Uncovering the Impact of COVID-19 on Pulmonary Critical Care Fellows: A National Study of In-Training Exam Performance
The impact of COVID-19 on pulmonary critical care fellows extends far beyond the bedside. Between 2020 and 2022, trainees faced a complete upheaval of their learning environment—rotations shifted, clinics shut down, and ICUs overflowed. As the pandemic redefined healthcare education, researchers sought to determine whether this chaos affected cognitive performance on critical assessments like the “in-training examination (ITE)”.
The Disrupted Training Landscape
During the pandemic, fellowship programs nationwide restructured clinical rotations, pulling trainees from outpatient clinics and pushing them into high-pressure ICU environments. This shift forced a reliance on independent study, diminished protected educational time, and brought emotional fatigue. These challenges prompted concern among educators about the long-term academic performance and well-being of fellows.
Research Objective: Measuring Educational Impact
This study aimed to assess the academic outcomes of pulmonary and critical care medicine (PCCM) fellows by analyzing their ITE performance across different stages of the pandemic. Using a retrospective national dataset, fellows were divided into three cohorts: pre-pandemic (PP), first COVID-19 wave (CW1), and second wave (CW2). The goal? To explore if pandemic-era disruptions truly hindered knowledge retention and exam readiness.
Methods: A National Retrospective Cohort Analysis
Researchers evaluated 12,774 ITE scores from 8,391 fellows between 2015 and 2022. Fellowship years were categorized from FY0 (early entry) to FY3 (final training year). A linear mixed-effect model allowed for the assessment of test performance across different training timelines, while controlling for pandemic conditions. This method ensured a fair comparison across education levels, accounting for variations in exposure and study time.
Key Findings: A Complex, Layered Outcome
Interestingly, results showed minimal decline in overall cognitive performance. In fact, FY2 and FY3 fellows during CW1 scored 2.0–2.9% higher than those in the pre-pandemic period, possibly due to enhanced self-study opportunities. However, FY0 fellows—those at the very start of their training—had lower scores in critical care subsections, suggesting they were disproportionately affected by the lack of structured education.
Pulmonary vs. Critical Care Performance
For the pulmonary section of the ITE, FY3 trainees during CW1 achieved scores 5.3% higher than the pre-pandemic group, reflecting perhaps the increase in real-time, hands-on pulmonary exposure during COVID-19 surges. However, no such improvements were seen in critical care performance, with FY0s performing significantly worse during both CW1 and CW2. This disparity hints at the uneven educational support among different fellowship levels.
Interpretation: A Mixed but Reassuring Picture
Ultimately, the impact of COVID-19 on pulmonary critical care fellows appears more nuanced than feared. While newer trainees struggled, senior fellows may have benefited from autonomy, deeper clinical involvement, and extra time for self-guided learning. These findings offer hope and guidance for medical educators designing training pathways amid future crises.