Training non-intensivist doctors to work with COVID-19 patients in intensive care units

Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations

INTRODUCTION

Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic.

METHODS

The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period.

RESULTS

Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives.

DISCUSSION

This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.

Education and Training Adaptations for Health Workers during the COVID-19 Pandemic: A Scoping Review of Lessons Learned and Innovations

Introduction: The COVID-19 pandemic has considerably impacted the clinical education and training of health workers globally, causing severe disruptions to learning environments in healthcare facilities and limiting the acquisition of new clinical skills. Consequently, urgent adaptation measures, including simulation training and e-learning, have been implemented to mitigate the adverse effects of clinical education. This scoping review aims to assess the impact of COVID-19 on medical education and training, examine the implemented adaptation measures, and evaluate their effectiveness in improving health workers' education and training during the pandemic. Methods: Employing the PRISMA-ScR framework and Arksey and O'Malley's methodological guidance, we conducted a scoping review, systematically searching PubMed, medRxiv, Google, and DuckDuckGo databases to account for the grey literature. The search included studies published between 1 December 2019 and 13 October 2021, yielding 10,323 results. Of these, 88 studies focused on health worker education and training during the pandemic. Results: Our review incorporated 31,268 participants, including physicians, medical trainees, nurses, paramedics, students, and health educators. Most studies (71/88, 81%) were conducted in high-income and lower-middle-income countries. The pandemic's effects on health workers' clinical skills and abilities have necessitated training period extensions in some cases. We identified several positive outcomes from the implementation of simulation training and e-learning as adaptation strategies, such as enhanced technical and clinical performance, increased confidence and comfort, and an expanded global educational outreach. Conclusions: Despite challenges like insufficient practical experience, limited interpersonal interaction opportunities, and internet connectivity issues, simulation training, e-learning, and virtual training have proven effective in improving clinical education and training during the COVID-19 pandemic. Further research is required to bolster preparedness for future pandemics or similar situations.

Addressing Mental Health Needs Among Frontline Health Care Workers During the COVID-19 Pandemic

Frontline workers experienced inordinate stress levels during the COVID-19 pandemic, as historically high volume and acuity in our hospitals was accompanied by concerns about our safety. We suggest that supporting frontline workers is an essential part of the pandemic response plan. We propose strategies to address the emotional and mental health (MH) needs of frontline health care workers during and after a pandemic that integrates knowledge from the disaster MH literature with the lessons learned during the COVID-19 pandemic. The disaster MH literature emphasizes distinguishing development of defined psychiatric disorders from emotional distress representing normative responses to disaster trauma and stress. Differentiating psychopathology from distress requires diagnostic assessment by a trained clinician. Where shortages of psychiatrists exist, primary care physicians may be trained to assist with disaster-related psychiatric assessment and initiation of treatment for psychopathologic features. The first component of a pandemic MH plan for critical frontline workers is to distinguish psychiatric illness from normative distress and to provide adequate treatment of psychopathologic symptoms. A second component of the comprehensive pandemic MH response is the provision of supportive care interventions and resources for normative distress. These interventions may include psychological first aid, individual or group counseling, broadening the pool of frontline workers, and buddy systems. Although these interventions were unknown or difficult to put in place at the beginning of the COVID-19 pandemic, we now have an opportunity to implement postpandemic MH response plans and to create response planning for subsequent COVID-19 surges integrating MH care into the front lines.

Health worker education during the COVID-19 pandemic: global disruption, responses and lessons for the future-a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis identified early evidence quantifying the disruption to the education of health workers by the COVID-19 pandemic, ensuing policy responses and their outcomes.

METHODS

Following a pre-registered protocol and PRISMA/AMSTAR-2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random-effects meta-analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end-year. We assessed risk of bias (Newcastle-Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE.

