Residency training in the time of COVID-19: A framework for academic medical centers dealing with the pandemic.
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ABSTRACT: Background
As cases of COVID-19 climb worldwide, academic medical centers (AMCs) are scrambling to balance the increasing demand for medical services while maintaining safe learning environments. The scale and nature of the current pandemic, limitations on key resources, risks of transmission, and the impact on trainee wellbeing pose additional challenges to AMCs. We propose a framework for AMCs to utilize in facilitating health system, organization and program-level adjustments to meet the needs of medical trainees during the pandemic.Approach
In February 2020, we developed a three-level approach to the pandemic response of training programs at our AMC. The first level involved AMC alignment and engagement with regulatory stakeholders. The second level utilized the graduate medical education committee and leveraged organizational functions such as human resources, finance, and clinical departments. The third level of intervention focused on common approaches used by programs to ensure continuity of learning in the context of dynamic changes in workflows and service operations.Evaluation
Outcomes at each level are reported. These include the co-development of a national framework on medical trainee responses to COVID-19, the composition of an operational guidance document, organizational protocols to accommodate novel challenges posed by the pandemic, and multiple program-level interventions.Reflection
This methodical approach, employed during a global crisis, was critical in facilitating interventions required to fulfill the mission of AMCs. Future steps include assessing the impact of these changes on trainee performance and the applicability of the approach in diverse settings.
SUBMITTER: Abdel-Razig S
PROVIDER: S-EPMC7545371 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe COVID-19 pandemic compelled healthcare systems to rapidly adapt to changing healthcare needs as well as identify ways to reduce COVID transmission. The relationship between pandemic-related trends in emergency department (ED) visits and telehealth urgent care visits have not been studied.MethodsWe performed an interrupted time series analysis to evaluate trends between ED visits and telehealth urgent medical care visits at two urban healthcare system in Colorado. We performed pairwise comparisons between baseline versus each COVID-19 surge and all three surges combined, for both ED and telehealth encounters at each site and used Wilcoxon rank sum test to compare median values.ResultsDuring the study period, 595,350 patient encounters occurred. We saw ED visits decline in correlation with rising telehealth visits during each COVID surge.ConclusionsDuring initial COVID surges, ED visits declined while telehealth visits rose in inverse correlation with falling ED visits, suggesting that some patients shifted their preferred location for clinical care. As EDs cope with future staffing during the ongoing COVID pandemic, telehealth represents an opportunity for emergency physicians and a means to align patients desires for virtual care with ED volumes and staffing.
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Project description:BackgroundThe battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan's success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success.ObjectiveThis nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic.MethodsWe conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19-related posts or non-COVID-19-related posts. COVID-19-related posts were split into 4 categories: policy of Taiwan's Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of "likes," number of messages left, number of shares, video or non-video post, and date of search.ResultsThe Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more "likes," comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook.ConclusionsSocial media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19.
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Project description:PurposeCoronavirus disease 2019 (COVID-19) has had a global effect on the training of residents of medicine because of what has been required in the pandemic. The field of oncology has not been spared, as prepandemic training schedules have not been available for residents. We conducted an online survey to understand the effect of the pandemic and the effect of online teaching schedules as a measure to help residents of oncology in their training.Methods and materialsAn online survey consisting of 31 questions was sent through various social media platforms based on the training pattern before the onset of COVID-19, effect of the pandemic on educational activities, and the effect of online academic activities on residency training and learning. The survey addressed the need for online academics as an alternate mode of teaching. The survey was left open for a period of 4 weeks with participation requests from the various branches of oncology, including radiation, surgical and medical oncology, onco-anesthesia, palliative oncology, neuro-oncology, and so forth. The frequencies obtained in the survey were analyzed using descriptive statistical analyses.ResultsAfter a 4-week period, there were 255 responses received from students of oncology from various specialties. Around 69.8.1% of respondents (n = 178) were junior residents, followed by senior residents (n = 72; 28.2%). The majority of the respondents were radiation oncologists (n = 204; 80%). Around 70.9% had an ongoing structured teaching program related to oncology training, with the majority (40.3%) of them having more than 3 hours every week of oncology-based training. Another 31.3% reported having 1 to 2 hours of such training every week, and 60.8% of participants agreed their training was affected by pandemic and related safety regulations. Most students (90.9%) found the online teaching sessions helped maintain training qualities as they were in the pre-COVID times. About 69.1% of the students felt that the quality of these online sessions was better compared with the institute-based onsite classroom teaching. However, as is expected, 77.6% of them agreed that their hands-on training was affected in the pandemic. When asked if online teaching can replace every aspect of classroom teaching, 66.7% of respondents did not agree. The majority (83.9%) felt that students should be given the opportunity to present a given topic under the supervision of a senior faculty member experienced and expert in that topic. The students pointed out the lack of practical exposure as the most common deficiency, followed by the lack of direct interaction with the teaching faculty.ConclusionsThe pandemic has limited the access to essential training in the branches of oncology, and though online sessions cannot replace the hands-on training and clinical exposure needed for the students, online academics and webinars have proven to be an effective tool to minimize that effect and can lead to a positive outcome, as shown by the survey. A combination of online and onsite training modules may be the future of teaching and training in our country.
