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      Residency redeployment during a pandemic: Lessons for balancing service and learning Translated title: Redéploiement des résidences au cours d’une pandémie : leçons pour équilibrer la prestation de services et l’apprentissage

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          Abstract

          Introduction The COVID-19 pandemic has required a rapid healthcare system response worldwide, including in Canada. 1 As of July 21 2020, 111,124 Canadians were diagnosed with COVID-19 with 8858 deaths, an estimated case fatality rate of 8%. 2 In Quebec there are a total of 57,796 cases, with the Greater Montreal area the epicenter 3 . To respond to health service delivery needs while maintaining standards of physician training, the Postgraduate Medical Education (PGME) Office of McGill University’s Faculty of Medicine developed a resident redeployment strategy to support its teaching hospitals. Redeployment was framed as an integral aspect of doctors’ implicit social contract. 4 McGill’s redeployment strategy took place between April 3 and June 30. During that time, 376 residents from 47 training programs were redeployed primarily to intensive care units and newly-established COVID-19 wards. The PGME Office requires that residents’ standing contracts be respected, including supervision and assessment. A pandemic redeployment assignment, of one- to two-weeks duration, provided structure to the learning experience. Recognizing the ongoing need for resident redeployment, a survey was developed and administered with a continuous quality improvement lens. We investigated two themes: 1) residents’ experiences of redeployment, and 2) the impact of redeployment on resident education. Pandemics suggest unique learning opportunities in medical knowledge, clinical skills, teamwork and resilience. Few studies investigate educational impact on trainees’ participation in emergency response. We gathered preliminary ‘lessons learned,’ aiming to discern satisfaction and effectiveness of COVID-19 redeployment learning activities, and frame a larger study of educational outcomes of resident pandemic redeployment. Methods A 13-question, tailor-made survey was developed, consisting of pre-selected response categories and free-text fields, and made available to 1200 residents in 70 specialties across MUHC, using the Microsoft Forms platform. Questions included: whether a redeployment rotation was completed; type of service attended two weeks prior to redeployment; scholarly activities; type of COVID-19 assignment; site of redeployment; level of satisfaction with redeployment; reasons for level of satisfaction; preferences for redeployment scheduling; satisfaction with communication; and suggestions for improvements. We collated numerical results and analyzed these using Microsoft Forms. Free-text results were thematically analyzed by comparing and contrasting codes attributed to particular words. This article was internally reviewed by Dr. Peter Nugus of the Institute of Health Sciences Education, McGill University. The survey was conducted by the Postgraduate Medical Education office as a Quality Improvement exercise. No IRB was necessary. Results One hundred forty six residents responded, of whom 79 were redeployed. Fifty eight were redeployed to COVID wards, ten to COVID-ICU units, four to ICUs, three to Internal Medicine wards, and four to other sites (including Clinical Teaching Units). Most residents worked at one of three major teaching hospitals (76). Most expressed satisfaction (49) noting exceptional faculty support, alignment between competence and work, and reasonable workload. Residents who reported dissatisfaction (20) had concerns about inadequate personal protective equipment (PPE), heavy workload, short notice to deploy and poor orientation, and perceived gaps between knowledge and needs of COVID clinical settings and their training. One resident reported aiding dying patients overnight as emotionally difficult. Recommendations for improvement emerging from free-text responses are categorized as: 1) longer notice for preparation and improved communication within sites; 2) suitable PPE (availability and fitting); 3) appropriate context of redeployment (ie. better calibration of level of competence to service, including allocation to familiar settings); and 4) preparation for emotional and stress-inducing demands of palliation. Summary Our study aimed to understand residents’ experiences of COVID-19 redeployment and impacts on educational experience. This is an important foundation for our next phase – for which we invite collaborations with colleagues engaged in similar emergency educational activities elsewhere – to understand relationships between educational experiences from the pandemic and particular specialties-to inform educational design. Preliminary lessons learned include: 1) deployment to high stress and complex environments requires emotional and technical preparation; and 2) supportive faculty in familiar surroundings enhances the learning experience in high-stress services. The pandemic response underscores the person-centred, collegial and communal support that must always underpin technical learning.

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          Teaching Medical Professionalism : Supporting the Development of a Professional Identity

          This book presents ideas, evidence and guidance for those interested in using the most recent advances in knowledge about learning and human development to enhance medical education's ability to form competent, caring and publicly responsible physicians. It does this by establishing the development of a professional identity in medical students and residents as a primary goal of medical education. This new approach is emerging from experience and experiment by medical educators articulating a new way of understanding their mission. It is an optimistic book - the voices are those of the leaders, theorists and experienced practitioners who have found in this new approach a promising way to confront the challenges of a new era in medicine. It summarizes the theoretical basis of identity formation, outlines our current knowledge of how best to assist learners as they acquire a professional identity, and addresses the issue of assessment of progress towards this goal.
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            Coronavirus disease 2019 (COVID-2019)

            (2020)
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              Covid-19-a pivotal moment in community care

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                Author and article information

                Journal
                Can Med Educ J
                CMEJ
                Canadian Medical Education Journal
                Canadian Medical Education Journal
                1923-1202
                30 July 2020
                23 September 2020
                September 2020
                : 11
                : 5
                : e132-e133
                Affiliations
                [1 ]McGill University, Quebec, Canada
                Author notes
                Correspondence: Fernanda Claudio, Postgraduate Medical Education, Office of Accreditation and Education Quality Improvement, Faculty of Medicine, McGill University, 2001 McGill College, suite 1310 Montreal QC H3A-1G1; email: Fernanda.claudio@ 123456mcgill.ca
                Article
                CMEJ-11-e132
                10.36834/cmej.70267
                7522867
                712d884e-7925-488b-a4ef-fa12321bb9b1
                © 2020 Claudio, Aalamian, Cummings, Hannouche, Zanelli, Tourian; licensee Synergies Partners

                This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

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                Works-In Progress

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