COVID-19 Impact on Electives and Clerkships

[HappyAndHopeful]

Clerks here are still continuing clinical activities for the time being, too. All visiting and away electives have been cancelled here, though, and optional electives for pre-clerks have been cancelled as well. Lectures for pre-clerks and review lectures for MS4s will be online from now on instead of in person, and exams will be online as well. OSCEs have been postponed. 

[frenchpress]

49 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.

I agree. But I can’t help but wonder what happens if this goes on for a prolonged period of time. At some point we can’t just stop training new doctors.

[JohnGrisham]

54 minutes ago, Edict said:

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. 

Agreed completely, but in times of crisis - we aren't going to be sitting around talking about dispo planning. In classic disaster triage mode, its the big stuff. 



 

[NutritionRunner]

At Queen's, Undergraduate medicine and Nursing classes are still continuing, as are rounds and grand rounds. Seems every university is taking a different approach.

 

From The Faculty of Health Sciences at Queen's:

Quote

Should committee, departmental or intra-departmental meetings be cancelled?
All regularly scheduled departmental, intra-departmental or intra unit meetings may proceed. This includes committee meetings, rounds, grand rounds, faculty meetings and academic council. During these meetings, please take the following precautions:

• Attendees should practice meticulous hand hygiene
• Attendees should practice appropriate social distancing in the room to the extent possible
• Attendees should self-screen per the protocol outlined by Public Health and the Faculty of Health Sciences
• Where possible, provide a remote option for those who are not able to attend in person

Quote

Undergraduate Nursing
All undergraduate nursing courses remain in session with all clinical learning and labs proceeding. Please refer to information from Dr. Erna Snelgrove-Clarke with regards to the delivery of classes online. 
 
All undergraduate classes that are not delivered by the nursing program (ie. elective courses delivered by other faculties) are suspended until March 23^rd.  
 
Undergraduate Medicine 
Classes remain in session. Please refer to information from Dr. Tony Sanfilippo with regards to the delivery of classes online. 

Quote

GRADUATE PROGRAMS
ALL graduate programs and courses will continue as originally scheduled. 
 

Queen's also has an FAQ for students working in clinical settings:

Quote

When should I suspect COVID-19 infection?

COVID-19 infection is suspected in patients who have a febrile respiratory illness AND have had recent travel to an affected area or contact with an infected person

What should I do if I suspect that I have a coronavirus infection?

If you have a febrile upper respiratory tract illness but do not have any of the risk issues below, no measures are required.

If you have febrile upper respiratory tract illness AND one of the following two features: 

1. You have travelled an affected area
2. You have had contact with a known case of COVID-19

Please take the following steps:

1. Avoid contact with others. If you are not seriously ill, call your health care provider and tell them about your symptoms. After hours, or if you do not have a health care provider, contact Telehealth Ontario at 1-866-797-0000. Do not visit your health care provider or a walk-in clinic without calling ahead.
2. If you are seriously ill, go the Emergency Department of the nearest hospital and advise of your recent travel or contact.

If you are required to stay at home or miss class, please follow standard procedures and report to your program office.

I am a student working in a clinical setting. What should I do if I suspect a coronavirus infection in a patient or client?

Students who suspect a COVID-19 infection in a patient or client - based on appropriate symptoms and recent travel to an affected area or contact with a confirmed case - should report immediately to their direct clinical supervisor.

I am a student working in a clinical setting. Should I still be providing patient care?

Students will be expected to continue to provide patient care, except in cases where a COVID-19 infection is under investigation, presumptive or confirmed.

I am a student working in a clinical setting. Should I still be providing patient care to patients with COVID-19 infection?

Students will not be expected to provide direct care to patients in cases where COVID-19 is under investigation, presumptive or confirmed:

• COVID-19 is considered under investigation if symptoms develop in a patient who has recently travelled to an affected area, or who has come into contact with an individual with confirmed COVID-19 infection
• COVID-19 is considered presumptive if local serologic testing is positive
• COVID-19 is confirmed when local positive testing is confirmed at the central national testing facility

If a student is excused from clinical service, they should report this immediately to their program office by email or phone so that alternative educational experiences can be arranged.

I am a student working in a clinical setting. What if there is a presumptive or confirmed COVID-19 case on my service or in my setting?

All students working in clinical settings should use the following guidelines:

• Always practice good hand hygiene, cough etiquette and stay home if you’re sick
• If you are a working in the hospital, ensure you have undertaken N95 mask fitting
• Follow all hospital/clinic IPAC directives regarding infection control practices and be aware that should an outbreak occur, practices and guidelines will change accordingly

 

[divinecomedy]

Compiling a list of elective cancellations at different institutions:

 

Ottawa - cancellations of all electives (CMG and IMG) until June 30th

Toronto - cancellation of all electives (CMG and IMG) until June 28th

UBC - cancellation of all electives (CMG and IMG) until July 5th

Dalhousie - cancellation of all confirmed electives and pending applications (IMG only)

Western - cancellation of all electives (CMG and IMG) until further notice

McMaster - cancellation of all electives (IMG only) until August 31st

Queen's - cancellation of all electives (IMG only) until May 1st

Northern Ontario - cancellation of all electives (IMG only) until further notice

Manitoba - not accepting applications from IMG at this time

Saskatchewan - suspension of all learners from emergency department

Alberta - cancellation of electives (IMG only), all electives outside Alberta have been cancelled (CMG and IMG)

MUN - cancellation of electives (IMG only) until further notice, CMG electives subject to change

 

What a mess!

[Snowmen]

9 hours ago, Edict said:

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. 

