From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.
Department of Anesthesiology and Critical Care Medicine.
Anesth Analg. 2021 Mar 1;132(3):605-615. doi: 10.1213/ANE.0000000000005314.
The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis of unprecedented proportions that has altered the practice of medicine. The pandemic has required pain clinics to transition from in-person visits to telemedicine, postpone procedures, and cancel face-to-face educational sessions. There are no data on how fellowship programs have adapted.
A 17-question survey was developed covering topics including changes in education, clinical care, and psychological stress due to the COVID pandemic. The initial survey was hosted by Qualtrics Inc and disseminated by the Association of Pain Program Directors on April 10, 2020, to program directors at Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowships. Results are reported descriptively and stratified by COVID infection rate, which was calculated from Centers for Disease Control and Prevention data on state infections, and census data.
Among 107 surveys distributed, 70 (65%) programs responded. Twenty-nine programs were located in states in the upper tertile for per capita infection rates, 17 in the middle third, and 23 in the lowest tertile. Nearly all programs (93%) reported a decreased workload, with 11 (16%) reporting a dramatic decrease (only urgent or emergent cases). Just more than half of programs had either already deployed (14%) or credentialed (39%) fellows to provide nonpain care. Higher state infection rates were significantly associated with reduced clinical demand (Rs = 0.31, 95% confidence interval [CI], 0.08-0.51; P = .011) and redeployment of fellows to nonpain areas (Rs = 0.30, 95% CI, 0.07-0.50; P = .013). Larger program size but not infection rate was associated with increased perceived anxiety level of trainees.
We found a shift to online alternatives for clinical care and education, with correlations between per capita infection rates, and clinical care demands and redeployment, but not with overall trainee anxiety levels. It is likely that medicine in general, and pain medicine in particular, will change after COVID-19, with greater emphasis on telemedicine, virtual education, and greater national and international cooperation. Physicians should be prepared for these changes.
2019 年冠状病毒病（COVID-19）大流行是一场前所未有的公共卫生危机，改变了医学实践。大流行要求疼痛诊所从门诊转为远程医疗，推迟手术，并取消面对面的教育课程。关于研究员课程如何适应的，尚无数据。
制定了一份包含 17 个问题的调查问卷，涵盖了教育、临床护理以及因 COVID 大流行导致的心理压力等主题。该初始调查由 Qualtrics Inc 主办，并于 2020 年 4 月 10 日由疼痛项目主任协会（Association of Pain Program Directors）分发给经研究生医学教育认证委员会（Accreditation Council for Graduate Medical Education，ACGME）认证的研究员课程主任。结果以描述性方式报告，并按 COVID 感染率进行分层，该感染率是根据疾病控制与预防中心（Centers for Disease Control and Prevention）关于各州感染的数据和人口普查数据计算得出的。
在分发的 107 份调查中，有 70 个（65%）方案做出了回应。29 个方案位于人均感染率较高的州，17 个位于中等水平，23 个位于较低水平。几乎所有方案（93%）报告工作量减少，其中 11 个（16%）报告工作量急剧减少（仅处理紧急或紧急情况）。超过一半的方案已经（14%）或认证（39%）了研究员提供非疼痛护理。较高的州感染率与临床需求减少（Rs = 0.31，95%置信区间[CI]，0.08-0.51；P =.011）和研究员重新部署到非疼痛领域（Rs = 0.30，95%CI，0.07-0.50；P =.013）显著相关。较大的方案规模但不是感染率与受训者的焦虑水平增加有关。
我们发现临床护理和教育向在线替代方式转变，人均感染率与临床护理需求和重新部署之间存在相关性，但与总体受训者焦虑水平无关。一般来说，医学，特别是疼痛医学，可能会在 COVID-19 后发生变化，更加注重远程医疗、虚拟教育和更大的国家和国际合作。医生应该为此做好准备。
