The impact of COVID-19 on vascular training

The global impact of COVID-19 has affected everyone, including healthcare providers caring for the surge in critically ill patients.^{1 , 2} Vascular interventionists have always been involved with direct patient care. The effect has been compounded for teaching physicians and vascular trainees.^{3 , 4} The rotations for many third- and fourth-year medical students have been suspended, often because of a shortage of medical supplies. New quarantine policies have limited surgeries to urgent and emergent cases.⁵ However, students could perform other medically related tasks such as triage or patient assessments to free up clinicians’ time or could possibly assist in some administrative tasks. Final semester students could help create surge capacity.⁶ Education conferences have been conducted virtually at the institutional and regional levels.

Virtual clinic visits have been used to reach out to desperate patients.7, 8, 9 Many institutions have been teaching their vascular fellows and residents about ventilators, respiratory therapy, intubations, and triaging patients. They can also perform many bedside procedures for critically ill patients such as placement of central intravenous catheters and temporary vascular access. The Society for Vascular Surgery recently published new regulations for vascular trainees, which includes accepting 44 weeks of clinical time, including any nonvoluntary time for the 2019-2020 academic year without preapproval, and a 10% decrease in the total number of reported cases. Nonvoluntary time off used for clinical or education purposes can be counted as clinical time. Trainees are learning about “check-ins” and “E-visits,” with the newly introduced Healthcare Common Procedure Coding System codes G2010 and G2012 and about remote patient monitoring services such as a patient's oxygen saturation levels using pulse oximetry (Current Procedural Terminology codes 99091, 99457-99458, 99473-99474, 99493-99494). Medicare physician supervision no longer requires direct physician supervision for outpatient or critical cases. However, team segregation policies to limit the risk of intercircle cross-contamination is extremely important, as is complying with the new Medicare telehealth update (ie, available at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes).

In conclusion, the COVID-19 pandemic has posed unprecedented challenges to our healthcare system. Although we are often restricted by the aspects of accreditation, the pandemic has opened the door for many potential areas of training. The main goal is to manage the surge, but maintain patient and provider safety.