Critical Care and Critical Care Fellowships in the Time of COVID-19: MCIRCC Interviews Jakob McSparron, MD

COVID-19 ushered in major changes to plans, protocols, and procedures as hospital teams around the world adapted to the unpredictability of the pandemic. These effects were also strongly felt among learners in the medical fields, from students just beginning their journeys, to fellows continuing on the path to specialization. 

This month, MCIRCC sat down for a virtual one-on-one with Dr. Jakob McSparron, Clinical Associate Professor in the Division of Pulmonary and Critical Care Medicine and Director of the Pulmonary and Critical Care Fellowship program, to discuss the past year of critical care and hear from the perspective of one who guided teams of specialists-in-training during a time of learning unlike any other.

Jakob McSparron, MD, Clinical Associate Professor (Pulmonary and Critical Care Medicine)

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Can you tell us about some of the unique challenges that have affected fellows and fellowship programs this past year? How have your teams risen to those challenges?

One of the biggest challenges has been adapting our programs to the disruptions caused by the pandemic. Generally, fellowship programs are tightly scheduled, and there is a certain order to things. COVID-19 turned that order on its head. For example, we weren’t seeing as much influenza, RSV (respiratory syncytial virus) or other diseases the fellows needed to learn because it was all COVID/ARDS (Acute Respiratory Distress Syndrome). As a result, self-directed learning was crucial.  

Of course, we knew our fellows were exceptional physicians and scientists from the outset, but they have shown time and time again that they are able to expertly manage and rise above these unpredictable situations in ways nobody could have anticipated. It was truly humbling to see how they answered the call.

While your position is largely focused around teaching and leading, what have you learned from your fellows?

From the beginning, leadership was concerned about the risks our teams faced when caring for patients with COVID-19. How do we keep everyone safe? As thoughts like this were happening, the fellows came to us wanting to jump right in. They were asking us, “How can we get in to the RICU? How can we help?” It was very important to hear that they wanted to do this no matter what, that they wanted to be at the forefront clinically. 

On top of everything else, our fellows have also been taking care of each other. If someone has a difficult week, someone else steps up to help. They are watching out for faculty, too, and checking in on us. They have really taught me the importance of setting up our teams to support each other.

Do you think critical care or critical care education has changed in the past year (methods, mindsets)? If so, how?

The shift to virtual learning and working has opened up many opportunities and has made it much easier for us to collaborate and share knowledge across states and institutions.

This year has also demonstrated the importance of thinking critically across the board about clinical research and patient care. There is a reason we do science the way we do science. We often hear personal anecdotes about novel solutions, but it is important to remember the decades of existing literature that we have. 

Your work with the PULSE Post-ICU clinic helped patients and families traverse the road to recovery following an ICU admission. As the world works through the lingering effects of the pandemic, what do you think is most important for people to understand about life after a critical illness?

The recovery process is unique to each individual. Reactions post-ICU differ, and it can be difficult to make sense of it. The concept of PICS (Post-Intensive Care Syndrome) was around long before the pandemic, and thought leaders—including Dr. Hallie Prescott and Dr. Jack Iwashyna here at U-M—have done extensive work in the physical, psychological, and cognitive sides of PICS. Now, even though roughly 90% of patients we are seeing in PULSE clinic are COVID survivors, we are seeing a lot of what we have seen before. The support these survivors need is similar, and what we have learned still holds true.

While we have experienced many trials in the past year, we have also seen many triumphs. What are some of the victories you or your unit/teams are celebrating?

Positive outcomes and good clinical results are always reasons to celebrate. We share pictures and stories we get, and have Zoom calls with patients who want to say thank you. Because of all of the activity in the ICU, the bedside teams might not have the chance to process that someone improved. It’s important to remind everyone to celebrate patients who have made it out of the ICU. 

Research is another victory we are celebrating. There is a lot of important work being done across U-M and Michigan Medicine related to the pandemic. Our fellows are also participating in major studies that have altered management of these patients worldwide. 

Finally, we are seeing collaborations across teams on a whole different level than before. The RICU was staffed by intensivists from all specialties. We all have a new familiarity with each other and have forged lasting relationships that will pave the way for future collaborations.