SAU Best Practice Guidance

For Urology Residency and Fellowship Programs During COVID-19 Pandemic

The duty to provide care for patients above all else is integral to being a physician. During this pandemic, our systems as well as educational processes are going to be challenged. Patient care must remain at the center of all our decisions.

Current Setting

• COVID-19 pandemic and associated restrictions.
• Increased concern for exposure and safety of residents
• Reduced clinical and surgical activity for core urology specialty
• Increased demand towards non-urological care

Conceptual Priorities

• Resident safety and reduced exposure to coronavirus/COVID-19
• Preservation of available teams to provide care in case of exposure
• Clinical educational opportunities in the operating room, ambulatory, and inpatient setting
• Gain educational opportunities in didactics and research
• Provide excellent service to patients
• ACGME policies and regulations

Resident Safety and Reduction of Exposure to COVID-19:

• Residents must be trained in appropriate infection prevention
• Residents must be provided appropriate PPE
• Residents must be provided with appropriate and frequent communications from health authorities, hospital leadership, as well as program leadership
• Residents double scrubbing should be reduced to decrease exposure risk and use of PPE
• Residents who are potentially higher risk for complications from infection should have limited/no contact with suspected or known positive patients.
• Pregnant residents should avoid contact with COVID-19 confirmed or suspected patients
• Residents stress and concerns are broadly present. Residents should be offered special counseling services help cope with stress related to COVID-19

Preservation of Available Teams to Provide Care in Case of Exposure

• Programs should consider splitting teams at major teaching sites on weekly or biweekly rotations to reduce exposure and also to preserve a team in case of exposure resulting in quarantine of the resident compliment.  Given reduced urological surgical cases and ambulatory load, educational and service opportunity can be matched appropriately
• Smaller resident teams at other teaching sites can be considered for cross coverage with weekly or biweekly presence so educational and service opportunities can be matched with in-hospital residents

Educational Opportunities in Clinical Settings

• Surgical cases should be assigned to appropriate level residents
• Chief residents should be prioritized for cases needed to fulfill case requirement or build appropriate confidence for independent practice
• Minimize resident involvement as second-assist or in multidisciplinary cases with limited involvement
• Limit involvement to higher yield clinical activity due to reduced patient numbers might serve as an opportunity for improved resident learning in clinic (this should be balanced with in-hospital teams and clinic presence may be minimized for overall reduction of exposure).
• Resident should participate in telehealth initiatives

Other Educational Opportunities

• Programs should consider availibilty of didactics and conferences via video and teleconferencing media
• Frequency of conferences can be increased if clinical work load is low and at-home resident team can stay engaged
• Faculty members with reduced work load generate additional lectures /didactic activities with expectations that all residents not involved in clinical activity should participate
• Residents not involved clinical activity should spend time on study plans and areas of improvement
• Encourage residents not involved clinical activity to spend time working on research projects, quality initiatives, or other scholarly type work

Care of Patients

• Residents should stay engaged in providing excellent patient care
• Residents should continue to seek excellence in competencies
• Residents should help patients and families impacted by the pandemic and provide context for them to aid coping and care
• Program leadership should speak to residents, explain redeployment, and comply with resident redeployment as needed

ACGME Policies and Regulations

• Program leadership, residents, and faculty members should familiarize themselves with ACGME guidelines and plans during the COVID-19 pandemic at www.acgme.org/covid-19
• Program leadership should stay up to date in changes in policies and guidelines
• Program leadership should participate and stay engaged with local GME office and DIO