Effects of COVID-19 Pandemic on Pediatric Emergency Medicine Fellowship Training

Background: The COVID-19 pandemic brought shelter-in-place orders by public health organizations and eliminated large gatherings. Training programs abruptly stopped in-person learning to ensure the safety of medical trainees and redesigned curricula to use virtual platforms for didactic learning with variable success. Trainees had decreased patient contact time as pediatric emergency department (ED) patient volumes dropped, operative cases were canceled, clinic visits rescheduled, and use of telehealth visits became more prominent. Resident well-being became even more vital with social isolation and fears of infecting loved ones increased.

Our study evaluated the impacts of COVID-19 on pediatric emergency medicine (PEM) fellowship programs, including effects on fellows’ clinical, didactic, and research experiences, and effects on fellows’ health and well-being.

Methods: Two surveys were developed using an iterative process by the PEM Collaborative Scholarship Committee, 1 for program leadership (29 questions) and 1 for trainees (27 questions). Surveys were approved and distributed by the PEM-PD Survey Committee to program directors (PD) a total of 3 times in 2-week intervals. PDs were asked to forward the trainee survey to their fellows. Survey responses were anonymous. Survey questions met our study objectives and consisted of multiple choice, 5-point Likert scale, and free text responses. Surveys were completed online using Qualtrics software between March 17, 2021 and April 19, 2021.

Results: PDs had a 56.8% (50/88) response rate, fellows 34.6% (144/416). The majority of PD responses represented the Northeast US (n=18) followed by the Midwest (n=10). For trainees, responses mostly represented the Midwest (n=39) followed by the Northeast (n=38). Fifty-seven respondents self-identified as 1st year, 41 as 2nd years, 45 as 3rd years and 1 as 4th year fellows. All PDs reported a decrease in patient volumes during the height of the pandemic, estimating volumes decreased by 25-50% (n=17, 36%), 51-75% (n=20, 43%), or >75% (n=10, 21%). Most common responses included change in rotations and block schedules, didactics moving to a virtual platform, increased frequency of speakers from outside the institution, fellows being able to participate in COVID related research, and additional mental health services for providers (see Table 1). Reasons for changes to the rotation schedules included rotation cancelations, extra time in the pediatric ED, modifications to rotations, and pregnancy (see Figure 1). PDs and trainees report being required to provide service to COVID patients outside of a pediatric ED. Commonly cited locations included the adult ED and medical intensive care units (MICU).

Conclusion: COVID-19 had a clear impact on PEM fellowship training including decreases in pediatric patient volumes, canceled electives, increased care of adults, and altered didactics/conferences in accordance to CDC guidelines. The impact of these changes remains unclear. Future research might assess pandemic-related differences on in-training exam scores or how prepared fellows feel for unsupervised practice.