Department moves quickly to enable medical students to continue their education despite a global pandemic

Professor Jeffrey Wozniak, PhD, LP, works with a group of learners on the Zoom platform.

On January 20, 2020, the first patient in the United States was diagnosed with COVID-19. By mid-March, the virus had hit all 50 states, according to the Centers for Disease Control. When Department of Psychiatry and Behavioral Sciences Associate Professor and Vice Chair for Education Kaz Nelson (pictured below right), MD, saw what was occurring, she realized that something needed to happen at the U of M – fast. “In New York, psychiatry residents were pulled off their units to work with COVID patients,” she said. “It was like looking into a crystal ball. Everyone was concerned – the need for a plan was very apparent.”

Katharine Nelson, MDThe plan had to include how the department would continue caring for its patients and educating its learners – residents, fellows, and medical students – even though Minnesota hadn’t yet been affected by the virus. Nelson and Assistant Professor and Deputy Vice Chair of Education Lora Wichser, MD; created these guiding principles for their action plan:

  1. Patient care is essential, and we have a duty to serve; every effort will be made to continue to care for patients at full capacity
  2. We will continue to provide psychiatry services through means that do not increase the risk of viral transmission (i.e., videoconferencing, e-communication, telephone)
  3. If our healthcare system’s needs escalate, we may be asked to participate in patient care that requires an in-person presence
  4. If in-person presence is required, all reasonable steps to prevent viral spread/transmission must be taken (e.g., availability and appropriate use of personal protective equipment)
  5. Based on available resources, in-person duties will be handled by providers who are not identified as especially vulnerable (pregnant, immunocompromised, etc.).

Phased approach
“In addition, we recognized that our response to the virus should be in different phases, depending on the seriousness of the situation,” said Nelson. “If people in Minnesota started to get sick, including our residents, we could be short-handed. Our plan should preserve workforce capacity to ensure we could care for our patients and ensure that, if called on to staff COVID units, we could do it.”

In that context, the team implemented these phases:

  1. Situation Level Green – normal operations
  2. Situation Level Orange – adapting to the pandemic’s early phase, and
  3. Situation Level Red – contingency planning for disaster scenarios, such as those experienced in New York or Italy.

“Using this framework, Residency Program leadership began meeting weekly with all residents to discuss the current Situation Level and steps being taken to respond to community and health system needs,” wrote Nelson in an article about the Education Team’s pandemic response. In addition, people on the front lines – in the clinic and on the inpatient units – moved quickly to create systems and partnerships with onsite staff to facilitate the use of videoconferencing.

Just like how we deliver care
“Using existing teleconferencing technology available at the University of Minnesota, we could deliver care to our psychiatric inpatients in a teaching environment that includes medical students and residents. Nurses and case managers were available to continue to collaborate to develop treatment plans for patients. We translated our usual processes to take place on  the video screen.”

That’s an important point. medical students around the country were not being allowed to take on “in-person” clinical assignments while on COVID-19-related lockdowns. Enabling them to join patient care at the U of M meant their education continued seamlessly. “They were able to help write notes as usual and they could communicate with the patient to practice their interviewing skills,” said Nelson. “We could also accommodate more students on each care team. Other learners did online simulations, reading assignments, and parallel curricula.”

Fastest to adopt
The department was unique in offering its students ongoing learning opportunities during the initial height of the pandemic. “We were definitely the fastest to adopt this new reality,” said Nelson. That wasn’t the case for many Medical Schools, which decided to curtail or cancel such educational experiences. “Some institutions were using technology that only enabled the physician to connect with the patient and didn’t allow for others to dial in.”

To enable the most effective patient care and learning experience during the calls, the Education Team met with everyone involved in the videoconferences beforehand to assign roles. “It doesn’t go well in person when people interject when it’s not their turn,” said Nelson. “We translated that process to the virtual environment fairly seamlessly.”

Overwhelmingly grateful
How did the Medical School students react to the new processes? “Anecdotally, they were overwhelmingly grateful for the opportunity to interact with patients and to prepare for starting residency,” said Nelson. “If they didn’t have their required clinical experiences, they would go into the residency match process without anyone attesting to their skills.”

With a problem this vast, Nelson noted that it’s difficult for health systems to pivot overnight. “We had the support of our system to put innovative models in place,” she added. “Spearheading and piloting the things we did helped inform the system about how to scale measures that could be rolled out to other units. We benefitted from a strong relationship with your health system that allows mutual trust to innovate new processes that can help the system at large.”

What about this fall? “When the Medical School reached out to see when we could get learners back into the physical learning environment, I said that we’re comfortable picking the latest date,” said Nelson. “We have a functional system in place.”  

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