Adapting residency programs in a COVID-19 world
In June we ran an article that explained how Competence by Design (CBD) has adapted to reflect the realities of post-graduate medical training in a COVID-19 environment. This month, we provide a snapshot of how your colleagues continue to run rigorous CBD residency programs – and produce outstanding and skilled physicians – amid a pandemic. COVID-19 will likely be with us for some time. To get some perspective, we spoke with Dr. Daniel Dubois, MD, FRCSC, associate program director and CBD lead for the University of Ottawa’s Anesthesiology Training Program about how his program is adapting to meet the learning needs of residents.
How has COVID-19 affected the day-to-day life of residents?
When the emergency pandemic response was initiated in Ontario in mid-March, we enacted a skeleton group of residents onsite to protect people against having to congregate in large groups. This meant that much of our meeting and learning started to take place online. At the same time, nine of our 15 operating rooms closed, and elective surgery was cancelled, which impacted the residents’ clinical experience quite profoundly. We had to cancel all academic half days and evaluations in the first few weeks of the emergency response and, as a result, lost about half of a learning block. The changes were disorienting, but now we have our feet on the ground and we’re set for the longer term.
How have you adapted your training program so that residents continue to build competencies?
We focused early on ensuring that all residents’ learning experiences would count as much as possible toward achieving EPAs. Here are a few highlights:
- Because so many elective cases were cancelled and we had so little time in the OR, we developed a new, streamlined assessment form for residents that captures evaluations and observations for any clinical experience they have during their rotations.
- A weekly narrative self-reflection enables residents to discuss the learning opportunities they have had – such as OR management workflow, leadership, or any type of scholarship.
- One-on-one learning cases give residents access to case materials, which they read and discuss with staff.
- A grassroots movement called “chalk talks” sprang up where faculty presents an hour-long learning session online that anyone can participate in.
- Simulation took the place of many hands-on experiences. This is especially important in anesthesia, where we do a lot of aerosol-generating medical procedures such as intubations and extubations.
- Group in-situ simulation is also taking place within the OR for elective as well as emergency care.
Which residents are feeling the impact of COVID-19 the most?
Residents who have some type of remediation plan have faced the most difficulties. Many of their learning plans have been postponed for a few months. Residents preparing to transition to practice have also been affected because it’s difficult to give them opportunities to manage cases independently and be evaluated. Meanwhile, mid-career residents haven’t been able to do inter-hospital or inter-university electives, which could affect their career prospects.
Overall, the didactic components of CBD are not too hard to manage, but the clinical side of things is tougher. If a resident has completed only three days of the eight to 12 they need, it’s going to take some time to catch up.
What advice do you have for your peers for ensuring residents continue to thrive?
Acknowledge that the reality is what it is and focus the program on supporting residents’ personal well-being as well as professional development. Communication is key, which means a formal communication strategy must be in place, and all faculty and residents need to be aware of it. COVID-19 may lead to an extension of some residents’ training, so you have to be proactive – recognizing and planning for an increased need for longitudinal coaching and individualized learning plans to account for learning that might be missed.
You also have to be proactive in documenting everything you do to ensure the competence committee has at least some information to make reliable judgments on residents’ progress. In short, you need to be open to new opportunities and be creative with how to account for learning during this time.
What is the MedEd community doing to uphold the standard of excellence?
People have been really busy building resources. The Royal College is a main resource, with webinars looking at how medical educators are dealing with the pandemic, and showcasing different responses across various specialties and universities. In anesthesia, the competency chairs across Canada have started monthly video conferences to share strategies and practices. Some schools are doing amazing things and others are still figuring out how to deal with this challenge. For specific online resources, I’d recommend the following:
- The Pivot MedEd website
- Royal College’s list of virtual teaching resources
- American Medical Association COVID-19 resources for medical educators