Education Columns

by Sarah M. Tiggelaar, MD; R. Shumon Rahman, MD; and Muneeza Khan, MD, Saint Francis Family Medicine Residency, University of Tennessee Health Science Center, Memphis, TN

Background

The COVID-19 pandemic has created unprecedented challenges for graduate medical education.¹ In March 2020, a “Safer-At-Home” order was issued in Tennessee, resulting in the closure of many medical offices and disrupting training for residents on ambulatory rotations. The Saint Francis Family Medicine residency program’s emergency preparedness plan was developed to ensure that a ready-to-mobilize frontline workforce was readily available while rethinking teaching and training strategies to ensure that the at-home residents continued to meet their programmatic educational requirements. This article describes the program’s curricular development strategies and lessons learned.

Intervention

The resident academic year is divided into 13 4-week blocks, with 27 residents assigned to experiences, or rotations, every block. From March 2020 through June 2020, 14 ambulatory blocks were disrupted, including medicine subspecialties, pediatrics, psychiatry, gynecology, addiction medicine, practice management, surgery, ophthalmology, otolaryngology, dermatology, and orthopedics. The residents assigned to essential hospital-based clinical services continued working on the frontlines while those on disrupted ambulatory rotations were placed on home study. This approach minimized simultaneous resident exposure and ensured a ready-to-mobilize workforce when needed. Innovative home study curricula were created for the displaced residents to mitigate the disruption in their clinical training. Each home study curriculum consisted of an electronic document with objectives and an assignment list, using combinations of peer-reviewed journal articles,³ book chapters, online modules, clinical decision-making resources, podcasts, procedural videos, quality improvement certifications, medication-assisted treatment waiver training, online board review courses, and board-prep questions.⁴ The cost of these educational materials was contained by utilizing the institutional electronic medical library⁵ and free subscriptions to professional development resources generously offered by many medical organizations and societies.

Each curriculum was supplemented with a COVID-19 critical care course for non-ICU physicians,⁶ a Centers for Disease Control and Prevention video on proper donning and doffing of personal protective equipment,⁷ and a wellness-related mindfulness meditation app. Residents were also scheduled for private virtual check-ins with a behavioral counselor.

Results

Upon conclusion of each home study block, residents electronically submitted a learning point summary and a checklist of completed tasks. They also presented a high-yield topic during the weekly virtual didactic conference series. Faculty advisors served as supervisors and evaluators for their advisees by reviewing the assignment checklists, learning point summaries, presentations, and monitoring for completion of the other online activities. A spreadsheet was used to track assignment completion and assign rotation credit. An electronic evaluation system gathered resident feedback regarding the home study educational experience. The most common recommendations were to include more opportunities for physical exam learning and to avoid too much repetition across different source materials. However, the vast majority of Likert ratings were in the Good to Outstanding range, and the narrative feedback was overwhelmingly positive for the format, variety, and quality of educational content. Thus, going forward, this style of information delivery will be incorporated into all ambulatory rotations, though this will require faculty development and time for regular curricular resource updates.

Table 1. Descriptive Statistics From 33 Resident Evaluations of Home Study Rotations

*One question left unanswered.

Conclusions

Widespread disruption of resident training on ambulatory rotations due to medical office closures led to the creation of innovative and individualized home study curricula, allowing residents to continue their educational training and meet programmatic requirements. The innovations were well accepted, and if used again, resident feedback regarding maximizing visual media for physical exam teaching and minimizing topic repetition across modalities will be included. Regardless, some of the new modalities will be incorporated into the standard curriculum due to their educational value. This curricular strategy may be adapted by other programs to ensure that residents have alternative learning resources available if clinical rotations are further disrupted during this or other pandemics.

References

1. ACGME Response to Pandemic Crisis. Accreditation Council for Graduate Medical Education. Accessed October 29, 2020. https://acgme.org/covid-19.
2. COVID-19 Timeline. TN Office of the Governor. Updated October 21, 2020. Accessed October 29, 2020. https://www.tn.gov/governor/covid-19/covid19timeline.html.
3. AAFP Family Medicine Journals. American Academy of Family Physicians. Accessed October 29, 2020. https://www.aafp.org/journals.html?cmpid=_van_625.
4. Family Medicine Certification Activities. American Board of Family Medicine. Accessed October 29, 2020 (requires login). https://portfolio.theabfm.org/MCFP/Modules.aspx?tab=SAM
5. Health Sciences Library. University of Tennessee Health Science Center. Updated November 4, 2020. Accessed November 8, 2020. www.uthsc.edu/library.
6. Critical Care for Non-ICU Physicians. Society of Critical Care Medicine. Updated October, 2020. Accessed Octover 29, 2020. https://www.sccm.org/Disaster/COVID19/COVID19-ResourceResponseCenter
7. Personal Protective Equipment for COVID-19. Centers for Disease Control and Prevention. Posted February 18, 2020. Accessed November 4, 2020. https://www.youtube.com/watch?v=bG6zlSnePg