April 08, 2020
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Two-team system may allow for patient care, resident education in COVID-19 pandemic

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Institution of a two-team system during the COVID-19 pandemic may allow orthopedic departments to meet patient needs and provide excellent patient care while sustaining a commitment to resident education and academic investigation, according to a published review.

Scott D. Boden

In the department of orthopedics at Emory University, Scott D. Boden, MD, and colleagues restructured the resident component of care delivery to a standardized five-part approach to continue orthopedic training while providing patient and provider safety. According to Boden, to minimize exposure, they categorized residents into two teams structed as “active-duty inpatient” and “remotely working.” The remotely working residents participated in maximal isolation and, at predetermined time intervals, reversed roles with active duty residents to allow for rest and seclusion from exposure, according to the authors. To reduce the chance of infection of other members of the team or patients, the authors proposed 2-week cycles to observe the incubation period for potential infection. To safeguard a healthy network of indispensable leaders and decision makers, the authors noted a similar system should be in place for both faculty and administrators.

Continued resident education

Despite the prioritization of patient care during the COVID-19 pandemic, Boden and colleagues noted resident education can be continued through video conferencing in which faculty leaders enable interactive engagement with an entire residency through lecture presentations, case conferences or interactive question and answer sessions with an emphasis on Accreditation Council of Graduate Medical Education core competencies. In addition to didactic education, the authors also noted surgical education should be continued where possible, with resident participation in essential cases presenting as an ideal opportunity for education with the removal of time constraints of a busy elective practice.

“We recommend that residents produce thorough operative preoperative plans to discuss with the attending prior to the case,” the authors wrote. “Operative execution should continue to be practiced in a graduated manner that protects the patient but also promotes skill progression. Postoperatively, faculty and residents should discuss the case in relation to the preoperative plan to glean knowledge from the procedure’s intricacies.”

Maintain an unexposed resident population

However, the authors stated faculty members should cover clinics without resident assistance when possible to maintain a healthy, unexposed resident population. Although this may lead to loss in educational value, the authors noted a post-clinic virtual conference between attendings and on-service residents to discuss patient presentations and radiographic correlations may simulate the ambulatory clinic setting. Use of video-enabled telemedicine can be performed in most musculoskeletal subspecialty visits and can allow residents to be part of the virtual clinic visits in real time by performing the history and video examination prior to the attending, according to the authors.

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Finally, the authors recommend residents on remote-working teams use any additional time to study, prepare for the boards, execute and complete clinical research projects, grant writing, quality improvement ventures and other academic endeavors. Senior authors and residents can conduct video-enabled virtual research meetings to ensure progress is maintained and enhanced by unparalleled time availability.

“This methodical response to the pandemic optimizes an otherwise exigent depletion of orthopedic learning opportunities. With the creation of the remotely working resident cohort, a daily, attending-lead video teleconferencing didactic sessions couple with self-directed learning to perpetuate resident engagement,” Boden told Healio Orthopedics. “Further, a revitalized focus on academic investigation, grant-writing and quality improvement projects is derived from the obligate departure from traditional clinical duties. Sustaining the education and development of the finite timeline of an orthopedic resident in the face of this pandemic requires a departure from standard operating procedures, but is requisite, nonetheless. We hope our approach can guide other departments navigating an overburdened health care system battling a macabre international catastrophe.” – by Casey Tingle

 

Disclosures: Boden reports he has stock or stock options in Bone Biologics Corporation and SkelRegen; is a board or committee member for Eastern Orthopaedic Association; is on the editorial or governing board for the Journal of Bone and Joint Surgery, Orthopedics Today, Saunders/Mosby-Elsevier, Seminars in Spine Surgery, Spine and Spine Surgery Today; receives publishing royalties, financial or material support from Saunders/Mosby-Elsevier and SLACK Incorporated; and receives IP royalties and is a paid consultant for SeaSpine.