In a matter of weeks, the COVID‑19 crisis has totally upended clinical medicine and the practice of rheumatology. Our old ways of seeing patients in person, precepting fellows in clinic or on the consult service, and leading in-person interactive teaching rounds are gone for now and possibly for good. But how can we replace these critical teaching and training elements? Despite the mounting challenges of managing an exploding population of coronavirus-infected patients and caregivers, we must find innovative ways to foster our trainees’ professional development.
Koumpouras and Helfgott discuss evidence gathered during the 2013 SARS epidemic and the 2014 Ebola virus outbreak regarding the disruptive effect of health and environmental crises on medical training and whether trainees should be allowed to care for infected patients.
Some have argued that residents should be expected to participate in disaster responses. “Completely removing trainees from these situations can be detrimental to their overall experience and education.” As others have noted, “if we avoided all situations that we couldn’t understand in advance and that posed any risk, we would spend our lives in a state of paralysis.” The key is to strike a balance between the inherent risks associated with serving on the front-lines of care during a pandemic and creating sufficient safety measures for our trainees as they move beyond the normal scope of the practice of rheumatology.
We must remember that our fellows are specialists in training. They still need our mentoring and guidance to help them navigate through the COVID-19 crisis. The authors go on to discuss options for telemedicine (and the need for protocols), video consultations and virtual learning opportunities. They say the role of the fellow in a video consultation would be to assemble the history, review the data, write the note, discuss the case with the preceptor, formulate a differential diagnosis and recommend a treatment plan. It is important this activity demonstrate some form of evidence of the educational value for the encounter. Written communication is key.
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References
Koumpouras F, Helfgott S. Stand together and deliver: Challenges and opportunities for rheumatology education during the COVID19 pandemic. Arthritis Rheumatol. 2020 Apr 9. [Online before print]
