The SARS-CoV-2 pandemic continues to disrupt the normal operations of interventional pulmonology fellowship programs across the nation.

Fellows have had their educational experience altered by mandated procedural prioritization, staff isolation and quarantine, and fellow and faculty reassignments away from the practice. There is no end in sight to the fluidity created by COVID-19.

As a result, the American Association for Bronchology and Interventional Pulmonology (AABIP) and the Association of Interventional Pulmonology Program Directors (AIPPD) together have endorsed a “rational” and multistage approach to graduate medical education during this crisis published by the Accreditation Council for Graduate Medical Education (ACGME).

The endorsement was offered by way of the Joint Interventional Pulmonology Fellowship Accreditation Committee “with the firm belief that a uniform approach by both ACGME-accredited and non-ACGME-accredited training programs is crucial at this time.”

AABIP and AIPPD added four additional key points.

“Significant numbers of patients are arriving or being transferred to teaching hospitals,” ACGME’s website says. “These circumstances, and their continued evolution, require a new conceptual framework from which graduate medical education (GME) can effectively operate during the pandemic.”

ACGME’s framework consists of three stages that all participating sites will function within:

• Stage 1: “Business as usual”
• Stage 2: Increased but manageable clinical demand
• Stage 3: Crossing a threshold beyond which the increase in volume and/or severity of illness creates an extraordinary circumstance where routine care education and delivery must be reconfigured to focus only on patient care

“Business as usual” means there is no significant disruption to patient care or educational activities. The institution, however, is likely planning for an increase in clinical demands. Site visits, self-study activities and annual fellow and faculty surveys are suspended.

Stage 2 requires some fellows to shift to patient-care duties.

Some educational activities are also suspended. Fellows must only be assigned to participating sites that are able ensure their safety and safety of the patients. They may only provide care to patients under appropriate supervision and for the clinical circumstance and for the level of education they’ve achieved. ACGME’s protocol regarding work hours remain unchanged. Fellows shall receive adequate rest between clinical duties.

Stage 3 means the institution has reached pandemic emergency status. Most or all fellows shift to patient care, while the majority of educational activities are suspended. Work hour limits and supervision requirements remain, and fellows may function only in their core specialty. Fellows must be trained in, and be provided with, infection protection for the clinical situation.

AABIP lists 37 member fellowship programs.

Bronchoscopy is the most common interventional pulmonary procedure. AABIP, in a collaborative effort with the American College of Chest Physicians (CHEST), recently offered guidelines for performing bronchoscopy during the COVID-19 pandemic.

As of June 9, the novel coronavirus has killed 110,925 people in the United States.