Faculty Teaching Residents

UPDATED: MAY 27, 2020 | 12:15 PM EST

Webinar: May 27, 2020: Psychological PPE: Exploring Compassion Fatigue and Learning How to Keep Ourselves Psychologically Well
Register here

An Open Letter to NOSM Faculty Working with Residents in a Time of COVID-19

Wednesday, April 1, 2020

I spent the week working with residents in the intensive care unit this past week and found myself struggling. Struggling with uncertainty. With being vulnerable, and being wrong with no right answer. Coping with fear and with trying to support those who are scared around me. I want to just protect them and shield them from all that is wrong with our world right now. It made me reflect on what it means to be a supervisor in this time. There is so much going on for them, and the stakes are not low. The challenges COVID-19 presents will impact everyone. My hope here is to help preceptors understand what an educational opportunity this is, and to provide some guidance around how important clinical training is for our residents.

This is a challenging time for residents. There is so much uncertainty right now for residents. There are changes to examinations, licencing, rotations, electives, clinical experiences and even the ethics of how we practice medicine. This is all on a background of fears of getting sick, potential reassignment to areas that they may be less familiar with, PPE shortages, as well as whatever challenges that life usually throws at them. This is a time to err on the side of over supporting learners at every opportunity.
1. Residents should not come to work if they are unwell. They do not require a doctor’s note and can contact their program or the wellness office as needed.
2. Residents should refuse to do any work that is unsafe. They are entitled to appropriate PPE for any patient encounter.
This is a challenging time for all of us. Everything I have said about residents can be said for us too. We also have the challenge of being looked to as leaders at this time. The people that will make this “better,” without the power to actually do that. We need to make decisions that challenge our identity as a healer. There is so much uncertainty and fear that it can make us vulnerable. Remember, you can’t not teach. Your learners see you in your difficult moments. It’s okay. They know that they will face this in the future and are looking to learn from you. If you feel safe to do so, take a moment to process the situations with them. Talk about how you are doing it. Talk about how it makes you feel and how you take care of yourself. It may just be the most valuable lesson they will have in their training.
Keep the academic program going! Programs are relying on you to help them minimize the impact on training. To make decisions and give due credit they need you to engage residents in clinical learning where you can. They need you to assess and document competence in the key domains of the specialty. It is not a time to back off on academics, we need to double down and milk every experience for all the learning we can. Some suggestions:
1. For daily/single encounter assessments write at least two sentences. First, ‘Why I scored you like I did,’ and second, ‘Next time you could change this to be even better.’ If at all possible include one of the following words: Try, Consider, Next time, Suggest and/or Because.
2. For aggregate assessments, use as many examples as possible with specific actionable feedback. Try to include as many CanMEDS(FM) competency domains as possible. Your learner and your colleagues challenged with making difficult decisions will thank you!
Reassignment. In this time, residents are an important part of the clinical workforce and should be included in contingency planning.
Look for unique ways to engage residents. Virtual care practices, public health, advocacy and management issues are so prominent right now. Take advantage of every opportunity that is out there, and of course, document it!
Questions? Information comes fast and furiously. It seems to be changing daily at times. Do not feel like you need to know everything about what is going on in the academic programs. There is a tremendous amount of great information in the FAQs on the NOSM website. We are also always open to questions from our faculty! It is always preferable that we are honest with the residents when we don’t have the answer and commit to act in their interests and help them get the best information. We are striving to provide certainty in as many areas as we can, and that is also in our commitment to say when “we don’t know yet.”

Thank you all for your amazing work. Your leadership. Your mentorship. Your passion for education. I am so proud to part of this amazing NOSM team in facing this challenge!

Please see the following memo from Dr. Rob Anderson, Associate Dean, Postgraduate Medical Education and Health Sciences, regarding Supervising Residents and their Important Role During Public Health Emergencies (March 31, 2020).

Key Messages:

Residents are skilled health care providers and a resource during the pandemic
They can be reassigned to areas of need (guidelines here)
Final-year residents will join the workforce in July
Encourage all physicians to support, teach and give brief regular feedback (and complete evaluations) for residents. Exams are delayed so documentation of competency is critical so residents can graduate and join the workforce

PARO Principles for Duty Hours & the Government Emergency Act

Given the Emergency Act’s implementation, PARO has developed principles where it may be necessary to schedule residents inconsistent with the PARO-CAHO Collective Agreement.

While we recognize that the Ontario Government’s Emergency Act provides the ability to contravene the Maximum Duty Hours provisions in the PARO-CAHO Collective Agreement, in circumstances where the emergent need necessitates it, we ask that:

schedulers not take advantage of this time to add to residents work schedules unless necessary;
that workload is distributed as equitably as possible amongst all team members, including staff, residents, and other trainees;
that consideration be given to providing rest-periods for services/residents;
that consideration of health and safety be foremost – is the individual at a level of competence that they can work safely at the intensity the situation requires;
consideration should be given to using one of the PARO Approved COVID Models of Scheduling (see further below) that would work for your service/program;
should there be a need to make changes to the call schedule post-distribution, or after the two-week deadline, as much notice and compassion to the affected residents as possible should be provided. Where possible, the emergency clause process in the PARO-CAHO Collective Agreement, Article 16.1c should be used.
residents be paid call stipends if required to work in excess of the provisions of the Agreement even if it exceeds the maximum call stipends also included in the Agreement;
that we all remain flexible in scheduling to support residents who are experiencing difficulties during this time, including but not limited to residents with families to care for, grief, burnout and anxiety.

PARO Approved COVID Scheduling Models

To facilitate the modification of resident scheduling during this extraordinary time, and to foster the ability to do that while remaining as true as possible to the PARO-CAHO Collective Agreement PARO developed Back-Up Call Models with the hope that with these models, most scenarios – various services, sizes of programs – can find a workable model among them.

The models can be found at myparo.ca/residents-and-covid-19

PARO Approved COVID Back Up Call Model
PARO Approved COVID 7 On – 7 Off Model – Small to Large Programs (depending on expected daytime coverage required)
PARO Approved COVID 4 On – 4 Off Shift Model and 3 On/Off Variations
PARO Approved COVID Home Call Back-Up Model
PARO Approved COVID Night Float Model

Resources

COVID-19 Northern Ontario Online Clinical Resources