Ophthalmology
How the practice changed:
In our center, clinical and surgical ophthalmology volume abruptly decreased in April 2020 because of the COVID-19 pandemic. All the courses’ workload and journal clubs migrated to an online modality and our clinical practice, along with surgical activities, decreased by 90%, similar to other residency programs with a decrease in 79% of clinical visits.3 A survey on 716 ophthalmology trainees in India reported that 81% felt a negative impact to their surgical training.4
What stopped?
All elective surgeries had to be postponed, representing 95% of the surgeries performed in our residency program. Ophthalmological consultations also decreased by 90% thus reducing practice with patients for residents of our program. We performed a retrospective observational study to review the management of cataract phacoemulsification surgery (CPS) in COVID-19 times with the previous year, and we found that 240 cataract surgeries were performed in the 2020 period compared to the 643 surgeries performed in the same period of the previous year (-62.7% in 2020 compared to 2019, p < 0.0001). Affecting residents´ learning in surgical skills.
What’s new?
After finding a study reporting up to 31.6% of ocular manifestations in COVID-19 patients, we decided to start a protocol of ocular manifestations in the same hospitalized patients.5 Our program designed one weekly virtual clinical case session for residents and medical students to compensate for the lack of clinical experience at the moment. Nevertheless, 2020 has also had its bright side as the year of ophthalmology with more virtual resources being used.
Internal Medicine
How the practice changed:
Internal medicine residents were called immediately to the front line of the COVID-19 pandemic. Initially, it was unclear our role in the attention of patients; when the first cases arose in our state, we were kept out for our protection. However, when the cases exponentially increased, we became an important factor needed. Our clinical rotations continued in the hospitals that comprise our academic health center including the attention of non-COVID-19 and COVID-19 patients.
What stopped?
To ensure and enhance residents’ preparation in this emerging topic, academic coursework had to focus on its pathogenesis, management innovations, and mechanical ventilation. Therefore, both clinical and academic practice had to change and became COVID-19-focused.
What’s new?
It has been reported in several articles that burnout, anxiety, and stress had increased significantly in residents.6–8 The most relevant reasons are the increasing workload, the reduced sense of accomplishment, and particularly an unsafe feeling due to the risk from the exposure to transmit the virus to our families. Besides that, the pandemic has represented a big challenge to internal medicine residents because it forced us to boost our knowledge in related topics to SARS-COV-2; while, at the same time, try to continue our integral training.6
General Surgery
How the practice changed:
Our general surgery program oversees 2 hospitals that comprise our health system. One of these hospitals had to become a hospital for COVID-19 patients, so all surgical activity was stopped, and all non-COVID-19 was sent to a single hospital. Nonetheless, in the non-COVID-19 hospital was a considerable decrease on surgical activity, probably due to society’s fear of contagion.
What stopped?
In the COVID-19 era, with the risk of infection and the overload of healthcare systems, we were forced to suspend elective surgeries and gradually reduce the number of admissions for surgical diseases, referring these patients to tertiary care centers. As reported, surgery residents had to join the team of residents caring for COVID-19 patients and became the main force for the placement of central venous accesses and thoracostomy.9
What’s new?
Our program increased the number of online sessions of clinical cases, discussion, and research activities. The uncertainty about practical learning is vast and understandable due to the lower exposure to surgical pathologies and procedures. It is a medical specialty in which the experience and practice is essential to develop the needed skills for each procedure.10 However, we believe that with a reorganization of our learning competence systems in the following years, surgical residents will be able to recoup and achieve an adequate formation.
Anesthesiology
How the practice changed:
The pandemic has affected anesthesiology residency, in particular for not having almost any elective surgery scheduled, prioritizing obstetric, emergency, and COVID-19 related surgeries.11 This leads to very low practice and training involving general anesthesia and increasing risks of contagion.
Until now, one of the highlights during the pandemic is the importance of airway management, and as we know, anesthesiology is a key part of the team that manages endotracheal intubation and airway procedures.12,13
What stopped?
Considering this, guidelines have stated that only the most experienced personnel available should manage the airway of a patient with COVID-19 to minimize exposure and risks of infection 13 leading anesthesiology trainees, especially first year residents, to miss the opportunity of intervention during these procedures as well as losing practice experience for endotracheal intubation.
What’s new?
As well as the other specialties, we also had to join rotations in COVID-19-designated areas as general physicians. Additionally, our program supported us with training simulators and online certifications for airway management for COVID-19 patients. Worldwide adaptation to online academic sessions has also been an important part of our “new normal”.14