COVID-19 Impact on Electives and Clerkships

[LittleDaisy]

On 3/11/2020 at 6:44 PM, Snowmen said:

Oh my god I wish they did that at my school. Can't stand my family medicine rotation (which includes ER)... Hahaha

They've just cancelled all international electives for Quebec students per ministry requirement. Clerks also aren't allowed to be inside a suspected or confirmed case's room or to participate in their care. Fine for residents though.

For residents, from what I've heard, if you don't feel comfortable, you could always ask your staff physician to see. They are the MRP and have the ultimate responsibility.

If I am an academic staff physician, I will go see the COVID 19 cases myself instead of asking my residents and put them in a vulnerable situation. Just my two cents. 

[Aetherus]

23 minutes ago, LittleDaisy said:

For residents, from what I've heard, if you don't feel comfortable, you could always ask your staff physician to see. They are the MRP and have the ultimate responsibility.

If I am an academic staff physician, I will go see the COVID 19 cases myself instead of asking my residents and put them in a vulnerable situation. Just my two cents. 

I don’t think this is feasible. You are a physician, and whether or not you feel comfortable seeing a patient, it is your duty to provide care. If the proper equipment is in place (PPE) than you have no reason to compromise the patients care. 

Furthermore, the main exposure threat is with regards to patients coming in to clinics and are asymptomatic or have not been labelled as a COVID-19 case. Once they are identified, we have the proper procedures in place to prevent transmission. 

[Snowmen]

44 minutes ago, LittleDaisy said:

For residents, from what I've heard, if you don't feel comfortable, you could always ask your staff physician to see. They are the MRP and have the ultimate responsibility.

If I am an academic staff physician, I will go see the COVID 19 cases myself instead of asking my residents and put them in a vulnerable situation. Just my two cents. 

Clerks are not allowed to see potential or confirmed COVID-19 cases in Quebec so it's not that I'm afraid of it. I just hate family medicine that much.

[JohnGrisham]

23 minutes ago, Aetherus said:

I don’t think this is feasible. You are a physician, and whether or not you feel comfortable seeing a patient, it is your duty to provide care. If the proper equipment is in place (PPE) than you have no reason to compromise the patients care. 

Furthermore, the main exposure threat is with regards to patients coming in to clinics and are asymptomatic or have not been labelled as a COVID-19 case. Once they are identified, we have the proper procedures in place to prevent transmission. 

Not all hospitals and regions are as well equipped as people like to think. Canada is a very diverse place  

[JohnGrisham]

I am surprised more schools are not telling Clerks to go home - they are non-essential, and in an odd position from a labour law perspective. No pay, no union etc, yet still potentially being unnecessarily exposed.

May be over reacting, but certainly  2-3 weeks of missed clerkship isn't the end of the world.

Especially for graduating 4th years who are already matched. 

[ellorie]

Here, I think our clerks are being told not to see any patients who could be cases (i.e. with cold/flu symptoms) and residents are being told to continue providing care as usual, with the caveat that programs are being asked to consider that seniors writing exams may wish to avoid high risk exposures and facilitate that.

[WKGOS]

Western is done for classroom teaching.

https://news.westernu.ca/2020/03/presidents-statement-on-covid-19-efforts-march-12/?fbclid=IwAR0RQ0i0Nk6vggRjoiw8aHPS9Z_9nxv91oVcwxjgQjQ3JLaqhL7WQdAsEw0

I have a feeling class cancellations are going to sweep the country. As a pre-clerk... it was nice being here!

[1D7]

57 minutes ago, Aetherus said:

I don’t think this is feasible. You are a physician, and whether or not you feel comfortable seeing a patient, it is your duty to provide care. If the proper equipment is in place (PPE) than you have no reason to compromise the patients care. 

Furthermore, the main exposure threat is with regards to patients coming in to clinics and are asymptomatic or have not been labelled as a COVID-19 case. Once they are identified, we have the proper procedures in place to prevent transmission. 

Healthcare workers are superspreaders. We work with populations most likely to die from the disease. This isn't time for some hero-martyrdom complex bullshit; that's how vulnerable patients die.

