APP fellowships during COVID-19: One institution’s approach
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The number of confirmed COVID-19 cases in the United States is rapidly closing in on a half-million.
In this time of crisis, many Americans are feeling uncertainty and palpable fear — perhaps none more so than our immunocompromised patients.
Literature about COVID-19 and oncology is limited; however, data suggest patients with cancer are at high risk for poor outcomes if they contract the novel coronavirus.
Fortunately, we are able to offer extra support to our patients, as Atrium Health’s advanced practice hematology-oncology fellows have joined us on the front lines.
‘No blueprints’
Atrium Health’s yearlong fellowship accepts advanced practice provider (APP) fellows biannually to begin in October and April.
APPs in the April cohort are considered junior fellows, and those in the October cohort are considered senior fellows.
Under normal circumstances, junior fellows would be gearing up to start their inpatient rotations in benign hematology, malignant hematology and medical oncology after completing 2 weeks of onboarding. The senior fellows, now 6 months into the program, would be preparing to start their outpatient rotations in palliative medicine, supportive oncology, and hematologic and oncologic subspecialties.
The COVID-19 pandemic has changed the way medicine is taught and practiced. There are no blueprints for how to respond or act.
Rather than send talented APPs home and postpone their fellowship, Atrium’s HemOnc APP fellows will receive an education and experience unlike any of their predecessors.
Fellowship restructure
The HemOnc APP fellowship track at Atrium Health is dedicated to upholding educational promises to onboarding new and established fellows.
Junior fellows will have a general orientation virtually through the Center of Advanced Practice for 1 week before they are released to their respective specialties.
They will have an additional weeklong orientation completed virtually. This will consist of a virtual walk-through, general HemOnc fellowship and professional expectations, verbal presentation skills, note writing and templates, canopy training and fellowship pearls.
Due to the predicted surge of COVID-19 in North Carolina, junior APP fellows will spend another 2 weeks completing virtual interprofessional education. This will include learning about the responsibilities and indications for social work, nutrition, genetics, pharmacy and chaplains.
Additionally, junior fellows will be asked to complete the ASCO Basics 101 course and learn how to complete virtual visits for Atrium Health.
After these 4 weeks of onboarding, they will start their inpatient rotations to assist our HemOnc teams.
Senior APP fellows will transition to outpatient practices to better understand treatment regimens and chronic management of HemOnc patients.
Senior and junior APP HemOnc fellows will complete A/B staffing rotations along with Levine Cancer Institute (LCI). This rotation typically consists of 2 weeks providing patient-facing care, followed by 2 weeks of nonpatient-facing care.
Senior APP fellows will be utilized in the outpatient setting much like residents. They are to see patients alongside physicians to move patients through clinic as quickly and safely as possible.
On their nonpatient-facing weeks, senior APP fellows will be expected to complete urgent care virtual care visits, as they will not be ready to see HemOnc patients on their own virtually. They also will be expected to work on their quality improvement project, case studies and LCI-specific presentations.
The A/B staffing model will continue throughout the crisis or until it is no longer feasible, at which point the HemOnc fellows may be redeployed to other departments to help with COVID-19 efforts.
Forward thinking
Many of us who lead APP fellowship tracks are navigating uncharted territory due to COVID-19.
Several institutions face similar challenges juggling increased clinical responsibilities while attempting to maintain educational programs for APP fellows.
Representatives of multiple APP fellowship programs across the country recently participated in a virtual meeting to share their approaches to education amid the COVID-19 pandemic.
Although some programs have delayed onboarding of new APP cohorts, others have restructured their curriculum in response.
In the coming months, Atrium Health will continue to train and teach APP fellows during this crisis to ensure they learn how to practice at the top of their licensure, gain confidence and provide optimal care to HemOnc patients today, tomorrow and well into the future.
The bottom line: Patient care and safety is of upmost importance — as is the future of our profession, because we will prevail.
Reference:
CDC. Coronavirus Disease 2019 (COVID-19): Cases in U.S. Available at: www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. Accessed on April 8, 2020.
For more information:
Camille Petraitis Valente, DNP, FNP-BC, is director of advanced practice and co-director of hematology/oncology APP fellowship at Levine Cancer Institute at Atrium Health. She can be reached at camille.petraitis@atriumhealth.org.
Jessica M. Oser, DMSc, PA-C, is physician assistant in hematology/medical oncology at Levine Cancer Institute at Atrium Health. She can be reached at jessica.oser@atriumhealth.org.
Disclosure: Valente and Oser report no relevant financial disclosures.
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