May 6, 2020

Mayo Clinic NP/PA Hematology Fellowship Goes Virtual: Keeping Education Going in the Midst of a Pandemic

By A. Kate MacDougall

The COVID-19 pandemic has caused a tremendous amount of changes in health care, including moving clinicians to different areas of care and enforcing new policies and procedures around managing and treating patients. It has also significantly impacted the training process for medical fellows and other trainees all around the world. Thinking on their feet, the NP/PA Hematology Fellowship Program at Mayo Clinic reorganized its training curriculum to keep fellows learning and, most importantly, safe.

The fellowship program, which accepts two fellows per year, includes a didactic curriculum of required reading; five weeks of hematology lectures alongside the medical students at Mayo Clinic School of Medicine; mentored clinical rotations in disease-oriented outpatient clinics and hematology and blood and marrow transplant hospital inpatient services; rotations in transfusion medicine, hematopathology, palliative medicine, and infectious disease; and 100 hours of clinical research. When the pandemic began in the United States earlier this year and stay-at-home orders were issued throughout the country, Lisa Hwa, APRN, CNP, DNP, Nurse Practitioner in Hematology and the NP/PA Hematology Fellowship Program Director, worked with her fellows to modify the training curriculum so it could be conducted remotely for the time being but still remain robust and effective.

“Part of the [didactic] fellowship curriculum was easily converted to virtual online training,” Hwa explained, including the coursework and reading, the hematology lectures, and even some of the clinical research work. “But we found ourselves wondering how we were going to do the clinical rotations.”

Because many patient clinic visits at Mayo Clinic had been transitioned from in-person to virtual, Hwa and her fellows decided to make the clinical rotations virtual as well. They came up with a remote teaching model in which the fellows join Hwa on her virtual hematology patient visits.

“Before each patient visit, I share my screen and the fellow and I review the patient’s charts together, talk about the case, look at their labs, and discuss treatment history,” Hwa said. “Then, the patient joins us on a virtual [or telephone call] and we meet with them together, assess their symptoms and how they are tolerating treatment, make diagnoses, and discuss treatment options.” After the virtual patient visit, Hwa and the fellow meet again to discuss proper post-visit documentation, lab ordering, and other follow-up procedures.

Drew Gastin, PA-C, Physician Assistant Fellow in the program, said his typical day right now involves virtual patient visits with Hwa for the first half of the day and then an afternoon of training modules, lectures, reading, and working toward his clinical research hours—all from his home.

“It's definitely a transition from the norm,” Gastin said. “But even if you can’t see your patients in person…there are still so many opportunities to do many different types of learning [remotely], as well as get involved with any number of organizations or research projects that are going on in your local hospital or learning clinic. It’s really a matter of being able to be flexible with your expectations and with your own learning.”

Out of all these sudden fellowship training changes in response to the pandemic, Hwa said that there is at least one clear upside.

“One of the advantages from this pandemic is that our fellows are being exposed to and learning about telemedicine, which is not part of our traditional fellowship training,” Hwa said. “I can see a future for telehealth care because it does provide much easier access for a lot of patients. … We will definitely build telehealth training into the future fellowship curriculum.”

Read more from the  APSHO Advance: Special COVID-19 Series