Information for Residency Programs - March 20

COVID – 19 training impacts:

  1. Electives
    1. Visiting (non-Western) residents currently undertaking an elective in London, Windsor or the Distributed Education Network (DEN) can complete their elective rotation as scheduled.
    2. All new visiting (non-Western) resident electives, both domestic and international, from March 16th until June 30th have been cancelled. All elective trainees have been notified that their elective has been cancelled.
    3. If the elective is mandatory (i.e. a core rotation) and an inter-institution affiliation agreement is in place, visiting residents have been asked to contact Tara Coletti (tara.coletti@schulich.uwo.ca) immediately.
    4. Western residents currently away on an elective can complete their elective rotation as scheduled.
    5. Upcoming, non-core elective rotations for Western residents scheduled to take place in the DEN are canceled until further notice.
    6. Rotations in Windsor will continue.

  2. Travel policy
    1. Continuing to change almost daily – COVID update # 9 appended.

  3. Accommodation for pregnancy or immunocompromised residents
    1. We encourage residents to follow the advice of their treating physician. Also refer to PARO advice for residents as follows:

      Q: I'm pregnant or immunocompromised, do I need to go to work?
      A: Listen to the advice of your treating physician. If they feel that you should be deployed in a manner that minimizes your risk of exposure to COVID-19, let your Program Director or your PGME Office know. Solutions may include moving you to a service with a low risk of exposure or placing you on a paid leave of absence if you cannot be redeployed safely. You may be required to provide a letter from your personal physician. Do not hesitate to contact PARO if you require any assistance in ensuring you're protected.
    2. Program Directors are required to report to the PGME office for any resident/fellow that is on paid leave, and provide an estimated length of leave. Contact Karen Lancey at karen.lancey@schulich.uwo.ca. Residents are being moved back to home program – this seems to be happening, but it is not clear why, especially given the decrease in clinic and OR volume. In general residents should continue with their previously scheduled rotations where possible.
    3. Decrease in clinic and OR volumes – this is not problematic in the short term but over several blocks could impact ability for training, create gaps or impact EPAs – implication of this are uncertain at this time, neither RCPSC nor CFPC has provided guidance yet, and hoping that won’t be required.

  4. CPSO
    1. Coronavirus disease, update and information for physicians including FAQ. CPSO recommends screening of patients, virtual care to triage and provide ongoing care as appropriate with a fee code that is applicable.

      Fee code link MOHLTC:
      http://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/4000/bul4745.aspx
      CPSO supports scaling back the provision of any elective or non-essential in-person care. This is happening within hospitals with clinics and operating room changes etc.

      https://www.cpso.on.ca/News/COVID-19-Updates/Information-for-Physicianshttps://www.cpso.on.ca/Physicians/Your-Practice/Physician-Advisory-Services/COVID-19-FAQs-for-Physicians

      https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus

      MOHLTC – Guidance re: case definitions, risk levels etc.
      http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx
  5. Royal College and CFPC Examinations
    1. Exam cancelation:
      1. Examinations for CFPC and Royal College have been canceled as of March 13th.
      2. For example, the spring CFPC examination involves ~ 1600 candidates in 17 centres with both a written and oral examination, the oral component requires ~ 500 family physicians, CFPC is currently looking at rescheduling the written component (short answer management problems or SAMP) for early June; and delaying the ‘Structured Office Oral’ or SOO until fall
      3. Royal College written examinations will hopefully be rescheduled for late April and May, but this has not yet been finalized.
        1. http://www.royalcollege.ca/rcsite/documents/about/update-coronavirus-e
    2. Licensing:
      1. Medical Regulatory Authorities across Canada are aware of change in timing of examinations, the intent is to provide a temporary or restricted license to exam eligible trainees
      2. The licensing process may be slow and take some time, so initiatives are underway to try to begin applications and paperwork early – since we know who is exam eligible right now, and providing that information as well as a certificate of completion of training to facilitate licensure – however waiting for more information from MRA/CPSO.

  6. International trainee update
    1. Closure of Canada’s borders means no new international residents or fellows can enter Canada, and current fellows who had left Canada are not able to return.
    2. wo new ISRs arrived in Canada prior to border closure; discussion underway to delay start of PEAP given the need for a safe care environment for patients and learners.
    3. Update from the Canadian Medical Forum; the Public Health Agency of Canada and Global Affairs are working on an exemption request to allow international trainees to enter Canada, on the basis that they are an essential part of work force. Unclear at this time whether the border closure will impact arrival of trainees due to start in July and August, will update programs as information is available.
    4. Incoming new Canadian residents and fellows will not be impacted, no expectation that their start date will be delayed.

