare intern clinical exposure during the COVID-19 pandemic from June 2020 through February 2021 with the same academic blocks from 2017 to 2020. We attributed patients to each pediatric intern on the basis of notes written during their pediatric hospital medicine rotation to compare intern exposures with common inpatient diagnoses before and during the pandemic. We compared the median number of notes written per intern per block overall, as well as for each common inpatient diagnosis. RESULTS Median counts of notes written per intern per block were significantly reduced in the COVID-19 group compared with the pre–COVID-19 group (96 [interquartile range (IQR): 81–119)] vs 129 [IQR: 110–160]; P < .001). Median intern notes per block was lower in the COVID-19 group for all months except February 2021. Although the median number of notes for many common inpatient diagnoses was significantly reduced, they were higher for mental health (4 [IQR: 2–9] vs 2 [IQR: 1–6]; P < .001) and suicidality (4.5 [IQR: 2–8] vs 0 [IQR: 0–2]; P < .001). Median shifts worked per intern per block was also reduced in the COVID-19 group (22 [IQR: 21–23] vs 23 [IQR: 22–24]; P < .001). CONCLUSIONS Our findings reveal a significant reduction in resident exposure to many common inpatient pediatric diagnoses during the COVID-19 pandemic. Residency programs and pediatric hospitalist educators should consider curricular interventions to ensure adequate clinical exposure for residents affected by the pandemic.

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

“…The DLC represents the synthesis of the various research efforts in our review. Research teams published at various stages of the DLC; of the 61 non-CLE articles, all 61 (100%) identified EHR measures, 6–68 59 (97%) performed attribution, 6–65,67 and 17 (28%) designed trainee-level visualizations. 8–10,18,20,27,33,36,37,41–45,48,51 Currently, only Rattanaumpawan et al 40 have reached the stage of trainee-level improvement (1 [2%]); however, this motivation is articulated in 54 articles (89%), 6–16,18–22,26,27,30,33–66,68 and it is only a matter of time before the technical groundwork these teams have lain yields evidence of trainee-level improvement.…”

“…Seventeen articles measured trainee condition experience. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Investigations were typically limited to a single practice environment, although 2 articles (12%) created portfolios of condition experience that spanned the trainee's entire educational arc. 15,20 Across specialties, researchers focused on breadth and depth of exposure, stored in the EHR as International Procedural experience 14,[23][24][25][26][27][28][29][30][31][32] 11 (13) Trainee experience performing "all medical, diagnostic, and surgical procedures considered essential for the area of practice" 1…”

“…Percentage of visits in continuity clinic with patients for whom the trainee is the designated primary care practitioner 56 Panel size 63 1 (1) Number of patients assigned to a trainee in a specific role (e.g., primary care practitioner) Number of patients in primary care panel 63 Medical knowledge 32,49,64,65 4 (5) "Knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care" 1 Test scores on in-training exam compared with clinical volume 64 Accountability to patients 57,66,67 3 (3) Trainee behaviors demonstrating accountability to patients for whom they have a therapeutic relationship Trainee direct visualization of radiology studies performed on their inpatients 67 Equity of care 41 1 (1) Trainee practice examined along equity lines Trainee psychiatric management of a given condition, stratified by patient ethnicity 41 Physician well-being 68 [6][7][8]11,[14][15][16][20][21][22] Current Procedural Terminology codes, 6,7 chief concern, 6,12,13 or discharge diagnosis. 19 Most authors created bespoke mappings of raw EHR data to educationally meaningful groupings (16 of 17 [94%]).…”

“…19 Most authors created bespoke mappings of raw EHR data to educationally meaningful groupings (16 of 17 [94%]). [6][7][8][9][10][11][12][13][14][15][16][17][18][19]21,22 All articles that compared trainee data with national standards unearthed concerning gaps in the condition experience of individual trainees (9 of 9 [100%]). 11,[13][14][15][16][17]19,21,22 Eleven articles measured trainee procedural experience.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19]21,22 All articles that compared trainee data with national standards unearthed concerning gaps in the condition experience of individual trainees (9 of 9 [100%]). 11,[13][14][15][16][17]19,21,22 Eleven articles measured trainee procedural experience. 14,[23][24][25][26][27][28][29][30][31][32] A common aim was to quantify procedural volume; a common finding, however, was discordance between manually entered and EHR-measured procedural volume.…”