RESULTS

Of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1% (95% confidence interval 67.9-74.2) and learner redeployment at 29.2% (25.3-33.2). About one in three learners screened positive for anxiety (32.3%, 28.5-36.2), depression (32.0%, 27.9-36.2), burnout (38.8%, 33.4-44.3) or insomnia (30.9%, 20.8-41.9). Policy responses included shifting to online learning, innovations in assessment, COVID-19-specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two-thirds of learners (75.9%, 74.2-77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8%, 66.7-76.7). Learners preferred an in-person component: blended learning 56.0% (51.2-60.7), face-to-face 48.8% (45.4-52.1), and online-only 32.0% (29.3-34.8). They supported continuation of the virtual format as part of a blended system (68.1%, 64.6-71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence.

CONCLUSION

The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.

The impact of a "short-term" basic intensive care training program on the knowledge of nonintensivist doctors during the COVID-19 pandemic: An experience from a population-dense low- and middle-income country

BACKGROUND

The utility of basic intensive care unit (ICU) training comprising a "1-day course" has been scientifically evaluated and reported in very few studies, with almost no such study from resource-limited settings.

AIM

The study assessed the utility of basic ICU training comprising of a "1-day course" in increasing the knowledge of nonintensivist doctors.

MATERIALS AND METHODS

This is an observational study conducted at a medical university in North India in 2020. The participants were nonintensivist doctors attending the course. The course was designed by intensivists, and it had four domains. The participants were categorised on the basis of their duration of ICU experience and broad speciality. Pretest and posttest was administered, which was analysed to ascertain the gain in the knowledge score.

RESULTS

A total of 252 participants were included, of which the majority were from the clinical medicine speciality (85.3%) and had ICU experience of 1-6 months (47.6%). There was a significant improvement in the mean total score of the participants after training from 14/25 to 19/25, with a mean difference (MD) of 5.02 (p < 0.001). Based on ICU experience, in groups I (<1 month), II (1-6 months), and III (>6 months), there was a significant improvement in the total score of the participants after training with MD with 95% confidence interval (CI) limits of 5.27 (4.65-5.90), 4.70 (4.38-5.02), and 5.33 (4.89-5.78), respectively. In the clinical surgery specialty (n = 37), there was a significant improvement in the total score after training from 11/25 to 16.4/25 with an MD (95% CI limits) of 5.38 (4.4-6.3). Similarly, in the clinical medicine group (n = 215), the MD (95% CI limits) score after training was 4.95 (4.71-5.20), from 14.5/25 to 19.5/25. In feedback, more than half of the participants showed interest in joining ICU after training.

CONCLUSIONS

Training nonintensivist doctors for 1 day can be useful in improving their knowledge, regardless of their prior ICU experience and speciality.

A perspective of massive open online courses (MOOCs) and public health

Massive open online courses (MOOCs) have emerged as an innovative educational technology relevant to and affecting higher education, professional development, and lifelong learning. This paper introduces the principles of MOOCs and reviews the development of these platforms over time. We reflect upon the considerable investment by institutions to develop, deliver and promote such courses, particularly in public health. While open to interpretation, the inherent power, influence, and effectiveness of MOOCs is unquestionable. The potential contribution of MOOCs to public health education is immense, with almost universal reach and access. However, apart from research into participant engagement and knowledge, MOOC-related research and evaluation continue to lag with the rapid proliferation of these courses in response to emerging challenges, as seen with the Coronavirus Disease 19 (COVID-19) pandemic. This makes analyzing the contribution of MOOCs to public health education, health promotion and community programs challenging. This perspective article provides a robust rationale for the necessity of MOOCs and their utility in upskilling health professionals and the general public. It builds on current knowledge to comprehensively explore the factors influencing the development, and application of MOOCs.

Preparedness and management during the first phase of the COVID-19 outbreak - a survey among emergency primary care services in Norway

Background

The emergency primary care (EPC) services in Norway have been at the frontline of the COVID-19 pandemic. Knowledge about the EPC services’ management of the COVID-19 outbreak can be used to prepare for future outbreaks and improve patient management. The objectives of this study were to identify pandemic preparedness and management strategies in EPC centres in Norway during the COVID-19 outbreak.