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Project description:ImportanceElectronic consultations (eConsultations) are increasingly used to obtain specialist guidance, avoiding unnecessary face-to-face patient visits for certain clinical questions. During the COVID-19 pandemic, when in-person care was limited, eConsultations may have helped clinicians obtain specialist input to guide patient care.ObjectiveTo understand how the use of eConsultations changed during the COVID-19 pandemic and whether trends in eConsultation utilization differed based on patient's payer and primary language.Design, setting, and participantsThis retrospective cohort study was conducted at 6 academic medical centers in the United States, all participating in the Association of American Colleges Coordinating Optimal Referral Experiences program. Participants included adult patients who had an outpatient visit, referral, or eConsultation during the study period. Data were analyzed from June 4, 2019, to July 28, 2020.Main outcomes and measuresThe primary outcome was the eConsultation proportion of specialty contact, defined as the number of completed eConsultations divided by the sum of the number of completed eConsultations and specialty referrals, expressed as a percentage. eConsultation percentages of specialty contact were further stratified by payer type and language. Payers included commercial, Medicare, Medicaid, self-pay or uninsured, and other. Primary language included English and non-English languages.ResultsA total of 14 545 completed eConsultations and 189 776 referrals were included. More eConsultations were completed for English-speaking patients (11 363 eConsultations [95.0%]) than non-English-speaking patients (597 eConsultations [5.0%]). Patients with commercial insurance represented the highest number of completed eConsultations (8848 eConsultations [60.8%]) followed by Medicare (3891 eConsultations [26.8%]), Medicaid (930 eConsultations [6.4%]), other insurance (745 eConsultations [5.1%]), and self-pay or no insurance (131 eConsultations [0.9%]). At the start of the pandemic, across all academic medical centers, the percentage of specialty contact conducted via eConsultation significantly increased by 6.21% (95% CI, 4.97%-7.44%; P < .001). When stratified by payer and language, the percentage of specialty contact conducted via eConsultation significantly increased at the beginning of the pandemic for both English-speaking patients (change, 6.09% (95% CI, 4.82% to 7.37%; P < .001) and non-English-speaking patients (change, 8.48% [95% CI, 5.79% to 11.16%]; P < .001) and for all payers, except self-pay and uninsured patients (change, -0.21% [95% CI, [-1.35% to 0.92%]; P = .70).Conclusions and relevanceThis retrospective cohort study found that eConsultations provided an accessible mechanism for clinicians to receive specialist input when in-person care was limited.
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Project description: Not available
| S-EPMC8980917 | biostudies-literature
Project description:BackgroundAcademic Medical Centers (AMCs) must simultaneously serve different purposes: Delivery of high quality healthcare services to patients, as the main mission, supported by other core missions such as academic activities, i.e., researching, teaching and tutoring, while maintaining solvency. This study aims to develop a methodology for constructing models evaluating the academic value provided by AMCs and implementing it at the largest AMC in Israel.MethodsThirty five practiced educators and researchers, academic experts, faculty members and executives, all employed by a metropolitan 1500-bed AMC, were involved in developing academic quality indicators. First, an initial list of AMCs' academic quality indicators was drafted, using a literature review and consulting scholars. Afterwards, additional data and preferences were collected by conducting semi-structured interviews, complemented by a three-round Delphi Panel. Finally, the methodology for constructing a model evaluating the academic value provided by the AMC was developed.ResultsThe composite academic quality indicators methodology consists of nine indicators (relative weight in parentheses): 'Scientific Publications Value' (18.7%), 'Completed Studies' (13.5%), 'Authors Value' (13.0%), 'Residents Quality' (11.3%), 'Competitive Grants Budget' (10.2%), 'Academic Training' (8.7%), 'Academic Positions' (8.3%), 'Number of Studies' (8.3%) and 'Academic Supervision' (8.0%). These indicators were grouped into three core categories: 'Education', 'Research' and 'Publications', having almost the same importance on a scale from zero to one (0-1), i.e., 0.363, 0.320, and 0.317, respectively. The results demonstrated a high level of internal consistency (Cronbach-alpha range: 0.79-0.86).ConclusionsWe have found a gap in the ability to measure academic value provided by AMCs. The main contribution of this research is the development of methodology for constructing evaluation models for AMCs academic performance. Further studies are needed to further test the validity and reliability of the proposed methodology at other sites.
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Project description:Introduction:The Residency Match is becoming more competitive each year, and more than ever, medical students must prove themselves in the residency interview. Data from the 2018 National Residency Matching Program's Program Director Survey highlight the importance of the interview on Match performance. We developed a residency interview training program with the goal of preparing medical students for residency interviews, and we assessed the impact of the training on medical student confidence. Methods:Our residency interview training program includes (1) a short didactic session on the residency interview process, (2) an informational packet with commonly asked questions, (3) two 20-minute practice (mock) interviews, (4) 10 minutes of face-to-face feedback from interviewers, (5) a facilitated group debriefing, and (6) access to a participant's two videotaped interviews and a guided self-assessment. To evaluate the effectiveness of our program, we assessed student confidence with a pre- and postsurvey. Results:We have been running our residency interview training program since 2014. Over the last 5 years, 73 fourth-year medical students have participated. When polled after completing their first authentic residency interview, students felt they had more knowledge of the interview process, better preparation, and more confidence in their skills to interview successfully; they also believed that the program improved their interview performance. Discussion:Performance during the residency interview is the most important factor used by residency programs to rank applicants. Using our residency interview training program, medical students can improve their confidence prior to interviews.
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