The 2020 pandemic of coronavirus disease 2019 (COVID-19) has presented significant challenges to the health care workforce.1,2 As New York City and its environs became the epicenter of the pandemic in the United States, we continued to care for our patients while simultaneously maintaining the education and well-being of our residents.3 Keeping this balance significantly strained resources and presented new challenges for education and service in residency education. What first emerged as an acute emergency has become a chronic disruption in the clinical learning environment. Programs are working to respond to the critical patient needs while ensuring continued progress toward training goals.
Since pregnancy is one condition for which healthy patients continued to require both outpatient visits and inpatient hospitalization, volume was not anticipated to be significantly decreased on our units. Thus, our ObGyn residency programs sought to expeditiously restructure our workforce and educational methods to address the demands of the pandemic. We were aided in our efforts by the Accreditation Council for Graduate Medical Education (ACGME) Extraordinary Circumstances policy. Our institutions were deemed to be functioning at Stage 3 Pandemic Emergency Status, a state in which “the increase in volume and/or severity of illness creates an extraordinary circumstance where routine care, education, and delivery must be reconfigured to focus only on patient care.”4
As of May 18, 2020, 26% of residency and fellowship programs in the United States were under Stage 3 COVID-19 Pandemic Emergency Status.5 Accordingly, our patient care delivery and educational processes were reconfigured within the context of Stage 3 Status, governed by the overriding principles of ensuring appropriate resources and training, adhering to work hour limits, providing adequate supervision, and credentialing fellows to function in our core specialty.
As ObGyn education leaders from 5 academic medical centers within the COVID-19 epicenter, we present a summary of best practices, based on our experiences, for each of the 4 categories of Stage 3 Status outlined by the ACGME. In an era of globalization, we must learn from pandemics, a call made after the Ebola outbreak in 2015.6 We recognize that this type of disruption could happen again with a possible second wave of COVID-19 or another emerging disease.7 Thus, we emphasize “lessons learned” that are applicable to a wide range of residency training programs facing various clinical crises.
Ensuring adequate resources and training
Within the context of Stage 3 Status, residency programs have the flexibility to increase residents’ availability in the clinical care setting. However, programs must ensure the safety of both patients and residents.
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