The global health toll and disruptive effects of the COVID-19 pandemic have been staggering. Initial surges in the number of patients with COVID-19 threatened to overwhelm the capacities of emergency departments and intensive care units in many areas of the country, requiring rapid mobilization of limited resources including ventilators, personal protective equipment and health care workers.
In medical specialties with decreased clinical volume due to cancelled elective procedures and clinic visits, these extraordinary circumstances required some health care providers to step into new and unfamiliar clinical roles. In radiology departments across the country, technologists, nurses, residents, fellows and attendings were reassigned to areas of need within their hospital systems.
For many IR residents and fellows, this reassignment offered a daunting yet rewarding opportunity to contribute to the pandemic response. Although many of us had not worked in an emergency ward, medicine department or intensive care unit for several years, we relied on our training during medical school, internship and radiology rotations to provide value in our new roles. This article offers descriptions of several clinical redeployment roles IRs-in-training have performed during the COVID-19 pandemic.
Medicine floors
Thomas An, MD, chief resident at Massachusetts General Hospital in the IR/DR program
At Massachusetts General Hospital in Boston, the volume of COVID-19–positive patients began to increase rapidly in early March. Given the anticipated conversion of multiple floors into COVID-19 dedicated units, the medicine department reached out to all specialties in mid-March for residents and fellows to volunteer on COVID-19 surge teams on both medical wards and intensive care units. The radiology department was one of the first to respond to the request, with diagnostic and interventional radiology residents rotating on the COVID-19 wards beginning in late March. Our primary responsibilities on the wards were patient admissions, discharges and daily clinical management. The medicine department provided comprehensive training materials on COVID treatment protocols prior to reassignment and radiology trainees were supervised by a medicine attending while on the clinical team.
In total, the radiology department contributed to staffing on the COVID ward surge teams until mid-May, when the number of COVID-19–positive patients in the hospital started to decline from the peak. Ultimately, several radiology fellows and attendings volunteered on the wards as well. The radiology department at Massachusetts General Hospital has taken pride in being one of the first departments to answer the call to stand alongside our internal medicine colleagues against the initial surge in COVID-19 patient volume. The volunteers also appreciated the opportunity to interact with patients, refresh their knowledge of clinical internal medicine, and participate in multidisciplinary care with nurses, case managers and social workers.
ICUs and central line teams
Nicholas Voutsinas, MD, chief IR/DR resident at Mount Sinai Hospital in NYC.
At Mount Sinai Hospital in New York City, the IR department made a push to provide as much assistance to the health system as possible. As the COVID-19 pandemic began to escalate in New York City, our residency reached out to the ICUs to see if they needed assistance. Due to increased demand, many of our PGY2-4 IR/DR residents participated in ICU rotations during the initial surge of COVID-19 patients. Our residents demonstrated their value in the ICU by performing bedside procedures, interpreting portable chest radiographs in real time and doing bedside ultrasounds. In addition, they assisted in the throughput of the units by writing notes, calling consults, placing orders and discharging patients. Our IR/DR residents were excited to re-enter the clinical realm, as they missed patient contact during their diagnostic rotations. Our feedback from the ICU providers has proved that they are invaluable assets during this difficult era of medicine.
In addition to maintaining normal IR responsibilities such as interventional oncology cases, senior trainees were able to leverage their IR skills on a new dedicated line service for the ICU. IR residents and fellows worked closely with the vascular access team to place central lines, dialysis catheters and arterial lines on COVID-19–positive patients throughout the hospital to ease the clinical burden of other front-line providers.
Effects on IR interviews, match, ESIR year and Core Exam
Ahmed Farag, MD, PGY-4 ESIR resident at the University of Kentucky.
While COVID-19 wreaked havoc on hospital floors and the ICU rooms, it also altered the status quo for PGY-4 residents entering the match. Since most IR fellowship interviews occur during February through March, many in-person interview dates were postponed or rescheduled virtually. This severely disrupted the typical interview flow, with program directors and residents now relying on short Zoom interviews for crucial career decisions. As technical difficulties arose, program coordinators quickly became virtual IT professionals. Ultimately, the interview process was extended to April 30, 2020, and some residents in the country conducted over half of their interviews virtually.
The core exam for PGY-4 residents was also postponed from late May and early June 2020 to February 2021 and will transition to a virtual format. Many review courses were cancelled or postponed, thereby throwing most residents out of the typical study routine. This delay has also resulted in the additional challenge of navigating an Early Specialization in IR (ESIR) year while also studying for the Core Exam. Program directors were now tasked with the challenge of rearranging entire blocks of rotations to accommodate the changes.
Conclusion
Overall, the opportunity to contribute to the pandemic response when our colleagues in the emergency department, medical wards and intensive care units were stretched thin was both rewarding and heartening. Interdisciplinary collaboration took on a new meaning with trainees from interventional radiology, radiation oncology and others working alongside medicine residents in the face of a common challenge.
At the same time, balancing personal and professional obligations has been a challenge for many providers, especially those who are elderly, have pre-existing conditions or have vulnerable loved ones at home. In the uncharted territory of this pandemic, the risks of exposure are not insignificant and should be weighed carefully.
The COVID-19 pandemic continues to evolve, and it is hard to predict if or when we may be needed again. Even though we are subspecialists by training, the chance to care for patients during this time feels like a fulfillment of the oath that we took when we embarked on this path as physicians.
