How Program Directors Can Support Obstetrics and Gynecology Residents During the COVID-19 Pandemic

The American College of Obstetricians and Gynecologists, its Junior Fellow College Advisory Council, and its Council on Resident Education appreciate the challenges residency programs are facing due to the COVID-19 pandemic. Below you can find suggestions for supporting your residents during the COVID-19 pandemic. Read ACOG's letter to Program Directors.

• Restructure resident, fellow, and medical personnel clinical schedules to limit exposure and preserve the workforce. Many programs have transitioned to a call schedule with a lean team structure and we recommend considering staffing with the fewest residents/fellows that are needed to provide adequate and safe patient care. Also consider keeping the same teams together at the same hospitals may minimize exposure to other providers.
• Develop Telehealth Programs. We recommend considering how to involve residents and fellows in telehealth visits and to include them in the development of such programs to remotely care for the patients in your areas.
• Protect residents, fellows, and medical personnel with unique circumstances. This recommendation should apply to anyone with significant health concerns or co-morbidities that put them at risk as well as residents and fellows who live with children, spouses, or significant others that are immunocompromised. Consider providing temporary housing options for residents who cannot return to their home due to concern for COVID-19 exposure. Immunocompromised residents or others with specific conditions that make them vulnerable should not care for COVID positive or PUI patients.
• Prioritize distribution of rapid-response COVID testing to labor and delivery units when it is available.
• Provide adequate PPE and train residents on appropriate PPE, donning and removal, and which PPE is appropriate for different clinical scenarios as described by ACOG and the CDC. We urge you to advocate for policies that allow medical personnel to use personally supplied PPE, if there are shortages of hospital-supplied PPE. We also urge you to advocate for policies that seek to protect medical personnel from reprisal for speaking about the safety and health conditions at their hospitals.
• Continue Resident and Fellow education through virtual learning whenever possible and attempt to create structured didactic remote learning to supplement clinical exposure during this time.
• Comply with all current CDC guidelines including cancellation of all elective surgeries. ACOG’s Joint Statement on Elective Surgeries provides additional information about surgeries that should be categorized as elective.
• Adjust scheduling, delay, and/or cancel non-urgent ambulatory clinic visits according to ACOG and CDC recommendations and patient needs. Care that is time-sensitive should not be delayed.
• Regularly communicate with medical personnel with full transparency about the ongoing COVID-19 situation and risks they are being exposed to in their hospital and any changes in hospital or facility practice.
• Ensure that communications regarding the COVID-19 pandemic and ongoing care be free from implicit bias and racism.
• Consider clinical monitoring of symptoms of all medical personnel, especially if there has been a potential exposure.
• Continue to comply with work hour restrictions per ACGME guidance for each stage.
• Participate in data collection efforts; refer COVID cases to registries. There are limited data regarding the effect COVID-19 on specific patient populations. Demographic data allowing for identification of any disparities are also needed. Institutions are encouraged to refer any pregnant patients with COVID to the PRIORITY-Pregnancy Coronavirus Outcomes Registry or other collaborating or similar registries.