Fig. 1
Systematic approach to GME responses to the pandemic: stakeholders, scope, and the role of the AMC
Table 1
Objectives and outcomes achieved at each level of GME intervention
|
Objective |
Example outcome | |
|---|---|---|
|
System |
– Development of a national, unified, regulatory consensus framework on graduate medical education pandemic response including input from all relevant stakeholders (licensing bodies, accreditors, certifying agencies, AMCs) |
– Publication and/or dissemination of national/local pandemic response standards |
|
– Operational guidance for AMCs to facilitate alignment with regulatory framework (DIO expert consensus) |
– Development and dissemination of institutional protocols that align with regulatory framework | |
|
Organization |
– Mobilization of cross-specialty efforts including joint teaching opportunities, consensus on curricular modification strategies, and identification of appropriate opportunities for trainee placement in organizational pandemic related responses |
– Launch of online cross-specialty curriculum to provide additional learning experiences for programs with reductions in safe clinical learning opportunities due to the pandemic |
|
– Identification of organization-wide, non-patient facing, pandemic response functions that residents where residents may be allocated to count towards curricular elective or core experiences | ||
|
– Organization wide cessation of clinical elective experiences to mitigate exposure risk in non-essential rotations | ||
|
– Deployment of curricular modifications such as changes to minimal on-call schedule requirements to enable decreased resident deployment in high-transmission risk learning environments (e.g. ICUs) | ||
|
– Engagement of non-academic functions (e.g. HR, finance, legal) to enhance logistical support and identification of pandemic-related organizational protocols/policies/needs that affect medical trainees |
– Identification of impact of social distancing measures on resident facility space needs (call rooms, lounges, work spaces) with compensatory space provided | |
|
– Roll out of additional housing provisions to cater to residents living at a distance from the facility due to pandemic imposed travel restrictions | ||
|
– Execution of emergency evacuation/repatriation processes trainees abroad at the time of the pandemic | ||
|
– Review and assurance of health and mental health coverage for COVID-19 related resident needs | ||
|
– Review and execution of screening and quarantine protocols for COVID-19 afflicted residents | ||
|
Program |
– Utilization of online platforms for the delivery of educational content |
– Morning reports, educational conferences, morbidity and mortality rounds, journal clubs, etc. all held online |
|
– Development and delivery of educational content on pandemic related information |
– Teaching sessions on donning and doffing PPE, medical/surgical management of COVID-19 patients using online learning management systems | |
|
– Addressing resident wellbeing |
– Regular small group discussions and lectures held online between program faculty and residents with topics including stress management, mental health, resident led wellbeing topics, etc | |
|
– Dissemination of information to residents on institutional resources for well being | ||
|
– Augmenting access and availability of occupational/mental health services for residents | ||
|
– Altering resident scheduling to adjust for shifting service line volumes, workflows, availability of resources and the learning environment |
– Reallocation of residents on elective, off-site, and ambulatory experiences to inpatient rotations, COVID-19 related administrative/non-patient facing tasks such as calling families, contract tracing, etc | |
|
– Flexibility in curricular time to accommodate significant clinical service interruption |
– Shifting of curriculum to advance quality improvement, patient safety, clinical research, volunteer work, and other forms of scholarly activity/experiences while delaying clinical rotations towards later in the academic year | |
|
– Continuous considerations and adjustments of day-to-day clinical tasks assigned to medical trainees with specific consideration of PPE stewardship, availability of appropriate supervision, and task relevance to educational objectives |
– Modifying clinical rounding practices to mitigate exposure risk to residents | |
|
– Shifting personal encounters with patients to telehealth where appropriate and available | ||
|
– Minimizing resident involvement in emergency surgery/procedures |
AMC academic medical center, GME graduate medical education, DIO designated institutional official, HR human resources ICUs intensive care units, PPE personal protective equipment