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SAU Best Practice Guidance

For Urology Residency and Fellowship Programs During COVID-19 Pandemic

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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