Methods

Questions regarding patient management of the COVID-19 outbreak were included in data collection for the National Out-Of-Hours Services Registry. The data collection was web-based, and an invitation was sent by email to the managers of all EPC services in Norway in June 2020. The EPC services were asked questions about pre-pandemic preparedness, access to personal protective equipment (PPE), organizational measures taken, and how staffing was organized during the onset of the pandemic.

Results

There were 169 municipal and inter-municipal EPC services in Norway in 2020, and all responded to the questionnaire. Among the EPC services, 66.7% (n = 112) had a pandemic plan, but only 4.2% had performed training for pandemic preparedness. Further, fewer than half of the EPC centres (47.5%) had access to supplies of PPE, and 92.8% answered that they needed extra supplies of PPE. 75.3% of the EPC services established one or more respiratory clinics. Staffing with other personnel than usual was done in 44.6% (n = 74) of the EPC services. All EPC services except one implemented new strategies for assessing patients, while about half of the wards implemented new strategies for responding to emergency calls.

None of the largest EPC services experienced that their pandemic plan was adequate, while 13.3% of the medium-sized EPC services and 48.9% of the small EPC services reported having an adequate pandemic plan.

Conclusions

Even though the EPC services lacked well-tested plans and had insufficient supplies of PPE at the outbreak of the COVID-19 pandemic, most services adapted to the pandemic by altering the ways they worked and by hiring health care professionals from other disciplines. These observations may help decision makers plan for future pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08284-9.

Feasibility Study of a Fully Synchronous Virtual Critical Care Elective Focused on Learner Engagement

Background: The COVID-19 pandemic disrupted clinical education for medical students. With the rise of variants, meaningful in-person clinical experiences remain threatened. This report describes the design, implementation, and evaluation of a fully synchronous virtual critical care elective for medical students focused on learner engagement.

Methods: The two-week elective was offered during June and July 2020 in the COVID-19 extracorporeal membrane oxygenation (ECMO) unit. Medical students remotely participated in multidisciplinary rounds with the attending physician connected from the bedside via a head-mounted camera providing the first-person video view. Other team members connected outside the negative pressure area. Learners electronically completed daily intensive care unit (ICU) goals sheet (GS) for each patient. The daily completion percentage of the GS assessed the learner engagement, and the learners evaluated the experience with a five-point Likert scale survey.

Results: Nine medical students participated in two separate cohorts. Cohort A had 53 patient encounters, and Cohort B had 45 patient encounters totaling 301.5 total hours of supervised virtual patient interaction. The mean completion percentage of the daily ICU GS for the combined cohorts was 77.8%, (with a standard deviation of 9.6%), with sustained or increased completion from start to finish for all learners. All medical students agreed that the daily ICU GS was helpful for following rounds, organizing patient assessments and plans, and participating in patient care. The majority (88.9%) agreed that the elective increased their comfort in caring for critically ill patients.

Conclusions: During the COVID-19 pandemic, a fully synchronous virtual critical care elective successfully utilized the first-person view and daily ICU GS to promote and assess learner engagement.

Pulmonologists’ work and clinical life during the COVID-19 pandemic: a society-led survey

The continuous and ongoing coronavirus disease 2019 (COVID-19) pandemic has highly affected pulmonologists and pulmonology residents worldwide. To identify where additional work and resources must be focused, it is important to explore on what parameters the pulmonologists and residents are challenged. We present the results of a society-led survey on pulmonologists’ and pulmonology residents’ work and clinical life during the pandemic.

A total of 579 pulmonologists and pulmonology residents completed the survey (5.9% of the European Respiratory Society's physician members) and most respondents answered that they have had sufficient training on how to handle patients with COVID-19 (e.g. how to handle patients to prevent virus spread). However, more than a third of the respondents (n=210, 36.3%) had performed procedures they did not feel competent in due to the pandemic and, for example, relocation to COVID-19 units.

