Modification to Neurology Residency Training: The …...2020/06/22 · Page 3 Abstract We describe the University of Toronto Adult Neurology Residency Program’s early experiences
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DOI: 10.1212/CPJ.0000000000000894
Page 1
Modification to Neurology Residency Training: The Toronto Neurology COVID-19 Pandemic Experience
Ryan T. Muir, MD, BHSc1; Priti Gros, MD1; Robert Ure, MD, BSc1; Sara B. Mitchell, MD, MPH2,4,7; Charles D. Kassardjian MD, MSc3,7; Aaron Izenberg, MD, MSc4; Peter Tai, MD, MSc5; Houman Khosravani MD, PhD*2,6,7; David K. Chan, MD, MEd*3
*these authors contributed equally to the manuscript
Neurology® Clinical Practice Published Ahead of Print articles have been peer reviewed and
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We describe the University of Toronto Adult Neurology Residency Program’s early experiences with and response to the COVID-19 pandemic, including modifications to the provision of neurologic care while upholding neurology education and safety. All academic and many patient-related activities were virtualized. This maintained physical distancing while creating a city-wide videoconference-based teaching curriculum, expanding the learning opportunities to trainees at all academic sites. Furthermore, we propose a novel “split-team” model to promote resident safety through physical distancing of teams and to establish a capacity to rapidly adapt to redeployment, service needs and trainee illness. Finally, we developed a unique protected code stroke framework to safeguard staff and trainees during hyperacute stroke assessments in this pandemic. Our shared experiences highlight considerations for contingency planning, maintenance of education, sustainability of team members and promotion of safe neurologic care. These interventions serve to promote trainee safety, wellness, and resiliency.
Introduction
The COVID-19 pandemic has affected more than 185 countries, surpassing 4.2
million cases and 290,000 deaths as of May 12th 2020.1 2 The clinical spectrum and
disease severity related to COVID-19 is broad, but its inundating effect on health
systems is universal.
Neurologists and neurology trainees will undoubtedly care for patients with
neurologic manifestations of COVID-19, 3 4 5 6 7 8 9 and also guide decisions regarding
immunotherapy for patients with underlying neurologic diseases who contract COVID-
19.10 11 12 Neurology trainees have been additionally impacted in their education and
well-being. Training experiences have been disrupted by alterations in rotations,
electives, examinations, and redeployment to other services.
Herein, we describe the University of Toronto Adult Neurology Residency
Program’s safety modifications to the provision of neurologic care while sustaining
neurology education during the pandemic. Our program is the largest neurology training
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Table 1: Restructured ABC Split-Team Model of Neurology Care during the COVID-19 Pandemic Residents at a particular site on neurology and/or stroke services are split into one of three teams: “A”, “B” or “C” comprised of 2-3 residents per team. In this system, Team A covers daytime service and overnight call during the first week and a different Team C member serves as a 24-hour back-up, available to join the team should the day-time team need assistance due to high patient volumes or to cover overnight on-call service should a Team A member become ill. To help decrease the burden of call to team A members during a week on active day-service, members of the backup team will also be assigned to do overnight call to provide relief to Team A. Although Team A is assigned to active day-service for two of the four weeks, they do not serve as back-up during weeks that Teams B and C serve as the primary active day-service.
Table 2: Restructured AB Split-Team Model of Neurology Care during the COVID-19 Pandemic Residents at a particular site on neurology and/or stroke services are split into one of two teams: “A” or “B” comprised of 3-4 residents per team. In this system, Team A covers daytime service and overnight call during the first week while Team B serves as a 24-hour back-up, available to join the team should the day-time team need.
Figure 1: Protected Code Stroke Pathway Protected Code Stroke (PCS) framework14 comprises two key sections: Screening and Actions. Patient undergoes Screening: for infectious symptoms, unclear history, lack of ability to communicate or features suggestive of an alternate diagnosis. Any of these features trigger a PCS. As community transmission of COVID-19 became more prevalent, travel history became a less important parameter in the PCS protocol The code then proceeds using appropriate. Actions: Personal Protective Equipment (PPE) for standard or aerosolizing procedures, masking of the patient, and considerations for avoidance of Aerosol Generating Medical Procedures (AGMPs), and early airway management. Emphasis is placed on Crisis Resource Management. We introduce the concept of SAFE code strokes: Safety leader for ensuring donning/doffing of PPE. Attention to not rushing, and having situational awareness. First putting on PPE for all team members. Engagement of the team and avoidance of Environmental contamination. Physician discretion is paramount when designating a code stroke a PCS. Local practices and regulations should be followed with regards to each of the Actions as part of a PCS.
kehttp://cp.neurology.org//cgi/collection/all_cerebrovascular_disease_stroAll Cerebrovascular disease/Strokefollowing collection(s): This article, along with others on similar topics, appears in the
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