Introduction
First-year resident physicians began training in July 2020 in an environment of decreased clinical case exposure and increased feelings of insecurity secondary to the coronavirus (COVID-19) pandemic. To support resident learning, the University of Toronto Department of Otolaryngology - Head & Neck Surgery piloted a novel virtual case-based discussion series for first-year residents.
Methods
A weekly virtual resident-led case-based discussion series was designed. In 2020/2021, six residents (“Cohort 1”) and four staff otolaryngologists participated. A Likert survey retrospectively evaluated participant comfort level on a scale of 1 to 5, from “not well prepared or comfortable” to “very well prepared or comfortable” in seven clinical areas, at the beginning of the post-graduate year (PGY-1) August 2020, and in May 2021. Qualitative data collected assessed strengths and weaknesses of the intervention. In July 2021, the new 2021/2022 PGY-1 cohort (“Cohort 2”) also completed cross-sectional surveys in August 2021 and March 2022 to assess their comfort levels with consult management at the two separate timepoints.
Results
Cases presented revealed areas for practical, systemic, and cultural improvement. With respect to clinical decision making, both “Cohort 1” and “Cohort 2” residents reported increased comfort level in all areas assessed. “Cohort 1” residents reported percentage increase in comfort level addressing all consults of 28%, triaging consults overnight of 24%, pediatric consults of 30%, otology consults of 32%, airway consults of 30%, epistaxis consults of 28%, and peritonsillar abscess consults of 24%. “Cohort 2” residents reported increase in comfort level managing all consults of 32%, triaging consults overnight of 30%, pediatric consults of 38%, otology consults of 2%, airway consults of 30%, epistaxis consults of 18%, and peritonsillar abscess consults of 24%. All respondents agreed the intervention would benefit residents of other programs as a prolonged orientation to residency and a safe and confidential forum to discuss best practices.
Discussion
A weekly case discussion series potentially improves both resident education and patient care. It facilitated real-time discussion of topics relevant to self-perceived knowledge deficits, timely advice on management of a new and changing population of COVID patients and brought to attention hidden curriculum topics for exploration.
Conclusion
The case series described could be applied to benefit residents in Otolaryngology and other surgical specialty programs nationwide during, and following, the pandemic.