An Enduring Disaster Response: COVID-19 and Pediatric Residency Program Educational Experiences

Background: The COVID-19 pandemic has impacted every facet of our medical system, including trainee education. To date, the extent of the pandemic’s impact on graduate medical education training has not been well-characterized. Pediatrics education may have been affected uniquely, given the lower burden of COVID-19+ disease, but potentially high impact of infection control measures. The goal of this project is to describe pediatric program directors’ experiences adapting their approach to resident education during the COVID-19 pandemic.

Methods: Semi-structured interviews were conducted with United States pediatric residency program directors and associate program directors (PDs). Purposive sampling was employed to ensure diversity in program location and size. Transcripts were independently reviewed and analyzed for emergent codes, with a finalized codebook independently applied to each interview by the authors to ensure consistency. The authors met monthly to discuss memos, interview summaries, and data sufficiency. Thematic inductive analysis was used to identify common themes among interviews.

Results: Seventeen interviews were transcribed and coded. Emergent themes included (1) Experiential learning changes, (2) Non-experiential learning changes, (3) Evaluation of changes, (4) Perceived resident reactions to changes, and (5) Future plans (Table 1). All residency PDs described drastic changes to experiential learning, including modification or suspension of some rotations, reorganization of resident schedules, and the integration of telehealth. Additionally, PDs described significant changes in patient volume, disease presentation, and acuity, and they were concerned about the short- and long-term impact on residents’ readiness for independent practice. Regarding non-experiential learning changes, conferences were quickly adapted to a virtual environment, open-source resources were utilized, and novel independent learning activities were created. Changes have been assessed using preexisting structures, which have revealed the acceptability of virtual learning but with waning attendance and engagement. PDs perceived the resident experience as sub-par, with many concerned about the impact of isolation on resident wellbeing and work-life balance. Finally, though most PDs plan to revert to their pre-pandemic curricula, they anticipate continuing both telehealth and hybrid virtual/in person non-experiential learning due to enhanced accessibility of these formats.

Conclusion: Despite heterogeneity in location and degree of COVID-19 case impact for the pediatric programs interviewed, all PDs detailed similar and extensive changes to both experiential and non-experiential learning opportunities. Most changes included adapting educational experiences to a virtual environment while continuing core experiential activities in a way that maintained social distancing and preserved the resident workforce. PDs perceived initial engagement in distance learning as enthusiastic but have noted a waning engagement and are concerned about the impact distance learning can have on resident wellbeing. Though many changes were perceived as sub-optimal, some new opportunities for learning were created. Further evaluation is needed to understand the impact of the described changes on pediatric residents’ educational experiences and preparedness for practice.