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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 5  |  Page : 31-33

Challenges and Opportunities to Critical Care Training Programs during COVID-19 Pandemic


1 Adult Intensive Care Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia

Date of Submission26-Sep-2020
Date of Acceptance29-Sep-2020
Date of Web Publication7-Dec-2020

Correspondence Address:
Farhan Alenez
King Abdulaziz Medical City, Intensive Care Unit 1425, PO Box 22490, Riyadh, 11426
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sccj.sccj_54_20

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  Abstract 


Shortly after the COVID-19 pandemic announcement, health-care systems across the world were hugely affected by the mitigation measures to contain the infection. The training programs in different specialties were compromised, and the educational process was interrupted. The training program leaders have worked effortlessly to balance the educational process’s continuation with their trainees’ safety in ways that adhere to the mitigation measures. This review briefly discusses the challenges and opportunities to critical care training programs during the COVID-19 pandemic. The main challenges were interruptions of the educational process, reduced supervision, burnout, and reduced support. On the contrary, many opportunities have emerged including exposure to a new clinical disease and disaster response, virtual education, self-directed reading and assessment, and comprehensive support.

Keywords: Challenges, COVID-19, opportunities, training


How to cite this article:
Alenez F, Algamdi M. Challenges and Opportunities to Critical Care Training Programs during COVID-19 Pandemic. Saudi Crit Care J 2020;4, Suppl S1:31-3

How to cite this URL:
Alenez F, Algamdi M. Challenges and Opportunities to Critical Care Training Programs during COVID-19 Pandemic. Saudi Crit Care J [serial online] 2020 [cited 2023 Feb 8];4, Suppl S1:31-3. Available from: https://www.sccj-sa.org/text.asp?2020/4/5/31/302587




  Introduction Top


On December 31, 2019, the Chinese authorities notified the World Health Organization (WHO) regarding a novel coronavirus then the WHO declared the COVID-19 outbreak a pandemic on March 11, 2020.[1] As a response to the pandemic, many countries announced their mitigation measures to slow down the disease’s spread within the community and health-care system. The health-care system was the cornerstone of the mitigation measures, including the training programs, which have been affected globally[2],[3] and at the national level.[4] This review article will briefly discuss the challenges and opportunities to critical care training programs during the COVID-19 pandemic [Figure 1].
Figure 1: Challenges and opportunities to critical care training programs during COVID-19 pandemic

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  Critical Care Training Challenges during COVID-19 Pandemic Top


Burnout

The pandemic has placed all health-care workers under significant physical and emotional stress, especially to the frontliners. The frontline trainees were more vulnerable to stress as they were working both as trainees and health-care providers.[5] The trainees faced several issues including the high prevalence of burnout because of exhausting shifts, recurrent usage of full personal protective equipment, workforce limitation during the pandemic, and worries of getting infected with COVID-19. The trainees’ burnout was exacerbated by the cancellation of vacations, uncertainty about the pandemic duration, and physical avoidance of their families. Furthermore, dealing with high-risk procedures, risk of transmission of the infection to the loved ones, and lack of supportive wellness programs are important factors in increasing the prevalence and magnitude of burnout.

Interruption of the Educational Process

The mitigation measures that were placed in immediate effect within hospitals and communities interrupted the continuation of the trainees’ educational process. The mitigation measures have led to a considerable reduction in clinical exposure, cessation of academic activities,[6] cancellation of mandatory elective rotations, and morning rounds suspension. The social distancing measures within the health-care systems negatively impacted the quality of interactive sessions, which led to the dependency on online resources where many limitations present such as the lack of time and reliable internet sources. Furthermore, time allocated for reading was limited for the trainees as they were working as trainees and health-care providers in some centers.

Reduced Supervision and Support

The COVID-19 pandemic was overwhelming and fast evolving, resulting in reduced support to the trainees, especially in the pandemic’s early phase. Some trainees have lost their direct family support as they moved away to live alone. Furthermore, the busy schedules and strict infection control measures resulted in workforce exhaustion, which was propagated by the lack of social and psychological support.


