COVID-19 Poses Training Challenges for Rheumatology Fellows

Dr. Kolfenbach

When it comes to adopting new technology, the younger you are, the smoother the sailing, say some program directors. Incorporating the technological aspects of telemedicine into the clinic presented a steep learning curve for Dr. Libman and a shining moment for her students.

“Our fellows are technology savvy, so they quickly figured out how to see patients, with the fellow seeing the patient first, presenting [patient information] to the attending, then creating a three-way call for the attending to review and confirm the plan [with the patient],” says Dr. Libman.

“The most surprising part of this [situation] was how easy and enjoyable it was to use telemedicine [after] we understood the technology—and the coding and billing requirements,” she says.

At the University of Colorado, fellows review patient charts the week before a scheduled visit to identify which patients are appropriate for a tele­medicine visit. Virtual visits via Epic’s Polycom system allow the fellows to work from home. They receive an electronic notification that the patient and staff are online and ready for the appointment. In minutes, the patient chart and live pictures of each person show up on a screen the fellow operates from a computer or cell phone.

“As a faculty [member], I can join into that [session] remotely, as well. Up to five people can be in the virtual room, so at any time the patient, medical assistant, medical translator, fellow and faculty member can all be engaged in clinical care with no one actually in the physical rheuma­tology clinic,” says Dr. Kolfenbach.

Some medical needs, such as infusions, obviously cannot be accommodated by phone or telemedicine. Clinics remain open for rheumatology patients who require in-person care. “We still see patients in person if the clinical need mandates it,” says Dr. Kolfenbach. Although visits have decreased in part because some patients cancel appointments, “our doors are not shut,” he says.

Dr. Kolfenbach sees the recent adjustments as stopgap measures to keep patients as stable as possible during the challenges of the pandemic. It’s impor­tant for rheumatology fellows to gain experience with the hands-on nature of the specialty, such as examining a patient for swollen joints.

“Our job as rheumatologists, especially in patients with inflammatory joint disease, can be heavily influenced by exam findings,” says Dr. Kolfenbach. “An exam can be performed in a telemedicine visit, but there are limitations. If the pandemic continues to keep patients away for months on end, I worry that care could be impacted for patients who miss out on the opportunity to receive a thorough physical exam.

“We all learn from doing things by repetition, and if clinical volume is down, then that’s fewer opportunities to learn how to take care of somebody who has a chronic illness,” he says. “Our program is tracking patient numbers for the fellows, and we will think of creative ways to provide more opportunities if this is sustained.”