Graduate Medical Education Update

Update on Graduate Medical Education from Elizabeth Ferguson, MD, FACS, Alliance Designated Institutional Official and Assistant Dean for Graduate Medical Education at Creighton University School of Medicine.
 

Dear GME Community,
Here are our most recent updates.


MEDICAL STUDENTS: The American Association for Medical Colleges has now pulled M3s and M4s nationally from clinical work for the next 2 weeks. Valleywise Health has adopted and expanded this recommendation to all student rotations for the next 2 weeks.

BOARD REQUIREMENTS: For those of you in the final year of training, there are concerns if there are changes to schedules as to whether it will impact the ability to sit for boards. The boards are in the process of responding to questions about time in residency and required rotations. Program directors please work with your specialty boards and advise your residents accordingly. The flexibility is welcome as we adapt to what we need to do to take care of patients.

NUMBERS TO GRADUATE: The ACGME has officially released that residents can graduate with less numbers if the program director, with consideration of the recommendations of the program’s Clinical Competence Committee, deems an individual resident/fellow competent. This takes some pressure off of residents as elective cases are cancelled. Continue to work with your program on details.

TELEHEALTH: The ACGME has cleared tele-health and tele-supervision to count as training opportunities. When things return to normal these rules will be determined by each specialty so it may not remain permanent.  

MOONLIGHTING: It is still allowed at this time; just remember duty hour rules still apply. 

REGULAR COMMUNICATIONS FROM VALLEYWISE HEALTH & ST. JOSEPH’S: As policies, protocols and guidelines from our two hospitals are updated in response to this pandemic, they are being routed through the Alliance Communications office who is sending them out each day in summary from alliance@creighton.edu. Please keep an eye out for these emails. You can also access them at anytime here: https://alliance.creighton.edu/about/arizona-health-education-alliance-covid-19-information

CHECKLIST FOR SCHEDULE CHANGES: We have drafted and are vetting a checklist for programs considering major schedule changes in response to COVID-19. As soon as it is final, we will distribute it to you. Please do not make any sweeping changes to your Residents & Fellow’s schedules until it has been distributed and you are able to meet all of the criteria identified within.

ISOLATION PATIENTS AT SJHMC: SJHMC has sent communication that residents should not be caring for patients in isolation. We obtained clarification from Dr. Sugimoto that in an effort to conserve PPE, SJHMC would ask that resident and resident teams avoid entering isolation rooms unless absolutely necessary. e.g. does the whole team need to gown up to enter patients room during rounds. Please limit to one if possible.

RESIDENT EXPOSURE TESTING PROCEDURES: Attached is a flowchart that demonstrates the process for Residents to get tested if they have had an exposure to COVID-19 at Valleywise Health. Also attached are the FAQs from Dignity Health for employees which include Q & A on exposure.  Please remember that an exposure only occurs when coming within 6 feet of a COVID-19 patient without donning proper PPE. Treatment of or contact with COVID-19 patients with proper PPE does not constitute an exposure.

RESIDENT ILLNESS - WHAT TO DO TO RETURN TO WORK: There have been some changes from the CDC if you get ill for health care workers - below is a summary.  This has been submitted to go on the Creighton website but that may be delayed so keep this handy until then:


In an attempt to clarify processes for COVID 19 prevention, please follow the steps below.  The infection control team cannot manage the overwhelming number of case-by-case questions.  We hope this helps clarify questions you may have.  
1.       Monitor your symptoms:
i.    Fever 100.4 or greater
or 
ii.  Cough
                 or
iii.  SOB
2.       If you are ill, stay home, see your PC provider, and have a Respiratory Pathogen Screen (RPS) done. 
a.       If this is positive, stay home to recover before returning to work.
b.       Do not return to work until you are asymptomatic.
3.       If the RPS is negative, you may require further testing.
a.       Continue to stay home.
b.       Discuss with your PCP if you are high risk for COVID and if you need further testing done
4. If you do not qualify for COVID testing or your COVID test is negative you may return to work 72 hours after your fever resolves (this is resolution without taking antipyretics) AND your respiratory symptoms are resolved AND it has been 7 days since your symptoms started. Any absence of 3 days or more requires clearance from Employee Health for return to work,
5. If you test positive for COVID here are the latest recommendations from the CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html


SUSPENSION OF VISA SERVICES: We received from the ECFMG identifying that the US Department of State has announced a suspension of Routine Visa Services in most countries worldwide. This will have an impact on those folks who just matched to your programs and need a J1 visa. Your current J1s will have received this email directly from the ECFMG. At this time, it will not impact the continuations of those currently in the states and on J1s. The GME office will work with the incoming J1 Residents & Fellows to get all paperwork submitted as soon as possible so that we have the best chance at getting them to your programs for an on time start, but please plan for delays. Visit ECFMG for latest updates. 

UPDATE ON TRAVEL: We are strongly recommending you do not travel outside the United States at this time. It appears likely that you will not be allowed back into the country and this can affect your eligibility to finish your residency.  

GRADUATION: We have received a few questions about whether or not to cancel graduation events. Due to the evolving nature of this outbreak, we are not able to predict what the recommendations will be in June, as such, we are recommending that if you have already reserved a location and/or vendors, keep your reservations until further notice. If you have not, we are recommending that you do not place deposits on anything until further instruction. 

ACADEMIC EXCELLENCE DAY:  We have confirmed with AED planners that they are considering different options for conducting AED and will be sending guidance to us soon. We will keep you informed.

Thank you for all you do for our trainees! Please let me know if you have any questions.
 
Elizabeth M.N. Ferguson, MD, FACS
Alliance Designated Institutional Official
Creighton University Arizona Health Education Alliance
Assistant Dean for Graduate Medical Education
Creighton University School of Medicine