Critical care medicine training in the age of COVID-19.

IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Journal of Osteopathic Medicine Pub Date : 2023-09-01 DOI:10.1515/jom-2022-0244
Walter Mickey
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Abstract

Context: The COVID-19 pandemic caused the largest disruption to graduate medical education in modern history. The danger associated with SARS-CoV-2 necessitated a paradigm shift regarding the fundamental approach to the education of medical residents and fellows. Whereas prior work has examined the effect of the pandemic on residents' experiences during training, the effect of the pandemic on academic performance of critical care medicine (CCM) fellows is not well understood.

Objectives: This study examined the relationship between CCM fellow's lived experiences during the COVID-19 pandemic and performance on in-training examinations.

Methods: This mixed-methods study consisted of a quantitative retrospective analysis of critical care fellows' in-training examination scores and a qualitative, interview-based phenomenological examination of fellows' experiences during the pandemic while training in a single large academic hospital in the American Midwest. Quantitative: Prepandemic (2019 and 2020) and intrapandemic (2021 and 2022) in-training examination scores were analyzed utilizing an independent samples t test to determine whether a significant change occurred during the pandemic. Qualitative: Individual semi-structured interviews were conducted with CCM fellows exploring their lived experiences during the pandemic and their perception of the effect on their academic performance. Transcribed interviews were analyzed for thematic patterns. These themes were coded and categorized, and subcategories were developed as indicated during the analysis. The identified codes were then analyzed for thematic connections and apparent patterns. Relationships between themes and categories were analyzed. This process was continued until a coherent picture could be assembled from the data to answer the research questions. Analysis was performed from a phenomenological perspective with an emphasis on interpretation of the data from the participants' perspectives.

Results: Quantitative: Fifty-one in-training examination scores from 2019 to 2022 were obtained for analysis. Scores from 2019 to 2020 were grouped as prepandemic scores, while scores from 2021 to 2022 were grouped as intrapandemic scores. Twenty-four prepandemic and 27 intrapandemic scores were included in the final analysis. A significant difference was found between mean total prepandemic and intrapandemic in-service examination scores (t 49=2.64, p=0.01), with mean intrapandemic scores being 4.5 points lower than prepandemic scores (95 % CI, 1.08-7.92). Qualitative: Interviews were conducted with eight CCM fellows. Thematic analysis of the qualitative interviews revealed three main themes: psychosocial/emotional effects, effects on training, and effects on health. The factors that most effected participants' perceptions of their training were burnout, isolation, increased workload, decreased bedside teaching, decreased formal academic training opportunities, decreased procedural experience, a lack of an external reference point for normal training in CCM, fear of spreading COVID-19, and neglect of personal health during the pandemic.

Conclusions: In-training examination scores decreased significantly during the COVID-19 pandemic for CCM fellows in this study. The fellows in this study reported perceived effects of the pandemic on their psychosocial/emotional well-being, medical training, and health.

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COVID-19时代重症监护医学培训。
背景:2019冠状病毒病大流行对现代历史上的研究生医学教育造成了最大的破坏。与SARS-CoV-2相关的危险需要在医疗住院医师和研究员教育的基本方法上进行范式转变。虽然先前的工作已经研究了大流行对住院医师培训期间经验的影响,但大流行对重症监护医学(CCM)研究员学术表现的影响尚未得到很好的理解。目的:本研究考察了CCM学员在COVID-19大流行期间的生活经历与培训考试成绩之间的关系。方法:这项混合方法研究包括对重症监护研究员的培训考试分数进行定量回顾性分析,以及对研究员在美国中西部一家大型学术医院培训期间的经历进行定性、基于访谈的现象学检查。定量:利用独立样本t检验分析了大流行前(2019年和2020年)和大流行期间(2021年和2022年)的培训考试成绩,以确定大流行期间是否发生了重大变化。定性:与CCM研究员进行了个别半结构化访谈,探讨他们在大流行期间的生活经历以及他们对学业成绩影响的看法。对采访记录进行主题模式分析。对这些主题进行了编码和分类,并根据分析期间的指示制定了子类别。然后分析识别的代码的主题联系和明显的模式。分析主题与类别之间的关系。这个过程一直持续,直到从数据中收集到一个连贯的图像来回答研究问题。分析是从现象学的角度进行的,强调从参与者的角度解释数据。结果:定量:获得2019 - 2022年51个在职考试成绩进行分析。2019年至2020年的得分被归类为大流行前得分,2021年至2022年的得分被归类为大流行内得分。24个大流行前得分和27个大流行内得分被纳入最终分析。大流行前和大流行内在职考试平均分之间存在显著差异(t 49=2.64, p=0.01),大流行内平均分比大流行前得分低4.5分(95 % CI, 1.08-7.92)。定性:与八名CCM研究员进行了访谈。对定性访谈的专题分析揭示了三个主要主题:心理社会/情感影响、对培训的影响和对健康的影响。影响参与者对培训感知的主要因素是倦怠、孤立、工作量增加、床边教学减少、正式学术培训机会减少、程序性经验减少、缺乏CCM正常培训的外部参考点、对COVID-19传播的恐惧以及在大流行期间忽视个人健康。结论:在本研究中,CCM研究员在COVID-19大流行期间的培训考试分数显著下降。本研究的研究员报告了大流行对他们的心理/情感健康、医疗培训和健康的感知影响。
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来源期刊
Journal of Osteopathic Medicine
Journal of Osteopathic Medicine Health Professions-Complementary and Manual Therapy
CiteScore
2.20
自引率
13.30%
发文量
118
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