Thread by @drjenniferbest

John Choe, a fellow APD, had the great idea that we should share leasona from our residency program’s recent experience with the arrival of COVID-19 in Seattle with the APDIM @AAIMOnline listserv.

Adapted here for #MedTwitter Please RT!

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Hello colleagues. As all of you know, the Seattle area has been the epicenter of the novel coronavirus infection. It has been just over a week since the first US death was announced in a local skilled nursing facility, and since then the residency programs...

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at @UWMedicine + @VirginiaMason have had to undergo a crash course in infection control + epidemic management. We appreciate the words of support from many of you, but we wanted to share some early lessons from our experience here at UW....

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(which has been similar to the experience at VM) in order to help those of you in other parts of the country prepare for what seems to be the inevitable spread to other communities.

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Rumors/ hearsay/ false news has spread very quickly in these early days. Even with a local incident command team, delivering a consistent message has been challenging. At times, multiple offices have offered slightly contradicting information, all of which has added to...

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...uncertainty of faculty, trainees, + students. We recommend consolidating messaging where possible; and avoiding duplicative communication by clearly delineating what information comes from which office (residency program, GME, hospital/ clinic/system, public health)

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For our residents, the most effective means of communication has been nightly "debriefing" email directly from the PD. This daily message recaps updates most relevant to our residents, but also acknowledges directly the concerns and the anxiety that the faculty...

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...and the trainees have been experiencing.

The initial plan at the University of Washington had been to limit potential COVID patients to a select small group of hospitalists and intensivists with enhanced PPE training. We quickly realized that this was impractical...

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....given the scale and numbers of patients that we were seeing in our community, and we had to rapidly ramp up this enhanced PPE training to all our residents. This has been difficult to do in very short time especially as we have had to limit the equipment...

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....that we normally would use for training. Please consider expediting some PPE training NOW, including review of proper mask fitting, safe donning + doffing of protective gowns. Many of us were surprised to learn that even faculty were doing steps in this incorrectly.

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Do not neglect the very significant impact on mental health within your community, even when people are highly committed to this important work. Like many other programs, we offer peer/wellness support programs. Our programs are seeing larger than usual engagement.

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Work with your institution to scale for this. Program APDs + core faculty members are also reaching out proactively to check in with advisees to offer their support. At the same time, as core faculty we have had to explicitly acknowledge our own fears...

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...+ support one another to avoid "caregiver fatigue" in helping our patients + our trainees.

Work with institution to put into place steps for testing your own trainees + other staff. Our infection control specialists have had to rapidly develop practical protocols...

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...for what to do when employees develop symptoms potentially worrisome for COVID, or when employees are potentially exposed. Taking every potential exposure out of service for 14d is not practical, so we are very grateful for their thoughtful measures they’ve put in place.

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Residents have questions about the impact of sick or mandated leave on their return to work + training. Please address this directly where internal information is available. Share institutional leave policies. Our institution has communicated directly with the leadership...

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...of @ABMSCert + has learned they are actively working to navigate some of these issues.

Develop contingency staffing plans for your residents + fellows (and for that matter, your faculty and staff). Despite having a very robust "risk" / "jeopardy" system...

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...for our residents, we have had to develop additional contingencies for how we may need to ask residents to cover for one another beyond that risk system. Also, our community institutions like local schools are considering closing, which creates additional stress...

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...for all of us. We have had to consider individual learners' own health as well as part of this (e.g. pregnant trainees; on immunosuppressive meds; with sick family members at home), and have had to adapt our policies in an equitable but accepting way.

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We will try to share other lessons we learn, but we wanted to get these out there to our community now. We are grateful for our friends in other programs around the country. Wash those hands!

The Program Leadership @ the UW IM Residency Program

@acgme @SocietyGIM