COVID-19 Protection for ENT Residents

COVID-19 Protection for ENT Residents
March 23, 2020 Center for Surgery and Public Health

Protection of Residents: Considerations in Otolaryngology-Head and Neck Surgery

Alice Z. Maxfield MD1,2, Regan W. Bergmark MD1,2,3,4, Kevin S. Emerick MD1,5, David S. Caradonna MD1,6, Stacey T. Gray MD1,5

1Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA, USA

2Division of Otolaryngology – Head and Neck Surgery, Brigham and Women’s Hospital, Boston, MA, USA

3Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA

4Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women’s Hospital, Boston, MA, USA

5Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA

6Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA

Otolaryngologists are at high risk of exposure of COVID-19 due to aerosol-generating procedures and our trainees are on the frontline of patient care. As we adjust the way that we deliver care and create policies, we need to be cognizant of how this affects our trainees and actively make these changes for their protection and safety. With the main goal of retaining the ability to provide urgent and emergent care, we have implemented several strategies in our training program to mitigate risk to our Otolaryngology residents and meet patient care needs. The first is social distancing within residents by creating separate teams to ensure that if there is exposure, only one team requires quarantine and to maintain minimal in-person contact. We have emphasized the need for minimizing the number of residents entering patient rooms and creating separate workspaces to minimize potential exposure. Consults are triaged by the residents and faculty to determine if there is absolute need, and limiting aerosol generating procedures, such as endoscopies, to cases that are absolutely necessary.  In our program, we also drastically limited residents in clinic as well as in the operating room, to further limit our trainees’ exposure. We recognize that social distancing strains the support system inherent to a residency program. We have turned to other platforms, such as virtual conference calls, to maintain connection and camaraderie. Most trainees want to be engaged and view this profession as a calling not just a job. We must create ways for residents to remain involved when they are not at the hospital and maintain engagement in the clinical mission. We must take active measures to restructure residency training in response to the pandemic, while continuing to provide excellent Otolaryngologic care to our patients and support to our trainees.  Communication amongst programs at the national level is key to disseminating creative solutions to this unprecedented situation.