key: cord-0825684-7p48f8xh
authors: Xiao, Nicholas; Gordon, Andrew C.; Thornburg, Bartley; Sato, Kent T.; Lewandowski, Robert J.
title: Impact of COVID-19 on IR Fellowship
date: 2020-07-02
journal: J Vasc Interv Radiol
DOI: 10.1016/j.jvir.2020.06.021
sha: 25a17cfe982f41f0816e20ec77fbb9d20a8f5d61
doc_id: 825684
cord_uid: 7p48f8xh

nan

The 2020 Coronavirus (COVID-19) pandemic has had an obvious global impact; this includes a major disruption in medical training. Across most medical specialties, including radiology, there have been significant reductions in case volumes [1] . Fellows and residents have been reallocated to "off-specialty" services to assist with COVID-19 patient care and in-person educational conferences have been canceled, possibly compounding the loss of experience.

In disciplines such as interventional radiology (IR), where the majority of clinical and technical training currently occurs in a single fellowship year, there are concerns regarding disruptions in training leading to deficiencies in competency. COVID-19 began affecting U.S. hospitals starting in the latter half of this academic year, a time when fellows are typically starting to perform cases autonomously as the primary operator -an important stage of training when they develop independence, aptitude and confidence in preparation for independent practice. Fellows have attested that reductions in volume in practices across the country has negatively impacted their employment, with some unable to find work while others are Figure 2C ). IR department total case volumes were decreased compared to previous years, and only a minority of responders reported minimal (0-10%) losses in volume ( Figure 2D ). In terms of education, more than half of respondents noted less in-house service, didactics, conferences and that all in-person educational events were switched to an online platform.

More concerning was that 2 (9%) PDs noted that their fellows would not be able to complete their fellowship on time, and an additional 2 (9%) responded that it is still unclear whether or not fellows will complete training at the conclusion of the academic year. Program directors responded that prior to COVID-19, they had no concerns regarding their fellows' ability to practice independently, however, after the recent disruptions in training, 4% responded that they were "somewhat" concerned, and an additional 4% were "moderately" concerned. When asked to self-assess their readiness to practice independently next year, fellows reported higher rates of concern compared to before COVID-19 ( Figure   3A ). Forty percent of program directors and 46% of fellows felt that recent disruptions in training have impeded trainees from "achieving their maximum potential" (Figure 3B ). Several PDs also responded that current fellows may have suffered reductions in skill compared to prior fellows due to COVID-19 related disruptions ( Figure 3C ). 13% of PDs felt that the current fellows will not graduate with the same skill set, or "breadth of cases that could be performed independently", compared to typical graduates from previous years. An even greater number of PDs (70%) noted that fellows would be less skilled at performing certain procedures, specifically citing elective and "complex" cases such as TIPS, interventional oncology, complex venous and hepatobiliary procedures, and UFE/PAE ( Figure 3D ). As IR departments add new junior faculty, these procedures may be key target areas where more senior staff can offer additional mentorship and guidance to their junior colleagues. Despite this, all surveyed PDs and fellows were confident that graduates would be competent IRs at the completion of fellowship.

In addition to educational losses, almost 30% of fellows responded that their employment for the upcoming year was negatively impacted by the pandemic. 19.6% reported deferred job start dates and 20% of fellows suffered reductions in compensation. Approximately 10% of fellows did not have a job offer at the time of the survey and an additional 10% did not have a signed job contract. Job hunting amidst the reductions in demand is increasingly challenging, and this data may provide important insight to incoming fellows starting their employment search.

The main limitation to these data is the survey nature of the study. Response biases may skew results towards those whom were most affected by the COVID-19 pandemic, while social desirability bias may result in under reporting of disruptions in training or exaggeration of expected case volumes.

In summary, this survey indicates that the COVID-19 pandemic has had a major negative impact on IR training and employment. As hospitals across the country begin to adapt to the post-COVID-19 world, methods to optimize training in ESIR and integrated IR-DR training pathways need to be determined in order to maintain the development of excellent IR physicians and in turn ensure a bright future for our specialty. 

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