  Critical Care Training Opportunities during the COVID-19 Pandemic Top


Unique learning opportunities

The COVID-19 pandemic has exposed the intensive care unit (ICU) trainees to a new clinical entity with its distinctive safety measures, clinical approach, and medical management. Besides the clinical and practical aspects of COVID-19 infection, the ICU trainees have learned and exercised the fundamental concepts of infection control, surge capacity, and disaster response.


  Virtual Clinical and Practical Education Top


Due to the curfew and restriction rules that have been implemented globally as a response to the COVID-19 pandemic,[7] distant learning and videoconferencing platforms have gained wide acceptance. Many governmental organizations, private companies, and educational institutions have successfully maintained their businesses and provided services through virtual solutions, and critical care training was not an exception. Endless educational opportunities for the ICU trainees have emerged or gained popularity during the pandemic including virtual half days and lectures and virtual educational meetings, for example, virtual journal club, morbidities and mortality, and health-related ethics rounds. Furthermore, plenty of online critical care-oriented courses, for example, the online Fundamental Critical Care Support and the Advanced Cardiovascular Life Support courses,[8],[9] and virtual national and international conferences, for example, the CHEST Annual Meeting 2020, which has gone entirely virtual this year,[10] are within reach.


  Self-directed Reading and Assessment Top


Self-directed reading, which is not affected by the pandemic, is an effective method to strengthen the knowledge base and keep oneself updated with the current literature. Furthermore, the global lockdown of most of the outside home activities made self-directed reading an attractive option during the pandemic. Beside reference textbooks and review books, UpToDate,[11] eMedicine,[12] and Dynamed[13] provide easily accessible, updated, and trustworthy educational materials. In addition, several chest and critical care societies provide verities of high-quality assessment tools for the ICU trainees, for example, the CHEST SEEK questions[14] and the Self-Assessment in Adult Multiprofessional Critical Care.[15]


  Direct Observation and Supervision Top


The daily ICU round offers an excellent opportunity for the ICU trainees to gain the necessary knowledge and confidence. The ICU consultants/attendings are expected to observe the ICU trainees while conducting rounds and provide them with focused teaching around the reviewed cases with emphasis on the approach and management. Furthermore, as the ICU-related procedures are expected to increase during pandemics, direct consultant supervision of the junior ICU trainees while performing procedures is expected to improve patients’ safety,[16] maximize trainees’ gain,[16] and foster trainees’ progression.


  Comprehensive Support Top


The COVID-19 pandemic has negatively affected global public health, global economy and transportation, employment, education, and almost all other aspects of life. One or more detrimental effects of the pandemic have undoubtfully been inflicted on the ICU trainees. Furthermore, physical and emotional burnout and sickness due to the development of COVID-19 infection have surly traumatized some ICU trainees.[5],[17] Social and psychological departments at each health institution should provide their employees and trainees, with the necessary support, including active surveillance for traumatized staff, provision of educational material, and arrangement of courses focused on maintaining physical and psychological health during the pandemic and discussing coping strategies.[18] Training programs, postgraduate offices, and the training program regulatory bodies are required to take all the necessary actions to ensure the delivery of uncompromised training without overwhelming the trainees, for example, some regulatory bodies, such as the Saudi Commission for Health Specialties, have modified their promotion requirements and assessment methods to suit the COVID-19 pandemic time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jebril N. World Health Organization Declared a Pandemic Public Health Menace: A Systematic Review of the Coronavirus Disease 2019 “COVID-19”, up to; 26 Mar 2020.  Back to cited text no. 1
    
2.
Amparore D, Claps F, Cacciamani GE, Esperto F, Fiori C, Liguori G, et al. Impact of the COVID-19 pandemic on urology residency training in Italy. Minerva Urol Nefrol 2020;72:505-9.  Back to cited text no. 2
    
