Missing days due to corona and ACGME rules

[Que]

With this talk about quarantining residents, what do all these work days lost mean according to the GME and affecting graduation? Do we look the other way or take it out of vacation? Their website is vague.

Also, is there talk in your programs about canceling elective rotations and consolidating all residents to either take turns being home or working only on critical services as a way to reduce exposure?

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[DocVapor]

With this talk about quarantining residents, what do all these work days lost mean according to the GME and affecting graduation? Do we look the other way or take it out of vacation? Their website is vague.

Also, is there talk in your programs about canceling elective rotations and consolidating all residents to either take turns being home or working only on critical services as a way to reduce exposure?

This is likely specialty specific. Friday the ABA (Anesthesiology) sent out an email stating that mandated or self-quarantine will be counted as duty hours and leave it up to the PD's to determine appropriate study/activity, etc. If a resident contracts it and becomes ill, then the recently instituted extended leave rules go into effect that allow several weeks additional leave over standard vacation without extending training.

As far as electives/out rotations, yes my program is currently looking at that but no decisions made yet.

 

[Que]

This is likely specialty specific. Friday the ABA (Anesthesiology) sent out an email stating that mandated or self-quarantine will be counted as duty hours and leave it up to the PD's to determine appropriate study/activity, etc. If a resident contracts it and becomes ill, then the recently instituted extended leave rules go into effect that allow several weeks additional leave over standard vacation without extending training.

As far as electives/out rotations, yes my program is currently looking at that but no decisions made yet.

I'm not familiar with the extended leave rules, but applying it to residents who are infected seems understandable. What about for residents on electives who want to stay home so they don't get exposed?

 

[deleted480308]

I'm not familiar with the extended leave rules, but applying it to residents who are infected seems understandable. What about for residents on electives who want to stay home so they don't get exposed?

"I'm scared of sick people" doesn't tend to work for doctors

 

[DocVapor]

I'm not familiar with the extended leave rules, but applying it to residents who are infected seems understandable. What about for residents on electives who want to stay home so they don't get exposed?

They are physicians paid salaries to go to work and take care of patients. Why should they be able to just not show up and do their job?

 

[Que]

More specifically referring to residents on electives where they basically shadow all day. Not on important services

 

[DocVapor]

More specifically referring to residents on electives where they basically shadow all day. Not on important services

Sounds like they should go work on important services then, unless their program devises some sort of rotation.

 

[rokshana]

More specifically referring to residents on electives where they basically shadow all day. Not on important services

Got a feeling they will be reassigned...

 

[AMEHigh]

They are physicians paid salaries to go to work and take care of patients. Why should they be able to just not show up and do their job?

Because some rotations in the long run aren’t truly a necessity.

It seems we are in unprecendented times. Therefore, we’re trying to preserve our workforce and keep everyone as healthy as possible.

The details are still being worked out for our residents, but yes we’re pulling them from electives and non-essential rotations and figuring out a plan B. We want everyone healthy and safe and ready to step in when others get sick if needed. There’s nothing wrong with planning ahead.

 

[Mass Effect]

More specifically referring to residents on electives where they basically shadow all day. Not on important services

Despite the snark you're receiving, this is a 100% legit question. A lot of hospitals have canceled non-urgent patient visits and elective procedures. So it makes perfect sense that residents on these services will be either asked to fill another role (reassigned) or sent home. You should check in with your chief about it.

 

[DocVapor]

Because some rotations in the long run aren’t truly a necessity.

It seems we are in unprecendented times. Therefore, we’re trying to preserve our workforce and keep everyone as healthy as possible.

The details are still being worked out for our residents, but yes we’re pulling them from electives and non-essential rotations and figuring out a plan B. We want everyone healthy and safe and ready to step in when others get sick if needed. There’s nothing wrong with planning ahead.

For sure. I assumed the OP was asking about residents just not showing up due to their own decision. That may have been judgemental and harsh. Clearly if their program tells them to stay home that's entirely different and I 100% support that.

 

[Piebaldi]

More specifically referring to residents on electives where they basically shadow all day. Not on important services

Probably depends on your program - I would imagine that if a true crap hitting the fan situation happened where hundreds/thousands of patients needed treatment a ll those residents would get pulled out of electives and hit the floors to help the medicine residents and other services house/take care of patients. in my pain fellowship things are currently business as usual, and people still come for their Norco and their epidurals and mbbs. the only way the clinics would shut down is if the state declared a total shut down where people can't leave their houses, especially since they are elective procedures.
the other hospital I cover for has sent out notifications that all elective surgeries including things like joints, non emergent neurosurg procedures, etc. are all being postponed in case beds are needed.
so if a bunch of ppl come in i'm sure ur electives are gone, otherwise again i'd imagine it would be program dependent.
hospitals tend to be pretty important places with need for workers during true pandemics.

 

[AMEHigh]

For sure. I assumed the OP was asking about residents just not showing up due to their own decision. That may have been judgemental and harsh. Clearly if their program tells them to stay home that's entirely different and I 100% support that.

Yeah in times like this I'm trying to have compassion for everyone due to all the uncertainty.
Our program has definitely let residents know to let us know if they have concerns. For attendings over 60 and those with comorbid conditions they're also talking with their supervisors if they have concerns.
I think it's ok if people want to also prioritize their own well-being (physical and mental). Physicians are people too.

