Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
Featured topic and speakers
AMA Chief Experience Officer Todd Unger speaks with AMA Vice President of UME Innovations Kimberly Lomis, MD, Vice President of GME Innovations John Andrews, MD, and Chief Diversity and Inclusion Officer of ACGME William McDade, MD, PhD, on updates regarding COVID-19 including challenges in training and educating medical students and physicians during the COVID-19 pandemic and recently released recommendations from the Coalition for Physician Accountability.
Find out more about what the AMA is doing for medical education during COVID-19 with the medical education COVID-19 resource guide and COVID-19 resources for medical educators.
Learn more at the AMA COVID-19 resource center.
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 update. Today we'll discuss challenges in educating and training medical students and physicians during COVID-19, and recently released recommendations to help address these challenges.
I'm joined today by Dr. Kimberly Lomis, AMA's vice president of Undergraduate Medical Education Innovations in Nashville, Tennessee, Dr. John Andrews, AMA's vice president of Graduate Medical Education Innovations in Chicago and Dr. William McDade, chief diversity and inclusion officer at the ACGME and an AMA trustee in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago.
The Coalition for Physician Accountability has released key recommendations affecting students, residents and physicians, as well as hospital administrators and credentialing staff among others in response to COVID-19. Dr. McDade, for those of us who may be unfamiliar, what is the Coalition for Physician Accountability, and what role does it play in responding to education and trainee issues arising from the pandemic?
Dr. McDade: The Coalition for Physician Accountability was formed in 2009, had its first meeting in 2011 and consists of almost all of those national organizations that are responsible for assessment, creditation, regulation, and licensing for physicians throughout the continuum from medical school all the way through practice. The idea is that if these groups get together, they can start to think about a coordinated fashion, in a coordinated fashion to address issues of training and education and lifelong learning for physicians.
Unger: Dr. Lomis.
Dr. Lomis: Yeah. As you know, Todd, the disruption presented to medical education by the pandemic extends well beyond what any single institution can address on their own, whether that's a medical school or residency program or a health care delivery institution. So the coalition is really the important group to bring together the perspectives of all the right stakeholders to look at this from more of a systems lens. And a lot of the work is anchored in some guiding principles of keeping patients' safety and the safety of learners at the forefront, making sure that all our learners can meet core educational needs and to really recognize and acknowledge that there is difference across the country in the impact of this. And how can we mitigate this as much as possible, given the realities of our situation.
Unger: You each participated in different work groups within the coalition. Can you summarize what issues your work group addressed as well as the resulting recommendations? Dr. Andrews, why don't you start?
Dr. Andrews: Sure. Thanks, Todd. I was a part of a work group that aimed to address the uncertainty around the transition from medical school to residency that's coming up this summer. As people are probably aware, somewhere in the neighborhood of 30,000 medical school graduates will be transitioning to residency positions, many of them in cities other than the cities in which they attended medical school. And that raises a host of concerns about exposure to infection, about the impacts of a health screening and quarantine on their ability to start working in a new clinical environment, and frankly, on practical matters like their ability to find housing and participate in orientation activities. So my work group was charged with attempting to the best of our abilities to provide some guidance around those issues.
Dr. Lomis: I was serving on two different work groups, one focused on the volunteer activities that students started to engage in. As we've discussed before Todd, as you know, as soon as students were removed from the clinical environment, they jumped in wanting to serve with a variety of volunteer activities. Since that time, some of those activities have been taken under the wing of the schools and sometimes even leading to elective credit and looking forward, it may even be appropriate for some of those things to be included in mandatory coursework. So that particular team looked at the swath of those activities and made sure that people were fully aware of the potential risks associated with them and that the right precautions and protections were put in place. The issues of credit are very appropriate because a lot of these activities do contribute to the development of physicians in the way we would like to see them grow.
