Background: Nationally, internal medicine (IM) residency programs have been struggling with the balance of protecting residents from exposure to COVID-19, ensuring they are sufficiently trained in general medicine while still teaching them about a new disease process and preparing them to help fight the pandemic (1). Anxiety is common amongst providers in a pandemic, especially initially (2). Personal protective equipment (PPE) availability and familiarity, rapidly changing updates in practice, insecurity in managing an unfamiliar illness, and fear for personal and family safety all play into the heightened levels of stress and anxiety health care workers experience during a pandemic (2).
Purpose: We developed a COVID training program with the goal of employing a safe, intentional, and controlled learning experience to assuage anxiety and build both the confidence and competence of our IM residents in the care of COVID-19 patients.
Description: Starting on August 1, 2020, we introduced volunteer IM residents to one-week rotations alongside hospital medicine (HM) faculty in the dedicated COVID unit of a large, urban academic safety-net hospital. IM residents in their second and third year of training independently saw 4-8 patients daily with symptomatic COVID-19. HM faculty, who were seeing an additional 8-10 COVID patients independently, taught the IM resident paired with him/her a COVID curriculum based on clinical care (disease course, approach to hypoxemia, diagnostic evaluation and management, including active clinical trials), infection prevention and epidemiology, and COVID operations. HM faculty entered the COVID unit with the residents for the first two days to supervise the donning and doffing practices until residents felt comfortable on their own. Residents were also exposed to a weekly, case based virtual COVID morning report hosted by the IM chief residents with faculty discussants. Residents also accessed, both independently and with their HM faculty as navigators and teachers, the comprehensive HM “COVID Central” SharePoint website. We developed a survey that was administered before and after the one-week rotation. Survey questions assessed resident attitudes and feelings towards direct COVID-19 patient management as well as solicited feedback on the rotation. Chi-square tests were used to compare categorical variables. SAS version 9.4 was used for analyses. P-values of < 0.05 were considered significant.
Conclusions: The SIC COVID-19 training program has been well received by our IM residents. 15 residents have completed the one-week rotation. Ten residents completed the survey pre-rotation, and eleven residents completed the survey post-rotation. Surveys demonstrated a significant improvement in anxiety in relation to caring for COVID patients: 4 (40%) were anxious pre-rotation vs 0 (0%) anxious post-rotation (p = 0.0197). IM resident confidence in donning and doffing PPE correctly as it relates to COVID care also improved: 6 (60%) were confident pre-rotation vs 11 (100%) post-rotation (p=0.0197). Residents who volunteered for this rotation described the learning opportunities as “unparalleled” and reported it is “critical [for them] to care for COVID patients while under supervision,” as graduating without having taken care of a COVID patient “would be a disservice to them and their future COVID positive patients.”