The Impact of COVID-19 on Inpatient Psychiatry Resident Supervision
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LETTER TO THE EDITOR
The Impact of COVID-19 on Inpatient Psychiatry Resident Supervision William H. Coe 1
&
Hun Millard 1
Received: 14 July 2020 / Accepted: 5 October 2020 # Academic Psychiatry 2020
To the Editor: As an intern during the initial phase of the COVID-19 pandemic, the first author (WC) worked for an entire month on an inpatient adolescent psychiatry unit without ever seeing his attending in person. The pandemic changed everything from workflow, patient care, teaching, and learning. Yet, despite all this, the supervision he received during this month was endorsed to be “some of the best I had all year.” There are numerous articles to date that explore the impact of COVID-19 on resident training and education, particularly within the surgical and procedural subspecialties. Within psychiatry, however, there are significantly fewer articles exploring this topic. Both the American Academy of Geriatric Psychiatry (AAGP) and National Neuroscience Curriculum Initiative (NNCI) have created web-based didactics for residents [1, 2], but these are intended to be additive resources and do not directly address changes to clinical supervision or patient care as a result of the pandemic. Other articles discuss rapid advancements in telepsychiatry but do not reflect on the unique challenge of resident supervision on an inpatient setting [3, 4]. Given this, the authors felt it may be helpful to share their experiences in this regard. Before the pandemic, the 22-bed adolescent unit (for patients ages 13–18) included two clinical teams, each consisting of one attending, one intern, one medical student, and 2–3 social workers. In the mornings, everyone would meet for “huddle” to discuss new admissions, review potential discharges, and debrief any significant events from overnight before splitting up into their respective teams for patientcentered rounds. The social workers tended to see patients separately given their daily workflow. Attendings, residents, and medical students tended to see patients together, though this occasionally varied depending on learner experience, pa* William H. Coe [email protected] 1
Yale School of Medicine, New Haven, CT, USA
tient complexity, and other demands on time (such as family meetings, scheduled didactics, and administrative duties). Afternoons were typically reserved for evaluating new patients (done as an entire team), writing progress notes, following up with patients, and engaging in various didactics or learning opportunities. Once the pandemic hit, the hospital transitioned to “skeleton staffing” with as many clinicians working from home as possible. For two weeks at a time, one social worker and either the intern or attending would be on-site. This meant that while the resident was on the unit, the attending and two social workers were working from home. Morning huddle, rounds, family meetings, etc. all happened by phone or video. This transition was rapid, chaotic, and not without challenges, but when it came to virtual supervision and learning, this new system seemed
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