If a patient is suspected to have coronavirus on a service where the patient has to be seen relatively closely by an attending, and the patient isn't immediately dying in front of you, I would argue residents have a duty to request staff see the patient instead.

 

[JohnGrisham]

2 minutes ago, 1D7 said:

Healthcare workers are superspreaders. We work with populations most likely to die from the disease. This isn't time for some hero-martyrdom complex bullshit; that's how vulnerable patients die.

If it's a service where the patient has to be seen relatively closely by an attending, and the patient isn't immediately dying in front of you, I would argue residents have a duty to request staff see the patient instead.

 

My thoughts exactly, but towards clerks - majority of clerks are non-essential, and just more bodies transmitting and using up valuable/scarce PPE/gowns/equipment.  

 

[frenchpress]

26 minutes ago, JohnGrisham said:

My thoughts exactly, but towards clerks - majority of clerks are non-essential, and just more bodies transmitting and using up valuable/scarce PPE/gowns/equipment.  

 

Absolutely, it’s extra resources for people that are essentially just functioning as disease vectors without much other benefit. I suspect clerks will be out of hospitals fairly soon if the trend continues. If the hospitals weren’t basically at capacity already and potential risks not so high, it might be a great opportunity to learn... but not worth the risk of spread between patients for just students’ benefit.

[Aetherus]

2 hours ago, 1D7 said:

Healthcare workers are superspreaders. We work with populations most likely to die from the disease. This isn't time for some hero-martyrdom complex bullshit; that's how vulnerable patients die.

If a patient is suspected to have coronavirus on a service where the patient has to be seen relatively closely by an attending, and the patient isn't immediately dying in front of you, I would argue residents have a duty to request staff see the patient instead.

 

I understand all of this and I’m not advocating to be a hero-martyrdom. As a resident, there is often situations where you are the only physician to assess the patient and you report to your staff. I think it’s unreasonable in these situations to put your staff at risk (who may be older and more likely to have complications, and is arguably more useful to the system) when you could simply see the patient. 

Sure, if the patient has to be seen by the attending regardless, then maybe we don’t need 5 different people to see the patient. But there are many other situations where, as a resident, you will need to assess these patients. 

I agree that clerks should not see these patients as they are unable to provide independent care and are just exposing themselves unecessarly.

[Snowmen]

One of the major newspapers in Quebec has written that the Quebec government will announce the closure of all universities, CEGEPs and schools. Let's see how this affect clerkship.

Also, the french schools have cancelled their MMI for this year.

[divinecomedy]

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[lost__in__space]

UofT cancelled all classes. Clerks still on the wards but they may change that coming up on Monday.

[NLengr]

Honestly, once/if the volume starts to increase it will be all hands on deck if needed. Both the resident and the staff will be seeing different COVID patients. 

[LittleDaisy]

https://www.cfpc.ca/uploadedFiles/Publications/News_Releases/News_Items/CCFP-exam-postponement-re-COVID-19-ENG-Mar-13-20.pdf

It has become real! Same thing for Royal College and MCC!

I would advise residents who passed MCCQE2 to apply for restricted license, unless the provincial colleges can bend their rules and give independent license until residents pass their certification exam somewhere down the road. 

[JohnGrisham]

Rumour mill has it Western FoM has cancelled remaining 4th year electives, any other schools taking drastic, but necessary steps?

[yup]

6 minutes ago, JohnGrisham said:

Rumour mill has it Western FoM has cancelled remaining 4th year electives, any other schools taking drastic, but necessary steps?

UofT has also cancelled remaining 4th year electives, but CC3s are to continue rotations until further notice. Are other schools handling clerks differently?

[Edict]

23 hours ago, JohnGrisham said:

My thoughts exactly, but towards clerks - majority of clerks are non-essential, and just more bodies transmitting and using up valuable/scarce PPE/gowns/equipment.  

 

Still, they paid money to learn and if they are seeing non infectious cases, it is still learning. In my opinion, they are doctors in training. Ultimately, this is what we (as physicians) are getting paid the big bucks and the respect to do. You can't have your cake and eat it. It's like choosing to be a firefighter and deciding not to go into the burning building, or choosing to be a soldier but refusing to actually fight on the frontlines. Ultimately, if infectious cases aren't your thing, there are obviously great specialties out there that have much lower risk of getting infections. 