We must strive for investment in research on medical education and potentially simulation-based training in technical procedures to ensure competence and decrease the insecurity about new procedures, especially in the setting of worldwide pandemics or acute critical situations.

Pulmonologists and pulmonology residents are highly affected by the COVID-19 pandemic. More than a third have performed procedures they did not feel competent in. Investment in medical education research is necessary to counter future crises and pandemics.https://bit.ly/3tiOVh0

Prediction of SARS-CoV-2-Related Lung Inflammation Spreading by V:ERITAS (Vanvitelli Early Recognition of Inflamed Thoracic Areas Spreading)

Background Coronavirus disease 2019 (COVID-19) can be complicated by interstitial pneumonia, possibly leading to severe acute respiratory failure and death. Because of variable evolution ranging from asymptomatic cases to the need for invasive ventilation, COVID-19 outcomes cannot be precisely predicted on admission. The aim of this study was to provide a simple tool able to predict the outcome of COVID-19 pneumonia on admission to a low-intensity ward in order to better plan management strategies for these patients. Methods The clinical records of 123 eligible patients were reviewed. The following variables were analyzed on admission: chest computed tomography severity score (CTSS), PaO2/FiO2 ratio, lactate dehydrogenase (LDH), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio, C-reactive protein (CRP), fibrinogen, D-dimer, aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, and albumin. The main outcome was the intensity of respiratory support (RS). To simplify the statistical analysis, patients were split into two main groups: those requiring no or low/moderate oxygen support (group 1); and those needing subintensive/intensive RS up to mechanical ventilation (group 2). Results The RS intensity was significantly associated with higher CTSS and NLR scores; lower PaO2/FiO2 ratios; and higher serum levels of LDH, CRP, D-dimer, and AST. After multivariate logistic regression and ROC curve analysis, CTSS and LDH were shown to be the best predictors of respiratory function worsening. Conclusions Two easy-to-obtain parameters (CTSS and LDH) were able to reliably predict a worse evolution of COVID-19 pneumonia with values of >7 and >328 U/L, respectively.

The COVID-19 Patient in the Surgical Intensive Care Unit

COVID-19 continues to rampage around the world. Noncritical care-trained physicians may be deployed into the intensive care unit to manage these complex patients. Although COVID-19 is primarily a respiratory disease, it is also associated with significant pathology in the brain, heart, vasculature, lungs, gastrointestinal tract, and kidneys. This article provides an overview of COVID-19 using an organ-based, systematic approach.

A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries

Background

We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID‐19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden.

Methods

Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID‐19 disease during the first wave of COVID‐19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics.

Results

Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS‐CoV‐2, the ratio of requiring ICU admission for COVID‐19 varied substantially (1.6%–6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID‐19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%–85%) in all countries, the proportion of patients receiving renal replacement therapy (7%–26%) and various experimental therapies for COVID‐19 disease varied substantially (e.g. use of hydroxychloroquine 0%–85%). Crude ICU mortality ranged from 11% to 33%.

Conclusion

There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID‐19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention.

Who Cares What the Doctor Feels: The Responsibility of Health Politics for Burnout in the Pandemic

Modern health has become a defining facet of contemporary life managed by health policy. The COVID-19 pandemic has significantly affected mental health, resulting in stress and anxiety in doctors’ professional and private life. Since the beginning of the pandemic, doctors have been facing chronic stress, which was reported to the hospital managers and health-care agencies, but nothing was done in the practice to protect them. Although doctors are trained to stay emotionally restrained, a large number of patients in intensive care, along with the personal concerns for their families, has led to burnout. This article highlights the need for health politics to take responsibility for dealing with burnout in health-care workers with a new approach that should help doctors recognize, understand, and manage work-related stress with additional support in the pandemic.