3.
Nassar AH, Zern NK, McIntyre LK, Lynge D, Smith CA, Petersen RP, et al. Emergency restructuring of a general surgery residency program during the coronavirus disease 2019 pandemic: The University of Washington experience. JAMA Surg 2020;155:624-7.  Back to cited text no. 3
    
4.
Balhareth A, AlDuhileb MA, Aldulaijan FA, Aldossary MY. Impact of COVID-19 pandemic on residency and fellowship training programs in Saudi Arabia: A nationwide cross-sectional study. Ann Med Surg (Lond) 2020;57:127-32.  Back to cited text no. 4
    
5.
Kannampallil TG, Goss CW, Evanoff BA, Strickland JR, McAlister RP, Duncan J. Exposure to COVID-19 patients increases physician trainee stress and burnout. PLoS One 2020;15:e0237301.  Back to cited text no. 5
    
6.
Sahu KK, Mishra AK, Lal A. COVID-2019: Update on epidemiology, disease spread and management. Monaldi Arch Chest Dis 2020;90.  Back to cited text no. 6
    
7.
World Health Organization. Critical Preparedness, Readiness and Response Actions for COVID-19: Interim Guidance, 7 March 2020. World Health Organization; 2020.  Back to cited text no. 7
    
8.
Society of Critical Care Medicine. FCCS Online Licensed Course. Society of Critical Care Medicine (SCCM); 2020. Available from: https://www.sccm.org/Fundamentals/Fundamental-Critical-Care-Support/FCCS-Director-Led-Courses/FCCS-Online-Licensed-Course. [Last accessed on 2020 Aug 27].  Back to cited text no. 8
    
9.
ACLS Online Certification & Renewal. NHCPS.com; 2020. Available from: https://nhcps.com/acls-online-certification-renewal/. [Last accessed on 2020 Aug 27].  Back to cited text no. 9
    
10.
Home. CHEST Annual Meeting. CHEST Annual Meeting; 2020. Available from: https://chestmeeting.chestnet.org. [Last accessed on 2020 Aug 27].  Back to cited text no. 10
    
11.
Smarter Decisions. Better Care. UpToDate; 2020. Available from: https://www.uptodate.com/home. [Last accessed on 2020 Aug 27].  Back to cited text no. 11
    
12.
Diseases & Conditions-Medscape Reference. Emedicine.medscape.com; 2020. Available from: https://emedicine.medscape.com. [Last accessed on 2020 Aug 27].  Back to cited text no. 12
    
13.
DynaMed. Evidence-Based Content. EBSCO. Dynamed.com; 2020. Available from: https://www.dynamed.com/home. [Last accessed on 2020 Aug 27].  Back to cited text no. 13
    
14.
CHEST SEEK Education. CHEST Publications-American College of Chest Physicians. Chestnet.org; 2020. Available from: https://www.chestnet.org/Publications/CHEST-Publications/CHEST-SEEK. [Last accessed on 2020 Aug 27].  Back to cited text no. 14
    
15.
Society of Critical Care Medicine. Self-Assessment: Adult. Society of Critical Care Medicine (SCCM); 2020. Available from: https://www.sccm.org/Education-Center/Critical-Care-Review-Adult/Self-Assessment-Adult. [Last accessed on 2020 Aug 27].  Back to cited text no. 15
    
16.
Haber LA, Lau CY, Sharpe BA, Arora VM, Farnan JM, Ranji SR. Effects of increased overnight supervision on resident education, decision‐making, and autonomy. J Hosp Med 2012;7:606-10.  Back to cited text no. 16
    
17.
Guo X, Wang J, Hu D, Wu L, Gu L, Wang Y, et al. Survey of COVID-19 disease among orthopaedic surgeons in Wuhan, People’s Republic of China. J Bone Joint Surg Am 2020;102:847-54.  Back to cited text no. 17
    
18.
Balasubramanian A, Paleri V, Bennett R, Paleri V. Impact of COVID‐19 on the mental health of surgeons and coping strategies. Head Neck 2020;42:1638-44.  Back to cited text no. 18
    


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Introduction
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