Logic is logic, don't bring your entire posse of 7 learners into a COVID-19 patient's room to "do some teaching", but i don't really see the infection risk increasing as long as proper PPI is donned and minimal contact is performed. 

 

[divinecomedy]

University of Pennsylvania has temporarily suspended clerkships and electives for all students.

"Consistent with Penn Medicine's plans for COVID-19 that were disseminated this morning, we have decided to temporarily suspend all medical student clinical rotations effective today, March 13, 2020 noon, after safe transition of patients. This includes all clerkships, sub-internships and electives.

Your education and training are very important, but we must balance the learning environment with patient safety as well as your safety. We are at a critical junction with COVID-19..."

[JohnGrisham]

2 hours ago, Edict said:

Still, they paid money to learn and if they are seeing non infectious cases, it is still learning. In my opinion, they are doctors in training. Ultimately, this is what we (as physicians) are getting paid the big bucks and the respect to do. You can't have your cake and eat it. It's like choosing to be a firefighter and deciding not to go into the burning building, or choosing to be a soldier but refusing to actually fight on the frontlines. Ultimately, if infectious cases aren't your thing, there are obviously great specialties out there that have much lower risk of getting infections. 

Logic is logic, don't bring your entire posse of 7 learners into a COVID-19 patient's room to "do some teaching", but i don't really see the infection risk increasing as long as proper PPI is donned and minimal contact is performed. 

 

Many hospitals, even in big centres are already looking towards running low on PPE, gowns, gloves etc. 

We don't need med students scrubbing into ORs for learning and wasting supplies. 

2-3 weeks of no clerkship is not the end of the world for learning.

[ChemPetE]

McGill just cancelled their clerkship. Off starting Monday. What on earth is happening I don’t even

[Snowmen]

2 hours ago, Edict said:

Still, they paid money to learn and if they are seeing non infectious cases, it is still learning. In my opinion, they are doctors in training. Ultimately, this is what we (as physicians) are getting paid the big bucks and the respect to do. You can't have your cake and eat it. It's like choosing to be a firefighter and deciding not to go into the burning building, or choosing to be a soldier but refusing to actually fight on the frontlines. Ultimately, if infectious cases aren't your thing, there are obviously great specialties out there that have much lower risk of getting infections. 

Logic is logic, don't bring your entire posse of 7 learners into a COVID-19 patient's room to "do some teaching", but i don't really see the infection risk increasing as long as proper PPI is donned and minimal contact is performed. 

 

As clerks, we bring absolutely nothing positive to the healthcare system and especially in times like these. Students are nothing but vectors for the disease and, as mentioned, waste valuable PPE. On top of that, they slow down residents and attending who actually bring something to the table.

This is acceptable in normal conditions because there is a long term benefit (new doctors) and the system has the reserve capacity to handle that. During times where resources will be overwhelmed, this is not acceptable.

[Edict]

31 minutes ago, Snowmen said:

As clerks, we bring absolutely nothing positive to the healthcare system and especially in times like these. Students are nothing but vectors for the disease and, as mentioned, waste valuable PPE. On top of that, they slow down residents and attending who actually bring something to the table.

This is acceptable in normal conditions because there is a long term benefit (new doctors) and the system has the reserve capacity to handle that. During times where resources will be overwhelmed, this is not acceptable.

That's not actually true. In surgery, clerks are enormously helpful. I didn't believe it when i was a clerk, when residents told me, but as a resident i realized it is very true. Even in other rotations like emerg or family, sometimes even a conversation or a chat with a patient makes them feel cared for or allows them to bring information to the team that otherwise wouldn't be shared. 

[NLengr]

51 minutes ago, ChemPetE said:

McGill just cancelled their clerkship. Off starting Monday. What on earth is happening I don’t even

I have told my fellow staff and co-workers: We are going to wartime footing. The country needs to react like this is a war. So far, we have been.