551 - Effect of the COVID-19 Pandemic on Required Level of Supervision for Pediatric Fellows

Poster Number: 551
Publication Number: 551.325

Richard Mink, University of California, Los Angeles David Geffen School of Medicine, Torrance, CA, United States; Jennifer Rama, Texas Children's Hospital, Houston, TX, United States; Jay Mehta, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Scott H. James, University of Alabama at Birmingham, Birmingham, AL, United States; Christiane EL. Dammann, Tufts Childrens Hospital, Boston, MA, United States; Alan Schwartz, University of Illinois at Chicago, Chicago, IL, United States

Background: A vital component of medical education is providing care to patients. The COVID-19 pandemic reduced the number of pediatric patient encounters as hospitals mobilized resources to care for the high number of adults with COVID by canceling elective procedures, modifying educational activities, and reallocating hospital beds. Trainee supervision was also affected as faculty worked from home. The impact of the pandemic on the required level of supervision (LOS) for pediatric fellows is unknown.

Objective:

We hypothesized that pediatric fellows training during the pandemic would require more supervision compared with those who trained pre-pandemic.

Design/Methods:

Every 6 months starting in fall 2018 through spring 2022, Clinical Competency Committees (CCC) provided the LOS for the patient care EPAs for their subspecialty for each fellow using a 5-point scale (higher rating = less supervision). COVID-19 case load data were matched to the county in which the fellowship was located and averaged for the 5-month period before the CCC meeting. Pre-pandemic was defined as fall 2018 through fall 2019. Data were analyzed by fitting an ordinal mixed effects model with fixed effects of fellow year, covid cases/100k and covid deaths/100k.

Results:

Over the 8 rounds of data collection, there were 129,385 ratings from 2,459 fellows. Fellows were judged to need less supervision during the pandemic compared with pre-pandemic (p< 0.05). Higher COVID caseloads were related to less need for supervision (p< 0.05). Ratings were similar between 1^st year fellows who began fellowship pre-pandemic (n=774) versus those who began training during it (n=475; p >0.05). However, 3^rd year fellows who graduated during the pandemic (n=274) required less supervision compared with those who graduated before (n=448; p< 0.05). All subspecialties required less supervision during the pandemic but there were differences among them (p< 0.05). As caseload increased, adolescent medicine showed the greatest increase in LOS rating while hematology/oncology the lowest (p< 0.05; Figure).

Conclusion(s):

Pediatric fellows who trained during the COVID-19 pandemic required less, not more, supervision than those who trained before. Since LOS was related to COVID caseload and only 3^rd year fellows were affected, this finding was likely due to the pandemic. The reasons for this are unclear. Perhaps during the pandemic, fellows had more autonomy since faculty were working at home.  Subspecialty differences may be due to their specific training requirements. Further study is required since the lessons learned could lead to improved training in pediatric fellowships.