Restructuring of a General Surgery Residency Program in an Epicenter of the Coronavirus Disease 2019 Pandemic

Abstract

n March 1, 2020, the first case of coronavirus disease 2019 (COVID-19) was confirmed in New York City (NYC) and rapidly emerged as the nation's epicenter with more than 366 000 (22% of the US) confirmed cases and 29 000 (30% of the US) deaths as of May 27, 2020 (Figure 1). 1,2 At the peak in mid-April, NewYork-Presbyterian Hospital/Weill Cornell Medicine (NYP-WC) was treating 474 patients who had tested positive for COVID-19, with 237 (50.0%) admitted to the intensive care unit (ICU) and 212 (44.7%) requiring mechanical ventilation. Owing to the exponential rise in critical care needs, 3-5 NYC hospitals sought to quickly restructure existing systems to expand critical care capacities while limiting clinical care in nones-sential areas. Plans to restructure surgery programs have been previously described, 6-8 but the experience of a region as profoundly affected as NYC has yet to be reported. This restructuring had a particularly pronounced effect on surgery departments and training as elective cases were suspended. 9,10 On March 16, 2020, in response to the US Centers for Disease Control and Prevention recommendations in consensus with multiple surgical societies such as the American College of Surgeons and an order from the New York State governor, NYP-WC announced that elective surgeries would be postponed. 11 General surgery training in NYC was uniquely affected by decreased operative training opportunities lost during the 2019-On March 1, 2020, the first case of coronavirus disease 2019 (COVID-19) was confirmed in New York, New York. Since then, the city has emerged as an epicenter for the ongoing pandemic in the US. To meet the anticipated demand caused by the predicted surge of patients with COVID-19, the Department of Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medicine developed and executed an emergent restructuring of general surgery resident teams and educational infrastructure. The restructuring of surgical services described in this Special Communication details the methodology used to safely deploy the necessary amount of the resident workforce to support pandemic efforts while maintaining staffing for emergency surgical care, limiting unnecessary exposure of residents to infection risk, effectively placing residents in critical care units, and maintaining surgical education and board eligibility for the training program as a whole.

The impact of the COVID‐19 pandemic on the education and wellness of U.S. Pediatric Anesthesiology Fellows

“…In March 2020, an unprecedented global pandemic due to coronavirus disease 2019 (COVID‐19) or the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) resulted in state‐wide shutdowns of elective surgical activities that extended for several months throughout the United States 1 . A number of teaching hospitals canceled or postponed elective surgeries to accommodate potential (and in some places, actual) surges of COVID‐19 patients, 2,3 as well as to prevent undue exposure to perioperative personnel and preserve personal protective equipment (PPE) 1 . As a result of the ongoing pandemic, graduate medical education program directors had to quickly adapt to new and frequently changing rules implemented by their respective hospitals, graduate medical education accrediting organizations, and regional government.…”

“…As a result of the ongoing pandemic, graduate medical education program directors had to quickly adapt to new and frequently changing rules implemented by their respective hospitals, graduate medical education accrediting organizations, and regional government. This resulted in a comprehensive and rapid shift of educational culture, including everything from altered work schedules to newly virtual (or canceled) didactic lectures and unanticipated clinical rotations 2,3 . Educational leaders found themselves fraught with daily, complex dilemmas, and novel educational paradigms and constructs.…”

Impacts on Surgery Resident Education at a First Wave COVID-19 Epicenter

“…7 Unlike this study, prior literature did not address the effect of this restructuring on resident training, but discussed their experience and offered recommendations on how to safely and effectively prepare hospitals and programs. 8,9 In this study, we demonstrate that surgical residents had a significant contribution to the overall COVID-19 response at Danbury Hospital, with an average resident spending 28 to 38 hours per week caring for critical COVID-19 patients ( Table 1). This contribution resulted in a decrease in clinical duty hours by 35.1%, from 64.7 to 40.8 hours per week, in addition to fewer outpatient clinics attended, and less operative experience.…”

Impacts on Surgery Resident Education at a first wave COVID-19 epicenter

“…7 Unlike this study, prior literature did not address the effect of this restructuring on resident training, but discussed their experience and offered recommendations on how to safely and effectively prepare hospitals and programs. 8,9 In this study, we demonstrate that surgical residents had a significant contribution to the overall COVID-19 response at Danbury Hospital, with an average resident spending 28-38 hours per week caring for critical COVID-19 patients (Table 1). This contribution resulted in a decrease in clinical duty hours by 35.1%, from 64.7 to 40.8 hours per week, in addition to fewer outpatient clinics attended, and less operative experience.…”