Reading about the situation in Italy or Spain really makes me feel like this is a period where what we'll need is someone to chat with the patients.

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

[X Æ A-12]

No health authority has advised against domestic travel. Love to see medical schools contributing to the chaos, panic and overall mental unwellness of medical students by banning domestic travel of Canadian medical students to their planned electives. Very evidenec-based (y)

[X Æ A-12]

4 hours ago, divinecomedy said:

Compiling a list of elective cancellations at different institutions:

 

Ottawa - cancellations of all electives (CMG and IMG) until June 30th

Toronto - cancellation of all electives (IMG only) until June 28th

UBC - cancellation of all electives (out-of-province CMG and IMG) until July 5th

Dalhousie - cancellation of all confirmed electives and pending applications (IMG only)

Western - cancellation of all electives (IMG only) until further notice

McMaster - cancellation of all electives (IMG only) until August 31st

Queen's - cancellation of all electives (IMG only) until May 1st

Northern Ontario - cancellation of all electives (IMG only) until further notice

Manitoba - not accepting applications from IMG at this time

Saskatchewan - suspension of all learners from emergency department

Alberta - cancellation of electives (IMG only), all electives outside Alberta have been cancelled (CMG and IMG)

MUN - cancellation of electives (IMG only) until further notice, CMG electives subject to change

 

What a mess!

https://md.utoronto.ca/electives 

All UofT electives are cancelled

[divinecomedy]

13 minutes ago, swoman said:

https://md.utoronto.ca/electives 

All UofT electives are cancelled

Thanks. Will update.

[X Æ A-12]

Just now, divinecomedy said:

Thanks. Will update.

Western cancelled everything as well minutes ago.

[divinecomedy]

3 minutes ago, swoman said:

Western cancelled everything as well minutes ago.

Seriously?

[Darkchrono]

University of Montreal cancelled everything until further notice as well yesterday evening 

[divinecomedy]

Did McGill just cancel all electives for 2 weeks?

[yup]

38 minutes ago, swoman said:

Western cancelled everything as well minutes ago.

Clerkship included?

[ihsh]

20 minutes ago, yup said:

Clerkship included?

Western cancelled everything, including clerkship, until March 23rd. 

[Arztin]

University of Montreal pulled out all med students apparently.

For residents, royal college, mccqe2, and CFPC exams all postponed.

What's funny is that we keep working in hospitals, but an exam apparently is too dangerous, while 500 ppl can be at Costco at the same time.

[thethirdlaw]

This is going to be a mess with the 8 week cap on electives. People who are gunning for competitive specialties that organized away electives in April and May are going to have difficulty doing those rotations even at home. 

[divinecomedy]

2 minutes ago, thethirdlaw said:

This is going to be a mess with the 8 week cap on electives. People who are gunning for competitive specialties that organized away electives in April and May are going to have difficulty doing those rotations even at home. 

How about for less competitive specialties like family medicine? Do you think they'll be lenient when it comes to electives in this upcoming CaRMS cycle? I know some programs really desire students who have done electives there but some programs don't really care.

[thethirdlaw]

2 minutes ago, divinecomedy said:

How about for less competitive specialties like family medicine? Do you think they'll be lenient when it comes to electives in this upcoming CaRMS cycle? I know some programs really desire students who have done electives there but some programs don't really care.

No one knows, this is a unique situation that is still evolving. 

[Leon]

I would imagine that programs nationwide will be mindful of the restrictions and try to accommodate for that when assessing applications. I wonder how long the cancellations will be in effect for. Hopefully things settle and people don't lose too much elective time while being able to participate in training without unnecessary risk. 

[X Æ A-12]

53 minutes ago, Leon said:

I would imagine that programs nationwide will be mindful of the restrictions and try to accommodate for that when assessing applications. I wonder how long the cancellations will be in effect for. Hopefully things settle and people don't lose too much elective time while being able to participate in training without unnecessary risk. 

Programs with spring elective time (Calgary, McMaster, Queens, Edmonton) will have asterixes next to their application. Even if we tell PDs to be mindful, objectively, they will be weaker than their peers as they were barred from completing the electives they set up. I was informed of the cancellation at 5:30pm the day before my noon cross-country flight.

[prince-orlofsky]

Calgary has indefinitely suspended clerkship as well (and cancelled visiting electives). 

[LittleDaisy]

2 hours ago, Arztin said:

University of Montreal pulled out all med students apparently.

For residents, royal college, mccqe2, and CFPC exams all postponed.

What's funny is that we keep working in hospitals, but an exam apparently is too dangerous, while 500 ppl can be at Costco at the same time.

I agree that they should pull medical students out, they are in such a vulnerable position, if the staff asks them to see a COVID-19 case, they might not be able to say no. They should be placed in an optimal learning environment, not in a chaotic environment where their health will be compromised.

I find it ironic that the likelihood of residents getting the COVID-19 is much higher in hospitals than doing royal college exams with multiple testing centers and multiple dates. 

[Arztin]

23 minutes ago, LittleDaisy said:

I find it ironic that the likelihood of residents getting the COVID-19 is much higher in hospitals than doing royal college exams with multiple testing centers and multiple dates. 

Precisely what I think too.

[HappyAndHopeful]

37 minutes ago, LittleDaisy said:

I agree that they should pull medical students out, they are in such a vulnerable position, if the staff asks them to see a COVID-19 case, they might not be able to say no. They should be placed in an optimal learning environment, not in a chaotic environment where their health will be compromised.

Med students here are strictly not allowed to see or be involved in the care of any potential or confirmed covid patients. Thankfully, the staff all seem to be pretty well-aware of this and I haven’t heard of anyone being asked to see a patient with it.