The other group that I was part of arguably has had the most attention on its recommendations. And that's the group that looked at the residency selection process for the rising senior class, the class of 2021. Historically that process has involved a lot of travel between away rotations at other institutions and the entire interview season. So we knew we had to make some changes and it's important that those changes be consistent throughout the whole cycle, even though you might have some months in which that travel's okay, or some regions in which it's okay, if the playing field is not even for everybody throughout the cycle, then it makes, as you could understand, the applicants quite nervous. So that group had three main recommendations that they put out to really pretty much ban away rotations, to be more specific, really curtailing the audition rotation. That's when a student goes to a specific program, hoping to strut their stuff and getting to know that single program a bit better.
There is a carve out because there's a need for away rotations to meet core educational requirements, so there's a little bit of protection there, but for the most part, really trying to discourage students to move into a different system right now. That's not the best for anyone. And then for the interview season really recommending that everything be done virtually with no in person interviews across the board. And then finally, because of all this, shifting the application deadline by just a few weeks. That's enough to help schools and students adjust the administrative reporting. As you know, because of the disruption of COVID, coursework is different, the grades are different, so the Dean's letter, the MSPE that the schools produce needs to be adjusted accordingly, and that window gives a little bit more time to make that as replete as possible. But students need to know it's not enough time to rebuild some of the experiences that they would have hoped to have had, whether that is various clinical rotations or whether it be global health experiences or research experiences. But it's important that the students are aware that the programs fully recognize that and they're not expecting as many of those activities in the application this coming year.
Unger: Dr. McDade, your work group?
Dr. McDade: So my work group focused on the maintenance of quality and safety standards amid the crisis. And one of the things that we're most concerned about is that various states and governors have permitted individuals who are outside the normal licensing practice for the state to enter into practice in that state and the flood of cases that were coming in. Some states also allowed people who graduated from medical school prematurely, that is before graduation period, and allowed some international medical graduates potentially to come in to become practicing physicians for a temporary basis in those states. So our group really focused on, first of all, ensuring that the attestations of the individual were consistent with the licensor information that was available for those individuals, so that you knew whether they were board certified or not. You knew whether they had licenses elsewhere or not. And you could figure out whether or not this person was really consistent with the picture they were showing.
The other thing we wanted to make sure is that the provision of care was going to be adequate for those individuals who are in practice. And so that if an individual had not been in a practice environment that you were now going to ask them to serve in, that there was adequate supervision of that individual and instruction as to how to regain those sorts of skills and accelerate back up to where they could actually handle patient care safely. One of the things that goes along with that is the adequate provision of PPE, personal protective equipment, to ensure the safety of those individuals coming into those environments. There's also the idea that physicians in general have a duty to serve even during these pandemic situations, and that's part of the AMA ethical principles, but I think has really adopted for positions across the continuum. And the final thing is we wanted to make sure that safety standards were adhered to as part of what we were doing by bringing in people from the outside, whether it's retired physicians who've come back into licensure or whether it's new physicians who've just left graduate medical education or just left medical school to help out in the crisis.
Unger: Dr. McDade, we know these disruptions will likely have a rippling effect on many areas. How do you see them impacting diversity specifically?
Dr. McDade: Well, as you well know, the initial problems that we saw with COVID-19 were very much concentrated in areas that had a high concentration of underrepresented minority individuals. And in fact, in Chicago, where I am, where you are now, of the first hundred cases of COVID, 70 of them were of African Americans. 70% of cases were African American. 50% of deaths were African American. We saw the same sort pattern in Louisiana and its initial outbreak. And the thought was that because we have people who work in the gig economy, that is, they are part of the essential group that may not necessarily be in health care, they had to keep working.
One of the things that you are really seeing is that the social determinants of health underlie what we see in general for health and exacerbate in those situations of crises like COVID. So it's really pulled off the scab on a bad wound that our country's had in the disparate health care between minority populations and the majority population. Our hope is that we can use this as a means to think about prevention and planning for future pandemic situations and to really work on equity in the health care system in general so that we can eliminate the risk that we put certain communities at.
Unger: Well, thank you, Dr. McDade, Dr. Lomis, and Dr. Andrews for being here today and for sharing your perspectives. That's it for today's COVID-19 update. We'll be back tomorrow with another update. In the meantime, for resources on COVID-19 visit the AMA COVID-19 resource center at ama-assn.org/COVID-19. Thanks for being with us here today and take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
