Excerpt – “Nephrology Fellowship Education: Moving Apart to Come Together during COVID-19”

By Sam Kant, MD, and C. John Sperati, MD, MHS

April 28, 2020


COVID-19 has necessitated a transformation in how medical education is delivered to trainees, presenting new opportunities, but also concerns for the adequacy of ongoing instruction. Education during the pandemic must “balance education with safety,” state Sam Kant, MD, and C. John Sperati, MD, in a Perspective to appear in the June Kidney News.  Here, we look at four areas that require the attention of educators and fellows in caring for patients with COVID-19. Sam Kant, MD, is a nephrology fellow at Johns Hopkins Hospital. C. John Sperati, MD, MHS, is associate professor of medicine and fellowship program director at Johns Hopkins Hospital.
 

1. Workplace policies

“Although the threat of infection should not prevent appropriate medical care, there are times when the trainee and attending nephrologist can deliver effective nephrology care without having to be at the bedside. . . . Technology can be leveraged to this end. Innovative approaches, such as the use of a head-mounted phone under PPE or camera-enabled workstations on wheels, can allow multiple team members to engage in bedside clinical care through interactive video conference (IVC) while only 1 provider is at the bedside. Care providers such as pharmacists and case managers, for example, could even join rounds from an off-site location to maximize physical distancing in the hospital.”
 

2. Backup protocols for fellows, training program directors unable to work

It seems critical to have defined protocols for backup clinical coverage should a fellow be unable to work. Moreover, all training programs should identify faculty and staff responsible for assuming control of the operations and accreditation of the fellowship if the program director and/or coordinator should be incapacitated. This backup plan should include ensuring that these individuals have the necessary credentials for accessing key electronic systems, both nationally and locally.
 

3. Fellowship didactics

“Acutely, structured education may be deferred while response plans are implemented. In its place, trainees receive firsthand experience in public health epidemiology, medical triage, crisis response, resource conservation, and rapid deployment of translational medicine. These experiences may motivate trainees to pursue a career path not previously considered. The extent to which a program is affected by COVID-19–infected patients will dictate the timeline for returning to a more typical curriculum. Ultimately, however, the formal educational mission must proceed as soon as possible, and trainee engagement needs to be sustained. Moving didactics to an IVC has helped mitigate this issue.”
 

4. Trainee wellness

We have attempted to strengthen resiliency and minimize the risk of burnout by acknowledging the resolve, sacrifice, and contributions of our fellows during the pandemic. The institutional response is a shared mission, with both faculty and trainees jointly contributing wherever service has been needed. Informal weekly IVC check-ins and “happy hours” help maintain program cohesion. Social networks, even when remote, have been demonstrated to alleviate not just immediate anxiety but also long-term distress.
 

Please tune in to the June issue of Kidney News for more information.

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Author:
Sam Kant, MD, and C. John Sperati, MD, MHS
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COVID-19 has necessitated a transformation in how medical education is delivered to trainees, presenting new opportunities, but also concerns for the adequacy of ongoing instruction. Education during the pandemic must “balance education with safety,” state Sam Kant, MD, and C. John Sperati, MD, in a Perspective to appear in the June Kidney News.  Here, we look at four areas that require the attention of educators and fellows in caring for patients with COVID-19. Sam Kant, MD, is a nephrology fellow at Johns Hopkins Hospital. C. John Sperati, MD, MHS, is associate professor of medicine and fellowship program director at Johns Hopkins Hospital.
 

1. Workplace policies

“Although the threat of infection should not prevent appropriate medical care, there are times when the trainee and attending nephrologist can deliver effective nephrology care without having to be at the bedside. . . . Technology can be leveraged to this end. Innovative approaches, such as the use of a head-mounted phone under PPE or camera-enabled workstations on wheels, can allow multiple team members to engage in bedside clinical care through interactive video conference (IVC) while only 1 provider is at the bedside. Care providers such as pharmacists and case managers, for example, could even join rounds from an off-site location to maximize physical distancing in the hospital.”
 

2. Backup protocols for fellows, training program directors unable to work

It seems critical to have defined protocols for backup clinical coverage should a fellow be unable to work. Moreover, all training programs should identify faculty and staff responsible for assuming control of the operations and accreditation of the fellowship if the program director and/or coordinator should be incapacitated. This backup plan should include ensuring that these individuals have the necessary credentials for accessing key electronic systems, both nationally and locally.
 

3. Fellowship didactics

“Acutely, structured education may be deferred while response plans are implemented. In its place, trainees receive firsthand experience in public health epidemiology, medical triage, crisis response, resource conservation, and rapid deployment of translational medicine. These experiences may motivate trainees to pursue a career path not previously considered. The extent to which a program is affected by COVID-19–infected patients will dictate the timeline for returning to a more typical curriculum. Ultimately, however, the formal educational mission must proceed as soon as possible, and trainee engagement needs to be sustained. Moving didactics to an IVC has helped mitigate this issue.”
 

4. Trainee wellness

We have attempted to strengthen resiliency and minimize the risk of burnout by acknowledging the resolve, sacrifice, and contributions of our fellows during the pandemic. The institutional response is a shared mission, with both faculty and trainees jointly contributing wherever service has been needed. Informal weekly IVC check-ins and “happy hours” help maintain program cohesion. Social networks, even when remote, have been demonstrated to alleviate not just immediate anxiety but also long-term distress.
 

Please tune in to the June issue of Kidney News for more information.

Date:
Tuesday, April 28, 2020