COVID-19 Driving Evolution in Rheumatology Teaching

In the span of just a few months, the COVID-19 pandemic has transformed the practice of rheumatology and the entire field of clinical medicine. Traditional ways of doing things, from seeing patients to leading teaching rounds, have been temporarily or permanently abandoned.

Nevertheless, teaching hospitals must stay true to their mission of educating the next generation of clinicians. And so, many are striving to adapt to this strange new reality.

“We’re learning on the fly all these interesting ways to provide the teaching that’s necessary to rheumatology fellows during this time,” said Simon M. Helfgott, MD, director of education and fellowship training at the Brigham and Women’s Hospital Division of Rheumatology, Inflammation and Immunity.

Dr. Helfgott is co-author of a new editorial in Arthritis and Rheumatology, “Stand Together and Deliver: Challenges and Opportunities for Rheumatology Education During the COVID-19 Pandemic.”

Video Visits Have Become the Norm

COVID-19 has brought face-to-face patient visits nearly to a halt across most specialties. Clinicians are instead seeing patients via videos platforms like Zoom or over the phone. “Our division has gone from fewer than five virtual visits a month to about 150 to 175 each day—and that’s in the space of a couple weeks,” Dr. Helfgott said.

These virtual visits give fellows the opportunity to watch and/or listen in as the attending physician conducts the examination and interacts with the patient. Dr. Helfgott admitted that although seeing patients in this manner isn’t perfect, senior physicians are finding workarounds to facilitate both patient care and teaching.

“The challenge is how much can you get out of a video visit by viewing the patient, talking to them, having them extend their joints, getting the general feel and then trying to teach from that without laying hands on the patient,” he explained. “But having said that, I think the expert clinicians amongst our faculty have figured out how to make it work and offer small pointers to trainees.”

For those cases where a patient must be seen in person, Dr. Helfgott has established some ground rules: While the attending physician does the hands-on examination, the fellow serves in a virtual capacity in assembling data and collecting information before the visit and providing a summary to the attending afterwards.

Enhancing Collaboration With Rheumatologists Nationwide

Video conferencing has produced promising results on the lecture side as well, according to Dr. Helfgott. He has found lecturing over Zoom to be just as effective as doing so in person.

Furthermore, he cited exponential growth in attendance. For example, he recently organized a multi-program journal club to discuss cytokine storm in severe COVID-19 cases. The event attracted about 70 participants—three times the usual number for a journal club. He has seen similar increases in attendance with interactive teaching rounds.

“We’ve also been able to enhance our collaboration with other programs around the country and other hospitals around the city,” he said. “Now that we’ve moved to Zoom, why can’t we have rounds with people in Chicago? In Los Angeles? Why can’t we have discussions that way?”

As a program director with the American College of Rheumatology, Dr. Helfgott has helped create a new program that allows rheumatology fellows from around the world to attend virtual lectures three times a week. More than 1,300 fellows have already signed up for at least one of the lectures in the program, which will run through the end of June.

“These are things that could have happened in the past, but there’s always a bit of hesitation when things are going okay,” Dr. Helfgott concluded. “Why rock the boat or look at novel approaches? Now that we don’t have the opportunity to just go with the status quo, we’re trying new things. I think this is a positive for us.”