Encompassing 240 beds across multiple care units, VA Bedford is one of the largest long-term care facilities in the VA healthcare system. Normally the geriatrics rotation at VA Bedford took place on the Geriatrics Evaluation and Management Unit, a 24-bed inpatient subacute rehabilitation and skilled nursing unit specifically designed to manage older Veteran patients in need of post-acute or community-dwelling veterans in need of complex geriatrics care.
Prior to the pandemic onset, residents came from 3 internal medicine and family medicine residency programs and rotated on two- or four-week blocks. Two residents, working under the supervision of an attending physician, are typically on rotation at any one time. To fulfill geriatrics training requirements, the residents participated in patient care and regularly structured didactic, active-learning, and self-directed experiences.
We thus sought to maintain a core geriatrics education program while adhering to restrictions imposed by the need to minimize exposure and transmission of SARS-CoV-2, the causative agent of COVID-19. From the onset of the pandemic in March 2020 until October 2020, several months following a surge in the U.S. Northeast, we converted the geriatrics rotation at VA Bedford to a fully virtual non-clinical GME experience.
Our overarching goal was to deploy the original curriculum, including its learning objectives and provided educational resources, virtually so that even with COVID-19 restrictions residents could complete the rotation with core tools needed to care for older adults. The topics covered fell under the major themes of geriatric syndromes, comprehensive geriatric assessment, and serious illness and end of life conversations.
We structured the rotation as much as an intensive graduate course as a clinical rotation, with the expectation that the resident would put in vigorous effort to engage with the material. We provided an orientation packet that detailed the curriculum, a robust set of educational resources, a guide for self-directed learning, and a schedule of daily learning activities, all accessible either on a shared website or in a physical binder. Learning sessions were typically conducted via video conferencing using secure Skype or Microsoft Teams platforms. Both have features that enable video conferencing and include a range of built-in tools that allow for screen sharing, file sharing, breakout rooms, and slide presentations. These video communication platforms created an interactive virtual environment that enhanced engagement between the instructor and learners.
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