S.K. Martin is associate professor, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-7431-4956 .
K.M. Finn is assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Acad Med. 2022 Nov 1;97(11):1683-1690. doi: 10.1097/ACM.0000000000004800. Epub 2022 Jul 5.
To quantify the extent to which internal medicine (IM) residents provided care for patients with COVID-19 and examine characteristics of residency programs with or without plans (at some point) to exclude residents from COVID-19 care during the first 6 months of the pandemic.
The authors used data from a nationally representative, annually recurring survey of U.S. IM program directors (PDs) to quantify early (March-August 2020) resident participation in COVID-19 care. The survey was fielded from August to December 2020. PDs reported whether they had planned to exclude residents from COVID-19 care (i.e., PTE status). PTE status was tested for association with program and COVID-19 temporal characteristics, resident schedule accommodations, and resident COVID-19 cases.
The response rate was 61.5% (264/429). Nearly half of PDs (45.4%, 118/260) reported their program had planned at some point to exclude residents from COVID-19 care. Northeastern U.S. programs represented a smaller percentage of PTE than non-PTE programs (26.3% vs 36.6%; P = .050). PTE programs represented a higher percentage of programs with later surges than non-PTE programs (33.0% vs 13.6%, P = .048). Median percentage of residents involved in COVID-19 care was 75.0 (interquartile range [IQR]: 22.5-100.0) for PTE programs, compared with 95.0 (IQR: 60.0-100.0) for non-PTE programs ( P < .001). Residents participated most in intensive care units (87.6%, 227/259) and inpatient wards (80.8%, 210/260). Accommodations did not differ by PTE status. PTE programs reported fewer resident COVID-19 cases than non-PTE programs (median percentage = 2.7 [IQR: 0.0-8.6] vs 5.1 [IQR: 1.6-10.7]; P = .011).
IM programs varied widely in their reported plans to exclude residents from COVID-19 care during the early pandemic. A high percentage of residents provided COVID-19 care, even in PTE programs. Thus, the pandemic highlighted the tension as to whether residents are learners or employees.
量化内科住院医师在 COVID-19 患者护理方面的参与程度，并研究在大流行的前 6 个月内，有无计划（在某些时候）将住院医师排除在 COVID-19 护理之外的住院医师计划的特征。
作者使用了一项针对美国内科住院医师项目主任（PD）的全国代表性年度调查数据，来量化早期（2020 年 3 月至 8 月）住院医师参与 COVID-19 护理的程度。调查于 2020 年 8 月至 12 月进行。PD 报告他们是否计划将住院医师排除在 COVID-19 护理之外（即 PTE 状态）。测试 PTE 状态与项目和 COVID-19 时间特征、住院医师日程安排调整和住院医师 COVID-19 病例之间的关联。
回复率为 61.5%（264/429）。近一半的 PD（45.4%，118/260）报告他们的计划在某个时候将住院医师排除在 COVID-19 护理之外。与非 PTE 项目相比，美国东北部的项目中 PTE 项目的比例较小（26.3%对 36.6%；P =.050）。PTE 项目代表具有更高比例的项目出现后期激增，而非 PTE 项目（33.0%对 13.6%，P =.048）。PTE 项目的住院医师参与 COVID-19 护理的中位数百分比为 75.0%（四分位距 [IQR]：22.5-100.0），而非 PTE 项目为 95.0%（IQR：60.0-100.0）（P <.001）。住院医师主要参与重症监护病房（87.6%，227/259）和住院病房（80.8%，210/260）。住宿条件不因 PTE 状态而有所不同。与非 PTE 项目相比，PTE 项目报告的住院医师 COVID-19 病例较少（中位数百分比=2.7 [IQR：0.0-8.6]对 5.1 [IQR：1.6-10.7]；P =.011）。
内科住院医师计划在大流行早期报告的将住院医师排除在 COVID-19 护理之外的计划差异很大。尽管在 PTE 项目中，仍有很高比例的住院医师提供 COVID-19 护理。因此，大流行凸显了住院医师是学习者还是员工的矛盾。
