The COVID-19 pandemic presented some truly unprecedented difficulties for anesthesia residency programs and their trainees, ranging from staffing ICUs, to meeting graduation requirements, and securing jobs. Now, as the academic year draws to a close and signs of recovery begin to grow brighter, I invited trainees from across California to reflect back on the past year and a half. What follows is compiled commentary from four anesthesia residents who shared their thoughts with me, affording a look into both shared challenges and the unique experiences that evolved out of the pandemic at each institution.
The spread of COVID-19 quickly began to affect the clinical experiences of trainees in the spring of 2020. As with most hospitals across California, surgical cases were cancelled, and anesthesia staff were redeployed. An additional challenge for academic facilities was the question of how to best utilize residents, balancing a desire to prioritize their safety while still appropriately making use of their clinical abilities.
Robert Landon, MD, Loma Linda University: During March 2020, the OR case volume decreased in anticipation of a wave of COVID patients. However, the total COVID case volume initially remained low. We reopened and then were suddenly hit with a significant number of patients in July 2020 and again in December 2020… our program even opened up an entirely attending/resident anesthesiology intensive care unit team, and many CA-1s returned to the internal medicine wards.
Taraz Nosrat, MD, University of California San Diego: Fortunately, our program came out strong with PPE for staff, and was an early institutor of universal COVID testing for all patients for elective surgery. Our department also came out with an early policy to have attendings (the most experienced airway practitioner) perform intubation on COVID suspected or positive patients to minimize exposure risk and time involved in intubating.
Rebecca Morris, MD, Stanford University: Our department made a deliberate decision to shield residents from unnecessary exposure as much as possible, forming a new 24/7 attending-only COVID airway team and deciding that ICU attendings would examine positive patients each day while allowing the residents to manage from outside the room. This practice could not have been maintained if the hospital became overwhelmed, but that luckily did not come to pass.
Daniel Salazar, MD, Harbor–UCLA Medical Center: Many residents were redeployed from previously assigned rotations to the COVID-19 ICU. Other anesthesia members such as CRNAs were also redeployed and served as critical care nurses. With time we learned more about COVID-19 spread and residents were slowly incorporated into the emergency airway team. Our department would hold the airway pager 24/7 and we experienced a tremendous amount of airway emergencies.
In a state as large as California, there is tremendous demographic diversity amongst patient populations, spanning race and ethnicity, socioeconomic status, political views, chronic disease burden, and more. Thus, it is no surprise that residents in different regions faced unique sets of challenges presented by the spread of the pandemic in their communities.
Dr. Landon: During one point in the pandemic, San Bernardino County was at the forefront of COVID-19 cases per capita. We saw many patients in the lower socioeconomic spectrum. As the only tertiary care and level 1 trauma center in our region, the surge placed a significant strain on our resources. At times during the pandemic, we received patients from other hospitals who were either overwhelmed or did not have the resources to treat such critical patients.
Dr. Nosrat: We take care of a fair number of patients with traumatic injuries related to the border wall, and several of these patients have COVID as well as a language barrier with English-speaking staff. It is challenging to provide high-quality care in a setting with isolation precautions and a language barrier, but it is an opportunity to practice compassion and to get creative in ways we connect with our patients.
Dr. Morris: Our patient population is perhaps an outlier given the proportion of individuals in Silicon Valley that are well-insured and have had longstanding access to preventative care. Perhaps even more important was a novel privilege for many in the community — the ability to work from home and support one’s family while sheltering in place. This meant that we were fortunate to be spared from some of the worst surges seen in other regions, which in turn gave us the ability to take in countless transfers from many corners of the state.
Dr. Salazar: Harbor-UCLA is a county institution and a safety net hospital… our patient population is of lower socioeconomic status and patients often present late in their disease course with multiple comorbidities. We experienced an astronomical surge and we were challenged to meet the demand. The hospital ICU capacity was stretched to 200% of its normal capacity. Additionally, many health care workers became infected, which placed an enormous stress on the hospital system as staffing was stretched very thin.
A common concern early in the pandemic was how redeployment of residents might affect their overall training. Given the finite nature of residency, the interruption from COVID-19 posed new uncertainties, but a year later it appears that programs across the state succeeded in balancing their missions of patient care and clinical training.
Dr. Morris: Our outgoing chief residents Drs. Justin Ward, Alix Baycroft, and Mike Tien (aka “JAM”) worked tirelessly to reduce the impact on residents’ training. The constant flux of patient volumes meant frequent rearrangements in surge teams and elective rotation staffing, and the chiefs worked hard to advocate for our needs and make changes as quickly and as equitably as possible. With nearly a hundred trainees in our program, this was a monumental undertaking.
Dr. Salazar: The residency program preserved all required ACGME rotations and gave priority to the CA-3 residents so that they could fulfill rotations necessary to meet graduation requirements. Fortunately, CA-3 residents were still able to meet their ACGME minimum case numbers and rotation requirements. Although surgical volume decreased, residents still felt competent in their proficiency as an anesthesiologist.
Perhaps the residents most affected by COVID-19 were incoming CA-1s. Their intern year had already been upended by the start of the pandemic, and in many cases, they were moving to a new city to start anesthesia training. The cancellation of all in-person activities meant difficulties welcoming them into a department and fostering a sense of community.
Dr. Nosrat: I think the CA-1s had a very different experience than our CA-2 class, as they were not able to meet through our regular department-sanctioned social events and mixers. The social element is a crucial one for our department, and definitely helped me with the transition to a new city and new department. Our chief resident in charge of social events held zoom happy hours and then outdoor events once we were vaccinated.
Dr. Morris: Last year all discretionary funds were frozen by the university, preventing not just the usual team-building trips, but even the welcome gifts. In light of this, residents and faculty collected thousands of their own dollars to buy jackets and bags for all thirty of the new trainees and fund some unofficial COVID-compliant activities. This by no means made up for everything the CA-1s missed out on but the small gesture was much appreciated
Another major milestone in the career of anesthesia residents is that of securing a fellowship or practice position and preparing to start independent practice. This year that meant hours of Zoom interviews in lieu of flying for in-person visits and leveraging other resources at their disposal locally.
Dr. Landon: As travel became limited, the value of professional networks became more important than ever for those looking for jobs and fellowship positions. It also seemed that more applicants were looking towards regions that were well known to them since traveling to far-reached areas was not possible during the pandemic.
Dr. Nosrat: Looking for a job has felt like a very organic process. There was an initial fear that COVID would result in less people hiring, but in my brief search so far it seems that surgical volume has picked back up and practices are hiring again. Having been vaccinated, I am optimistic that I will be able to fly and interview in-person with select practices at the top of my list.
Although at times exhausting and demoralizing, for many anesthesia trainees the pandemic has given our work as physicians a renewed sense of importance. And despite social distancing and Zoom lectures, in some ways it has helped to strengthen many bonds within our training programs.
Dr. Nosrat: COVID has provided some unique challenges to all facets of life. I feel grateful to be working in healthcare and making a tangible difference every day in the lives of my patients. Anesthesiology will continue to be a valuable field that has demonstrated its importance during this pandemic. Creating value through balanced clinical work, leadership, and organizational work will ensure that you always have a seat at the table.
Dr. Salazar: There is no doubt that the pandemic was challenging, but we rose to the occasion and we are very proud of the work we did to serve our community. A big shout out to our anesthesia department leadership including our department chair Dr. Jeanette Derdemezi and program director Dr. Clinton Kakazu for their heroic efforts throughout the pandemic.
To watch the full interviews, click here for Part 1 and click here for Part 2.