Background: The COVID-19 pandemic has placed additional stress on the healthcare system. Not only do we face large volumes of high acuity patients, but also acute shortages of healthcare providers. Physician shortages were particularly pressing to our institution. COVID-19 patients were cohorted to our Hospital Medicine (MHS) service to minimize exposure and risks to house staff. In response to these shortages, institutions, including ours, implemented COVID surge protocols mobilizing outpatient and hospitalist physicians.This pandemic has also stressed medical education, particularly residency programs, where residents’ patient interactions have been limited. Despite this, programs adapted to apply technology in novel ways. Many services have moved to telemedicine [1, 2, 3] and medical education has moved to electronic format virtual curricula [2, 4]. However, implementing similar changes in residency education, where patient interaction is required, is challenging.
Purpose: To present a novel application of technology to address acute physician shortages in the setting of a pandemic. We present an inpatient telemedicine-based COVID-19 curriculum for residents to assist in inpatient care.
Description: We developed an inpatient Telemedicine COVID support curriculum. Initially conceived as voluntary rotation for residents on quarantine, it was later opened to all residents. Rotators would work off site with a hospitalist working on-site in-person. Through telemedicine, residents would obtain patient histories, perform daily assessments, complete notes, pend orders, assist with family discussions, and provide patient education. Hospitalist attendings would verify histories, perform physical exams, and cosign notes and orders. Attending to Resident ratios were 1:1. Rotations were one-week long with team needs and rotator availability reassessed weekly. A preliminary curriculum was developed to provide rotators with the knowledge base for COVID, and pandemics in general.To date, we have completed two cycles of the curriculum. The first cycle, in late summer 2020, had one rotator with overall positive feedback. During the second cycle, there were a total of 24 rotators over 4 weeks. Rotation feedback was obtained from all participants. Overall feedback was positive, with Telemedicine nature, initial orientation, morning huddles, shared responsibility / offloading, and general camaraderie being common positive themes. Suggestions for areas of improvement included: reducing frequent changeover, lengthening duration of rotations, standardizing expectations, providing more background knowledge on COVID, improving telemedicine delivery, and providing more educational opportunities.
Conclusions: In response to the shortages brought by the COVID surges, we implemented a Tele medicine COVID curriculum to mobilize physicians. Successes and deficiencies identified can serve as a foundation for future pandemics and pandemic preparedness curricula.