Virtual care rotation for internal medicine residents during the COVID-19 pandemic.

Abstract

All learning objectives were met. This rotation was particularly effective at allowing residents to hone history-taking, communication, counselling, and rapport-building skills due the nature of providing care virtually. In the absence of the ability to examine patients or use body language to support interactions, residents learned to ascertain patients’ emotions and build common-ground without the benefit of face-to-face interaction. The rotation provided increased exposure to the wide scope of ambulatory internal medicine, sparking at least one resident’s interest in ambulatory care. The rotation initially focused on COVID-19 care to allow residents to feel part of the solution to the pandemic. During the PAR reflection process, we identified that residents felt that CPAC care was algorithmic and less educational than GIM clinics. To improve the educational experience of the AVCR, we now provide opportunities in virtual subspecialty medicine clinics. For technical reasons, video visits only became a possibility partway through the rotation; and we will be incorporating more for the next iteration. Barriers to implementing virtual care, privacy, legal issues, and payment models were suggested as topics of formal discussion during the rotation; we will be incorporating these topics into a weekly journal club. Administratively, finding supervisors for residents was challenging. Faculty cited having to learn the novel technology and keep abreast with the ever-evolving COVID-19 knowledge required to supervise as deterrents. Clarifying supervisory expectations for attending physicians can be helpful; nonetheless, getting buy-in from sufficient potential supervisors was only achieved through significant persistence. Notably, the flow of resident supervision in clinical interactions was not different. Patients accepted waiting on hold for case review. Moreover, speakerphone and video telecommunication made engaging in conversations between the attending physician, residents, and patients seamless. AVCR was a success. The demand for virtual care is increasing, as is the need to educate physicians in these newer models of care.2 Incorporating novel models of care into residency should be done irrespective of a pandemic in order to build residents’ skills for the future and to integrate such ‘novel’ models of care into everyday medicine.