Program Director’s Corner – January 2021
APDEM Pandemic Emergency Category Disaster Plan
Aaron Schulman, MD
Program Director, Fellowship in Endocrinology, Diabetes and Metabolism
New York-Presbyterian Hospital/Weill Cornell
Definition by ACGME: Sponsoring Institutions facing substantial and sustained disruption of GME operations resulting from the COVID-19 pandemic.
Who Declares: DIO, with the attestation of the sponsoring institution’s clinical leadership, via submission of Emergency Categorization Request Form to the ACGME.
Duration: 30 days. Extension beyond 30 days subject to review by the Institutional Review Committee.
Scope: Declaration applies at the institution level and involves all residents and fellows in all specialty and subspecialty programs.
Requirements: Sponsoring institution is still expected to fully comply with and ensure adherence to the following:
- Adequate resources and training – including appropriate infection protection
- Adequate supervision
- Adherence to work hour requirements
- Fellows may function in their core specialty (in our case, internal medicine) if: a) they are ABMS or AOA board-eligible or -certified; b) they are appointed to the medical staff; c) their time spent in their core specialty service is limited to 20 percent of their annual education time in any academic year.
- Continued assessment by programs of fellows in all six Core Competencies, with assessments forming the basis for decisions regarding promotion of fellows
If your sponsoring institution has requested or is considering requesting Emergency Categorization, consider drafting a disaster plan that is acceptable to everyone involved. Consider the following issues:
- Fellow deployment:
- What is the minimum number of fellows needed to maintain a functional inpatient endocrine consult service? Consider discussing with DIO to allow retaining them.
- Will a faculty-only inpatient consult service be necessary? Alert faculty to this possibility.
- Will fellows’ clinics need to be canceled or scaled back?
- Create a backup schedule for coverage of fellows who are deployed.
- Can fellows graduate on time or will extension of training be needed?
- Will fellows have completed required number of procedures by graduation?
- Faculty deployment:
- Will faculty be deployed?
- Working with your division chief, create a backup schedule for coverage of teaching faculty who are deployed (for inpatient consult service, precepting fellows’ clinics, didactics, etc.)
- Didactics:
- Should didactic activities continue or be temporarily suspended?
- Are faculty familiar with and able to use remote teaching platforms such as Zoom, Skype, Microsoft Teams, etc?
- Telehealth considerations:
- Are inpatient e-consults available and permitted?
- Are outpatient televisits (phone and/or video) available and permitted?
- What platforms are available for telehealth (me, Doximity, Amwell, etc.)? Do they support precepting and/or interpreter use?
- Are faculty and fellows familiar with these platforms? Is information technology (IT) support available?
- Does everyone have the equipment they need for televisits (webcams, headsets, etc.)?
- Make sure you review televisit requirements of CMS and private insurers with regard to resident encounters.
5- Support:
- Consider scheduling regular (at least weekly) virtual meetings with fellows to hear their concerns, keep them updated, maintain their connection to division and peers during deployment.
- Consider organizing regular meetings with participation of institutional mental health providers for support of fellows (and faculty).
- Consider asking for regular meetings with other PDs and DIO.
- Program Directors can contact members of the APDEM Pandemic Emergency Category committee with any questions:
- Aaron Schulman aas9008@med.cornell.edu
- Mira Sofia Torres torres@umassmemorial.org