EDUCATION AND CLINICAL PRACTICE: ORIGINAL RESEARCH

Impact of COVID-19 on Pulmonary Critical Care Fellows In-Training Exam Performance: A National Study

Mahmoud Alwakeel, Paru Patrawalla, Brian Carlin, et al

Chest 2025; 168: 710-718

Abstract

Background

Between 2020 and 2022, the COVID-19 pandemic disrupted health and education. Many training institutions modified trainees’ rotations, decreasing outpatient clinics while increasing inpatient and ICU time. Understanding the pandemic’s impact on medical trainees’ cognitive performance is essential for informing strategies and supporting trainee well-being during crises.

Research Question

What was the impact of the COVID-19 pandemic on the performance of pulmonary and critical care medicine (PCCM) fellows on the in-training examination (ITE)?

Study Design and Methods

Retrospective study included all PCCM fellows in the United States who completed the PCCM-ITE between April 2015 and July 2022. Participants were divided into 3 cohorts: a pre-pandemic (PP) (ITE before March 1, 2020), first COVID-19 wave (CW) (March 1, 2020 to June 30, 2021), and second CW cohort (on or after July 1, 2021). We used a linear mixed-effect model to explore the relationship between the pandemic and ITE scores. We designated fellows by fellowship year (FY0 through FY3). A test taken within the first 3 months of fellowship training was designated FY0. A test taken within fellowship years 1-3 was designated F1-FY3.

Results

A total of 12,774 PCCM-ITE examination scores were evaluated for 8,391 individuals. During the first CW, least squares (LS) mean total scores for FY0 and FY1 were similar to those in the PP period. However, FY2 and FY3 demonstrated higher LS mean total scores, with differences of 2.0% (95% CI, 0.4%-3.5%; P = .02) and 2.9% (95% CI, 1.3%-4.6%; P = .001), respectively, compared with the PP period. LS mean pulmonary subsection scores were 5.3% (95% CI, 1.5%-9.1%; P = .01) higher for FY3 trainees during CW1, and no significant differences were observed for other trainee levels during the first CW or second CW. Critical care subsection scores were similar for FY1, FY2, and FY3 trainees across all periods. FY0 trainees had lower critical care scores during the first CW (–2.2%; 95% CI, –4.3% to –0.1%; P = .04) and second CW (–2.9%; 95% CI, –4.9% to –0.8%; P = .007), compared with PP.

Interpretation

In conclusion, our results indicate that pandemic impacts on cognitive performance were minimal, possibly buffered by enhanced self-study opportunities among trainees during CW1.