  7. Leave reporting to PGME
    1. PGME sent out a request on Monday, March 16 requesting programs to identify all leaves surrounding COVID-19 to the PGME office. This should include everyone who has traveled outside of Canada (since March 1). If your program hasn’t already provided this information, please do so directly to Karen Lancey at karen.lancey@schulich.uwo.ca
    2. Program inquiries re cancellation of RC exams and how it impacts alternative childcare for the next two weeks. Program approach?
      1. Resident who was supposed to be off next week to write exams, which has since been cancelled now needs to stay home (possibly for 3 weeks during school closure), requesting for time off.
      2. Is this something that other programs are experiencing?
      3. PGME suggestion:
        1. Use vacation first
        2. Unpaid vacation or perhaps paid compassionate leave

  8. Service attendance expectations
    1. Until otherwise directed, residents are generally expected to continue to work during this time. However, we have had a number of inquiries from programs about residents not being essential to the running of the department and should they be sent home.
      1. Currently, if residents are being sent home, the time would be an unpaid LOA and this might mean an extension of training time.

  9. CaRMS update Second Iteration
    1. Western positions for second iteration:
      1. Neuropathology (1 CMG)
      2. Vascular Surgery (1 CMG)
      3. Nuclear Medicine (1 CMG)
      4. Family Medicine
        1. CMG positions – 4 including: Hanover, Chatham, Stratford
        2. 1 IMG position – Windsor
        3. 2 MOTP Surge positions - London
    2. No reversions, and family medicine does not have capacity for reversions
    3. All second iteration interviews are to be done remotely. This information has been sent to the program directors involved in the process.
    4. Currently, match deadlines are unchanged
      https://www.carms.ca/match/r-1-main-residency-match/r-1-second-iteration-timeline/

Appendix I

Travel Policy Tuesday March 17th 2:30 pm COVID Update # 9

Situation:

The COVID-19 situation is evolving in Ontario and the Premier has declared a State of Emergency. The Pandemic Management Incident Team is operating in Phase 4 of the Citywide Pandemic Plan.

We recognize that as the situation continues to escalate we may be feeling heightened anxiety. Please be kind to each other, remember that we are all doing our best to respond to an extraordinary situation as best we are able. Please use our supplies fairly and judiciously.

Updates:

LHSC assessed two confirmed cases of COVID-19

We can confirm that two new positive cases of COVID-19 were assessed at our hospital. The first is a woman in her 40s who the Middlesex-London Health Unit has confirmed recently travelled to St. Maarten.

The second confirmed case is a woman in her 20s who is a health-care worker at University Hospital. She recently returned from travel to Las Vegas. The worker was involved in patient care and interacted with colleagues. All patients and staff who had direct interaction with this individual are being notified, and advised to self-isolate for 14 days.

These are the third and fourth confirmed cases assessed at London Health Sciences Centre.

Health Care Worker Travel

We have received many questions regarding return to work following any travel outside of Canada and we have updated our policy. Our policy is consistent with the federal and provincial guidelines and aligned with St. Joseph’s Health Care London.

  1. Anyone working at LHSC who has travelled outside of Canada in the last 14 days and is symptomatic should stay home and follow your regular sick call-in process.
  2. Anyone working at LHSC who has travelled outside of Canada in the last 14 days and is asymptomatic is asked to contact their direct leader upon returning to the country. Your leader will determine if you perform an essential function at this time.
  3. If you are deemed essential at this time and are asymptomatic you will be required to report to work and wear a mask, as an extra layer of safety, while closely self-monitoring for symptoms.
  4. Those who are deemed non-essential by their leader at this time will be asked to stay home. If you are asymptomatic you must be prepared to come to work if required (this may include redeployment to another task). Those who can perform their functions from home, and are already equipped to do so, will be instructed by their leader.
  5. Those at home will be paid.
  6. Anyone, regardless of travel, who is symptomatic should stay home and follow their sick call-in process.

OHSS has set-up a COVID-19 Staff Hotline at ext. 42819.

Perimeter screening for staff and physicians

Effective immediately, active perimeter screening will be expanded to include all staff, as well as patients and visitors. Staff and physicians will require their hospital ID Badge to enter the hospital and will be actively screened to help quickly identify signs and symptoms of illness upon entering the hospital.

Maps of Victoria Hospital and University Hospital indicating which entrances are accessible to staff, as well as patients and visitors have been posted online. Please note that those screening you are your colleagues and acting in the best interest of staff and physician safety, as well as the safety of our patients and visitors.

Actions:

A COVID19 LHSC email account has been created for questions. Your questions will be forwarded to the most responsible individuals/departments. General questions will be themed and posted to an FAQ that is being redeveloped and will be posted soon. You will not get an immediate response. Contact your leader if one is required.

Next Steps:

The Pandemic Management Incident Team is meeting daily and will regularly communicate updates.

Thank you to our staff and physicians for their commitment to excellent patient care, and their understanding during a rapidly evolving situation.

Carol Young-Ritchie,
Co-Lead, Pandemic Management Incident Team

Dr. William Sischek,
Co-Lead, Pandemic Management Incident Team