Be flexible, adapt, and overcome. This has certainly been a mantra to embrace throughout 2020. The ability to navigate the challenges presented by the novel coronavirus pandemic will determine the success or failure of many businesses, organizations, and programs throughout the nation. The world of anesthesia is no exception, and to see how people are facing these challenges we sat down with members of the University of Iowa Anesthesia Nursing program to get a firsthand account of what it’s like to run a program in the midst of a worldwide pandemic.
Since its inception in 1994, the UI Anesthesia Nursing program has never faced a challenge like it’s facing today. “No, I’ve talked to program directors who have been at this for twenty to thirty years and we’ve never had to respond to anything like this,” said program director Dr. Cormac O’Sullivan. Iowa City, located in Johnson County, is the home to the University of Iowa program and was one of the first locations in Iowa where a COVID-19 case was identified. The University of Iowa Hospitals and Clinics also quickly became one of the few facilities in the state early on to treat severely ill patients with COVID-19. This required that the program immediately respond to the potential impact this would have on students. For Dr. O’Sullivan, student safety was the number one priority, and they worked to ensure all students had appropriate PPE. Program faculty were quickly in contact with clinical sites throughout the state where students gain anesthesia experiences outside of the university setting. “Were the students going to be welcomed back, and if so, do they have adequate PPE?” questioned Dr. Michael Anderson, clinical coordinator for the program. “The vast majority of the clinical sites considered students essential personnel, and they were able to provide care safely.”
However, as statewide coronavirus cases began to rise, restrictions were put into place that had the potential to drastically affect student experiences. For a period of roughly one month extending from the end of March through April, non-urgent and elective procedures were banned throughout the state. “Many students were doing only 1-2 cases per day for around three weeks when [the outbreak] first began,” says O’Sullivan. On April 24th, Iowa Governor Kim Reynolds allowed facilities to resume elective cases. “Then we went up to about 40-50% capacity in the two months or so following.” In other anesthesia programs this might have seriously put student experiences into jeopardy. Students are required to obtain a minimum of 2000 hours of clinical experience and perform 600 cases to sit for the national board certification exam for nurse anesthetists. Graduates from the University of Iowa often have double the required experiences by the time they finish the program. “Students always graduate with a wealth of experience. When COVID hit and our OR numbers dropped students weren’t at risk of not getting numbers. All senior students had already met their requirements before cases were being cancelled,” reported Dr. O’Sullivan.
While the faculty and clinical instructors worked to ensure students were receiving adequate case experiences and had appropriate PPE in the operating room, there were classroom issues on-campus as well that needed to be addressed. In late March the University of Iowa announced that it was suspending all in-person learning for the remainder of the school year. Additionally, state and local mandates required that meetings could only be held with 10 or fewer people in a room. For first-year students who were still in the didactic phase of their education and for students who would be entering the program in May, this meant the program needed to get creative and develop work-arounds for several classes that were normally held in-person. One such class was the gross anatomy lab which takes place in the first semester of the program. Normally this would involve in-person cadaver dissection and examination for the entire class. However, with new mandates in place, dissections had to be recorded and made available online while each student was given an opportunity to participate in live dissection on a limited basis. Interestingly, Dr. O’Sullivan noted, students preferred this option as it allowed them to review the material as often as they preferred instead of the single opportunity they would have otherwise had if they had performed live dissections.
One advantage for the University of Iowa program is that several of the required DNP classes have been administered online for several years. So when the time came to make the switch from in-person to online, the program was already in a good position, according to Dr. O’Sullivan. “We were teed up to go online pretty easily. This wasn’t the case in other programs.” Many of the equipment classes and OR simulations that students perform throughout their education also had to be reformatted. Associate program director Dr. Heather Bair needed to orient students who were beginning OR experiences in May and ensure students were familiar with the plethora of equipment that is essential to providing safe anesthesia. Information that normally could have been covered in a single class with all students present now took hours to complete with only 1 or 2 students physically present at a time. “Skilled workshops were definitely a challenge,” commented Dr. O’Sullivan. “We were trying to get away from strict lecture content and provide more hands-on, simulation, and work-through problem solving. This had to revert back to lecture format while figuring out how to do these sorts of things online.” Eventually, Dr. Bair began developing online simulations that could be performed over Zoom while still holding in-person simulations with as few students as possible to maintain appropriate social distancing.
Even with all the adjustments and accommodations, the additional stresses put on the students are not being forgotten. Interviews with student candidates had to be performed online for the first time ever with some having never stepped foot on the University of Iowa campus. For students entering the program the first few months can be very difficult and the relationships and bonds created with other members of their cohort are invaluable and last well beyond the day they graduate. Now the majority of the interactions between these students are occurring remotely, and those relationships are developing in vastly different ways. Many of the events that recognize the achievements students have made had to be altered as well. Defenses of DNP projects, which take months to develop and implement, were done online. Students missed out on the AANA Annual Congress, and the graduation ceremony had to be cancelled. “This program is hard. It’s difficult,” lamented Dr. O’Sullivan. “You eat, sleep, and breathe anesthesia. You’re taken away from your family for 3 years, and at the end, they get to see you walk across that stage and receive that degree.”
And while there are still many uncertainties on the horizon, hope still springs eternal. When examining how students have responded to the challenges COVID has presented, Dr. Anderson remained optimistic. “Students are resilient. Our students always answer the bell. They really embraced it and I think that reflects the quality of the students that we have.” As winter approaches and the looming threat of increasing COVID numbers nears, those within the program are prepared. “We have to remain smart and make good decisions,” said Dr. Anderson. “Our only goal is to produce remarkable CRNAs,” said Dr. O’Sullivan. “And if it takes a little work on our part to do that, we’re going to do it.”
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