Restructuring of a General Surgery Residency Program in an Epicenter of the Pandemic

A New York hospital's restructuring of general surgery resident teams and educational infrastructure in response to the COVID-19 pandemic is detailed in this article by Juprasert, et al. (2020), who explain that, "On March 1, 2020, the first case of coronavirus disease 2019 (COVID-19) was confirmed in New York, New York. Since then, the city has emerged as an epicenter for the ongoing pandemic in the U.S. To meet the anticipated demand caused by the predicted surge of patients with COVID-19, the Department of Surgery at New York-Presbyterian Hospital/Weill Cornell Medicine developed and executed an emergent restructuring of general surgery resident teams and educational infrastructure. The restructuring of surgical services described in this Special Communication details the methodology used to safely deploy the necessary amount of the resident workforce to support pandemic efforts while maintaining staffing for emergency surgical care, limiting unnecessary exposure of residents to infection risk, effectively placing residents in critical care units, and maintaining surgical education and board eligibility for the training program as a whole."

According to the authors, COVID-19 rapidly emerged as the nation’s epicenter with more than 366.000 (22% of the U.S.) confirmed cases and 29,000 (30% of the U.S.) deaths as of May 27, 2020. At the peak in mid-April, New York-Presbyterian Hospital/Weill Cornell Medicine (NYP-WC) was treating 474 patients who had tested positive for COVID-19, with 237 (50.0%) admitted to the intensive care unit (ICU) and 212 (44.7%) requiring mechanical ventilation.

As the authors note, "Owing to the exponential rise in critical care needs, NYC hospitals sought to quickly restructure existing systems to expand critical care capacities while limiting clinical care in nonessential areas. Plans to restructure surgery programs have been previously described,6-8 but the experience of a region as profoundly affected as NYC has yet to be reported. This restructuring had a particularly pronounced effect on surgery departments and training as elective cases were suspended. On March 16, 2020, in response to the US Centers for Disease Control and Prevention recommendations in consensus with multiple surgical societies such as the American College of Surgeons and an order from the New York State governor, NYP-WC announced that elective surgeries would be postponed. General surgery training in NYC was uniquely affected by decreased operative training opportunities lost during the 2019-2020 academic year. However, given the significant critical care training that general surgery residents routinely receive, these residents became poised to aid in the pandemic response primarily managing COVID-19 ICUs."

This article by Juprasert, et al. (2020) details the reassignment of general surgery residents and the restructuring of surgical services at NYP-WC, an 862-bed quaternary referral center in Manhattan, New York, with 8 categorical general surgery residents per class with 16 on dedicated research years. The researchers note, "The focus of our efforts was to safely deploy the necessary volume of the resident workforce to support pandemic efforts, while maintaining staffing for emergency surgical care, limiting unnecessary exposure of residents to infection risk, effectively placing residents in critical care units, and maintaining surgical education."

Reference: Juprasert JM, et al. Restructuring of a General Surgery Residency Program in an Epicenter of the Coronavirus Disease 2019 Pandemic: Lessons From New York City. JAMA Surg. July 7, 2020. doi:10.1001/jamasurg.2020.3107

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