Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minneapolis.
Department of Orthopaedic Surgery, Carolinas Medical Center-Atrium Health, Charlotte, North Carolina.
J Bone Joint Surg Am. 2021 Aug 18;103(16):e65. doi: 10.2106/JBJS.20.01948.
The COVID-19 crisis has challenged the U.S. health-care system in a variety of ways, including how we teach and train orthopaedic surgery residents and fellows. During the spring of 2020, the cessation of all elective surgical procedures and the diminished number of outpatient visits challenged graduate medical education. While residency programs in less affected areas may not have had to make many dramatic adjustments, some of those located in pandemic hotspots had to redirect trainees from orthopaedic rotations to COVID-19 units. No matter the region, the time that trainees have spent in rotations has been altered, and absences have occurred due to quarantines. This symposium summarizes the impact of restrictions related to the COVID-19 pandemic on residency and fellowship programs from the perspectives of the Accreditation Council for Graduate Medical Education (ACGME), a program director, and a graduating resident. Although new opportunities for virtual curricula, virtual surgical simulation, and virtual interviews have been innovated, residency programs and residents report primarily a negative effect from the pandemic due to decreased surgical volumes and the limitation of patient-care experiences. Ultimately, program directors have an obligation to the program, the trainee, and the general public to graduate only those residents and fellows who are truly prepared to practice independently; they have the responsibility of making the final decision regarding graduation. The COVID-19 pandemic has continued to underscore the need for competency-based medical education. Assessing competency includes evaluation of the knowledge, the operative skills, the nonoperative patient-care skills, and the professional behavior of each and every individual graduating from orthopaedic residency and fellowship training programs. A hybrid model for time and competency-based training, with established national standards not only for accreditation for our training programs but also for board certification of our graduating residents, was enhanced by the COVID-19 pandemic and is highlighted in this symposium.
新冠疫情以多种方式挑战了美国的医疗体系，包括我们教授和培训骨科住院医师和研究员的方式。2020 年春季，所有择期手术的停止和减少的门诊就诊量挑战了住院医师规范化培训。虽然受影响较小地区的住院医师规范化培训项目可能不必进行许多重大调整，但那些位于疫情热点地区的项目必须将受训者从骨科轮转调整到新冠病房。无论在哪个地区，受训者在轮转中的时间都已经改变，并且由于隔离而出现缺勤。本次研讨会从住院医师规范化培训与专科医师培训委员会（ACGME）、一名项目主任和一名即将毕业的住院医师的角度总结了与新冠疫情相关的限制对住院医师规范化培训和专科医师培训项目的影响。尽管已经创新了虚拟课程、虚拟手术模拟和虚拟面试的新机会，但住院医师规范化培训项目和住院医师报告主要受到手术量减少和患者护理经验受限的负面影响。最终，项目主任有义务对项目、受训者和公众负责，只让那些真正准备好独立行医的住院医师和专科医师毕业；他们有责任对毕业做出最终决定。新冠疫情继续强调了以能力为基础的医学教育的必要性。评估能力包括评估每个从骨科住院医师规范化培训和专科医师培训项目毕业的人的知识、手术技能、非手术患者护理技能和专业行为。时间和能力为基础的培训混合模式，以及为我们的培训项目建立的不仅是认证的国家标准，还有我们即将毕业的住院医师的委员会认证，在新冠疫情期间得到了加强，并在本次研讨会上得到了强调。
