Residency Program Responses to Early COVID-19 Surges Highlight Tension as to Whether Residents Are Learners or Essential Workers

• Published in: Academic medicine Vol. 97; no. 11; pp. 1683 - 1690
• Main Authors: Martin, Shannon K., Finn, Kathleen M., Kisielewski, Michael, Simmons, Rachel, Zaas, Aimee K.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-11-2022
• Subjects: Research Reports
• ISSN: 1040-2446; 1938-808X
• DOI: 10.1097/ACM.0000000000004800

Purpose
To quantify the extent to which internal medicine (IM) residents provided care for patients with COVID-19 and examine characteristics of residency programs with or without plans (at some point) to exclude residents from COVID-19 care during the first 6 months of the pandemic.
Method
The authors used data from a nationally representative, annually recurring survey of U.S. IM program directors (PDs) to quantify early (March–August 2020) resident participation in COVID-19 care. The survey was fielded from August to December 2020. PDs reported whether they had planned to exclude residents from COVID-19 care (i.e., PTE status). PTE status was tested for association with program and COVID-19 temporal characteristics, resident schedule accommodations, and resident COVID-19 cases.
Results
The response rate was 61.5% (264/429). Nearly half of PDs (45.4%, 118/260) reported their program had planned at some point to exclude residents from COVID-19 care. Northeastern U.S. programs represented a smaller percentage of PTE than non-PTE programs (26.3% vs 36.6%;
P
= .050). PTE programs represented a higher percentage of programs with later surges than non-PTE programs (33.0% vs 13.6%,
P
= .048). Median percentage of residents involved in COVID-19 care was 75.0 (interquartile range [IQR]: 22.5–100.0) for PTE programs, compared with 95.0 (IQR: 60.0–100.0) for non-PTE programs (
P
< .001). Residents participated most in intensive care units (87.6%, 227/259) and inpatient wards (80.8%, 210/260). Accommodations did not differ by PTE status. PTE programs reported fewer resident COVID-19 cases than non-PTE programs (median percentage = 2.7 [IQR: 0.0–8.6] vs 5.1 [IQR: 1.6–10.7];
P
= .011).
Conclusions
IM programs varied widely in their reported plans to exclude residents from COVID-19 care during the early pandemic. A high percentage of residents provided COVID-19 care, even in PTE programs. Thus, the pandemic highlighted the tension as to whether residents are learners or employees.