reports on reorganizing a medicine residency program in response to COVID-19 and on internal medicine resident work absence during the COVID-19 pandemic 4,5 , coverage for our extra medicine ward teams was accomplished by pulling residents and interns off most consult services, ambulatory rotations, and quality improvement rotations. We added more house officers to the pulmonary consult service and the infectious disease consult service. We maintained a resident on the cardiology service. Interns that were previously assigned to the ED remained on that service. The medical and surgical ICUs quickly filled and a thirdMICU unit, supervised by faculty fromcritical care, was createdwith the use of residents and interns fromprograms such as oral maxillofacial surgery, emergency medicine, medicine/pediatrics, general surgery and vascular surgery.
telemedicine capacity for trainees during the COVID-19 pandemicdemonstratedthatasuccessfulprogramrequired development of technical proficiency, virtual information gathering (inclusive of history, collateral information, and physical exam), and interpersonal communication skills. 6 Our house officers were able to overcome these challenges and continue to provide care to their clinic patients during this time.
TABLE 1: Program Patient Care: Comparison of Pre-COVID, COVID-19 First Peak, and COVID-19 Post First Peak
COVID-19 First Peak: March-May 2020
COVID-19 Post First Peak: June 2020- February 2021
PRE-COVID-19
University Medical Center
Pandemic Response after the initial COVID-19 peak decreased
• 4 ward teams • Call every 4 days
• 6 ward teams • Call every 6 days
• 4 ward teams • Call every 4 days • 14 patient cap/team
• 20 patient cap/team • MICU step down team • 1 MICU team • Subspecialty consult rotations • Ambulatory rotations • Qualityimprovement/ patient safety rotations • Emergency room rotations • Continuity clinic patient visits for all residents and interns
• 20 patient cap/team • Initiation of private hospitalist service • Cohort COVID-19 patients on specific units • 2 MICU teams
We maintained this new organization for patient care at all sites through May and transitioned back to our pre- COVID structure in June 2020 as the number of patients hospitalized with COVID-19 decreased significantly and continuity clinic activity returned. UMC maintained the locums private hospitalist service and supported LSUHSC to develop a direct care hospitalist service that was not reliant on residents or interns. A comparison of the internal medicine residency program’s patient care services pre- COVID-19 and through the pandemic is included in Table 1. Although we have had two additional peaks in COVID-19 activity, neither was severe enough to require changes to our patient care coverage. COMMUNICATION A key to successful management of patients and physician well-being during a pandemic or other disaster is communication. Communication is essential to maintain communityandasenseofnormalcy. 7 WayneStateUniversity School of Medicine developed a ‘Virtual Conversation Series” to connect students with physicians on the COVID-19 frontlines. 8 Learners positively rated this method of communication and this study demonstrated that information on patient experiences, resource shortages, and mental health challenges could be disseminated through the use of this ZOOM-based platform. 8 Several methods and levels of communication were used to update leadership, faculty, residents and interns on the COVID-19 pandemic trends, testing, treatments, rotation changes, didactic education opportunities, wellness initiatives, and vaccinations. Each of our hospital partners established COVID-command centers and held weekly meetings to provide hospital workers, medicine faculty and house officers updates on topics such as COVID-19 hospital census, personal protective equipment supplies, medication availability, wellness, and, more recently, vaccinations. At each site we would send a representative to this meeting who would report back to the internal medicine faculty and house officers. The electronic health record system, EPIC, was amended with a COVID-19 information tab. This site contained information on
• Private hospitalist service • Cohort COVID-19 patients on specific units • MICU step down team • 1 to 2 MICU teams • Subspecialty consult rotations • Ambulatory rotations • Quality improvement/ patient safety rotations • Emergency room rotations • Continuity clinic patient visits for all residents and interns
Pandemic response at Touro
• Opened extra MICU • Subspecialty consult rotations limited to
At Touro, we maintained the same pre-pandemic structure that had been in place since we only had enough graduate medical education residency cap positions to maintain the ward services and we did not have any residents on extras services at that site. The hospital administration decided that all COVID patients would be admitted to either our resident ward teams or to two other private hospitalist groups.
pulmonary, infectious disease, and cardiology • Emergency room rotations • Continuity clinic limited to telemedicine and prescription refills with only 4 ambulatory residents
Pandemic response at OKMC
At OKMC, we maintained the four inpatient medicine ward teams with one resident and one intern each that took call every four days and two night float interns rotating every three days. We added one extra intern, who was pulled off the consult services, as a “float” intern who would assist the ward teams with the highest number of the most complicated patients as requested by the hospitalist faculty at that site. This was a simple solution to offload teams on a day to day basis without having to constantly adjust house officer schedules. We shifted the remaining house officers on the consult services to either pulmonary/critical care or infectious diseases teams.
Touro Infirmary
• 4 ward teams • 14 patient cap/team
• 4 ward teams • 14 patient cap/team • Cohort COVID-19 patients on specific units
• 4 ward teams • 14 patient cap/team • Cohort COVID-19 patients on specific units
Ochsner-Kenner Medical Center
• 4 ward teams • 14 patient cap/team • Subspecialty consult rotations
• 4 ward teams • 14 patient cap/team • Extra float intern on Wards team • Cohort COVID-19 patients on specific units • Subspecialty consult rotations limited to pulmonary and infectious Disease
• 14 patient cap/team • Cohort COVID-19 patients on specific units • Subspecialty consult rotations
Pandemic response in our continuity clinic
Prior to the COVID-19 pandemic, all internal medicine residents and interns had a half-day per week continuity clinic. At the onset of the pandemic, the medicine clinic closed to patient visits and effectively ended our continuity clinics by April 2020. During this time, we assigned three to four house officers on ambulatory rotations to the medicine clinic to manage telemedicine patient visits and prescription refills. Challenges to telemedicine and virtual patient encounters included the technical aspects such as computer system requirements for both the patients and medical trainees. A published case study on building
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J LA MED SOC | VOL 173 | SUMMER 2021
J LA MED SOC | VOL 173 | SUMMER 2021
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