 

[DeucesHigh3]

Despite the snark you're receiving, this is a 100% legit question. A lot of hospitals have canceled non-urgent patient visits and elective procedures. So it makes perfect sense that residents on these services will be either asked to fill another role (reassigned) or sent home. You should check in with your chief about it.

I bowed out and took a vacation day today. I'm on breast imaging, and can't fathom that we're doing more good than harm by having elderly women congregate in one waiting room. I'm not shirking my duties... quite the opposite - trying to keep myself and the patients healthy until we're reassigned to doing intake/triage/hospitalist roles.

 

[Raryn]

ACGME isn't the problem here - the individual boards requirements to be able to get certified is the question.

Many of them have determined so far that any time quarantined related to COVID will still count towards clinical experience. But I'm unsure if all 20+ boards of the ABMS have ruled yet.

 

[Mass Effect]

ACGME isn't the problem here - the individual boards requirements to be able to get certified is the question.

Many of them have determined so far that any time quarantined related to COVID will still count towards clinical experience. But I'm unsure if all 20+ boards of the ABMS have ruled yet.

They all will. It would be enormously ridiculous not to.

 

[Piebaldi]

ACGME isn't the problem here - the individual boards requirements to be able to get certified is the question.

Many of them have determined so far that any time quarantined related to COVID will still count towards clinical experience. But I'm unsure if all 20+ boards of the ABMS have ruled yet.

Well I guess the problem is how long is reasonable though. I fsomeone decides to quarantine for 3months, I"m sure it won't go over well. And some programs might be more forgiving than others. And some states more hard hit than others.
I'm sure most residents are legit doctors and want to learn and work but there are always the bad apples that take advantage. I know this was becoming an issue at my old program - ppl would go to events, etc stay out late and then call in sick. It started getting noticed.

 

[TraumaLlamaMD]

They all will. It would be enormously ridiculous not to.

Someone should have told the ABS... don’t worry though, they are letting us tap into parental leave time for it! Hope there are no pregnant surgery residents out there.

 

[hallowmann]

The board has basically said that their rule still stands regarding missed time, but they encourage programs to work with residents to develop a curriculum so that at least some of that time can be counted towards electives. Our program is devising a curriculum for residents to work on if they have to quarantine at home. I don't love the idea of losing electives to quarantine, but I definitely prefer that over extending training.

 

[Mass Effect]

The board has basically said that their rule still stands regarding missed time, but they encourage programs to work with residents to develop a curriculum so that at least some of that time can be counted towards electives. Our program is devising a curriculum for residents to work on if they have to quarantine at home. I don't love the idea of losing electives to quarantine, but I definitely prefer that over extending training.

I think it depends on how long this goes on. If just a month, the ABS is silly for making residents lose electives over it. If it really does go on through the summer, there comes a point when you have to prioritize evaluating one's capability and competence based on already established time frames/procedure counts, even if it means extending training.

 

[TraumaLlamaMD]

I think it depends on how long this goes on. If just a month, the ABS is silly for making residents lose electives over it. If it really does go on through the summer, there comes a point when you have to prioritize evaluating one's capability and competence based on already established time frames/procedure counts, even if it means extending training.

I’m graduating at the end of June. I have all my case requirements fulfilled. I am also pregnant and due in early June, so this is fairly personal - if I get sick now, or quarantined, all the vacation block I’ve saved for a year and the parental leave may be gone. So at that point, I get the choice to return immediately to work after giving birth, or extend training and potentially derail my fellowship. If I were short cases, I’d understand, but I’m not. So I’m just hoping and praying I can avoid getting sick, but I fear it’s coming for many of us. I know I’m not the only resident in a similar position.

 

[Raryn]

I’m graduating at the end of June. I have all my case requirements fulfilled. I am also pregnant and due in early June, so this is fairly personal - if I get sick now, or quarantined, all the vacation block I’ve saved for a year and the parental leave may be gone. So at that point, I get the choice to return immediately to work after giving birth, or extend training and potentially derail my fellowship. If I were short cases, I’d understand, but I’m not. So I’m just hoping and praying I can avoid getting sick, but I fear it’s coming for many of us. I know I’m not the only resident in a similar position.

If I was your program director I'd make up some reading elective for you to take during those circumstances.

"TraumaLlamaMD wasn't off during that time. They were on their nutrition elective, which was achieved through online CME course XYZ"

No idea how legit that is, but I don't think the board will go looking for problems if you've met your numbers otherwise.

 

[calvinhobbes]

Our hospital leadership in a program in NYC told us that no one would be faulted for missing days or being quarantined, and that everybody would still graduate, not be delayed, no repercussions for being sick -- so hopefully that standard applies to many other programs.

 

[calvinhobbes]

Also, ACGME sent out an email a few days ago, saying it is up to the PD if they wish to waive cases/requirements for graduation, which I'm sure all PDs will, as this is unprecedented. No one's graduation will be delayed because of this. Some residents on elective are being told to stay home and be back-up, so they don't get exposed, while other PDs are giving residents online modules, readings, etc, to limit exposure but still count the rotation-from-home as a learning experience.