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. 2020 Apr 2;92(2):394–398. doi: 10.1016/j.gie.2020.03.3852

Table 1.

Clinical education

Affected area Change Suggested solution(s) Challenges and barriers New opportunities
Outpatient clinics
  • 1.

    “Nonessential” visits canceled

  • 2.

    Minimize physical examination

  • 3.

    “Essential” visits continue

 Telemedicine
  • 1.

    Lack of telemedicine experience

  • 2.

    More difficult to establish rapport

  • 3.

    How to define “essential”

  • 4.

    How to arrange follow-up
  • 1.

    Become effective in practice of telemedicine and learning how to bill

  • 2.

    Learn to triage urgency of clinic visit

  • 3.

    Expand experience beyond our specialty (monitoring of quarantined patients, understaffed areas)
Outpatient endoscopy
  • 1.

    Most procedures postponed

  • 2.

    Fellow does not participate
  • 1.

    Use of extra nonclinical time for other endeavors

  • 2.

    Watch American Society for Gastrointestinal Endoscopy videos

  • 3.

    Volunteer opportunities outside of specialty

  • 4.

    Future extra goal-directed endoscopy curriculum or rotations for impacted fellows

  • 5.

    Simulator lab
  • 1.

    Lack of structure

  • 2.

    Lack of access to medical facilities

  • 3.

    Unclear duration of canceled procedures

  • 4.

    Unknown effect on development of procedural skills
  • 1.

    Creation of an endoscopic simulator curriculum
Inpatient consults
  • 1.

    Mandated limitation of exposure and contact

  • 2.

    Personal protective equipment for suspected and confirmed COVID-19
  • 1.

    Choose prerounds or rounds to see patient

  • 2.

    Focused, goal-directed physical examination only when needed

  • 3.

    When appropriate perform consult via chart review only
  • 1.

    Fear of detriment to patient care

  • 2.

    Lack of experience with style of practice

  • 3.

    Decreased ability to establish rapport with a patient
  • 1.

    Assess when in-person visit may change management

  • 2.

    Assess when physical examination may change management
Inpatient endoscopy
  • 1.

    Limited involvement of fellow

  • 2.

    Postpone nonurgent procedures

 Choosing high-yield procedures for fellow to perform (eg, foreign body removal, therapeutic hemostasis) Fluctuating guidelines and variability of attending policy
  • 1.

    Predict which procedures likely to offer high-yield experience

  • 2.

    Triage urgency of endoscopic procedures

COVID-19, Novel coronavirus disease 2019.