Increased Interest in Critical Care Among Anesthesia Residents During COVID-19 Pandemic

The COVID-19 pandemic created a unique crisis in healthcare across the world. Due to the shortage of staff to cover surge intensive care units in many hospitals, the Society of Critical Care Medicine, among other organizations, recommended a tiered approach to forming surge capacity teams for coverage of additional critical care beds1. These models seek to extend the expertise and oversight of intensivists, and other critical care professionals, to a greater number of patients via a multidisciplinary team. Among these teams we have seen a remarkable effort by anesthesia residents volunteering for ICU shifts. This was irrespective of their post graduate year and level of training, or even future plans for further critical care training. Of our pool of residents, several volunteered for these shifts eagerly and of their own accord. When asked as to what the motivations for this were, some interesting aspects were brought to light. Some did it to relieve the pressure on the Department to staff these units, which was stretched thin in terms of manpower. One resident stated:

“I was part of the second wave of residents deployed to the ICUs. My main motivation was to provide relief for my co-residents and share the burden. Many expressed how exhausting the ICUs were and I wanted them to have somewhat of a break from the toll COVID-19 was taking on the department.” 

Others had a sense of duty and a desire to learn new skills:

“COVID turned the world upside down and inside out. My willingness and motivation to work in the COVID ICUs reflects the spirit of the Hippocratic Oath; simply, it was the right thing to do. Patients arrived at the hospital in dire straits and in desperate need of help. No single provider should bear the responsibility of helping these patients and their families navigate the countless unknowns even when we may not have all the answers. From a training perspective, it was a rewarding and remarkable experience to practice a skill set under the guidance of experienced and knowledgeable intensivists. While we may be dealing with COVID for months and years to come, I am not sure if I will practice medicine with such extreme need for flexibility and creativity. If the need arises in the future, I feel better prepared to comfortably feel uncomfortable to use my knowledge and skills for a greater good.”

Whilst most found the challenge rewarding, the long hours and prolonged disease duration of the COVID patients made the work even more tiring, especially with the heavy PPE worn all day in most of these units.

“For me, volunteering to work in the COVID ICUs was a pretty simple decision to help out in whatever way I could. We as a department were doing so much less OR work and I felt that in the middle of a worldwide health crisis, it felt strange for me to be less busy than normal. We are lucky enough to have ICU care be part of our standard residency training which made working in the surge ICUs an easy and obvious way to contribute to the cause. The experience itself was a bit of a double edged sword. I enjoyed the camaraderie of working with people in unusual circumstances, surroundings of a disaster-type situation. However, the nature of the disease meant long intubation and ICU stays with sometimes very little changing from day to day, which was depressing and brought out my most pessimistic side. In a way, I just felt like a ventilator baby-sitter some days.”

Whatever the motivation may be, this trend of residents volunteering for ICU shifts during the pandemic shows an increasing interest in critical care training and the rewarding aspect of rising to challenges and making a difference in times of global crises. This may resound deeply with the core of why we sign up to become doctors and the professionalism and altruism that is inherently linked to this field. We hope that in an age that may require an increased number of critical care staff in the future to run units, this trend results in more residents applying for critical care fellowships, and we must be prepared to accommodate these trainees by broadening the job pools as well.

References
  1. Halpern NA and Tan KS for the Society of Critical Care Medicine. United States Resource Availability for COVID-19. Revision 3, May 12, 2020. Available online: https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19. Accessed Sept 10, 2020.

Author

Shahla Siddiqui, MBBS, MSc (Medical ethics)
Beth Israel Deaconess Medical Center
Boston, Massachusetts