10 Ways HRSA-Supported Preventive Medicine Residencies Responded to COVID-19

A new report published in a special supplemental issue of the Journal of Public Health Management and Practice focusing on the Health Resources and Services Administration’s (HRSA’s) Investment in Public Health looks at the programs and activities involving HRSA-supported preventive medicine residencies in response to the SARS-CoV-2 pandemic. Dr. Lisa A. Miller and the HRSA-Funded Preventive Medicine Residency Program Director’s Workgroup surveyed all 18 HRSA-funded Public Health/General Preventive Medicine (PH/GPM) and Occupational and Environmental Medicine (OEM) residency program directors to evaluate program and resident involvement in pandemic response activities from January 1 through June 30, 2020. Of 116 residents, 110 (95%) participated at some level in the response activities.

Since the period referenced in the article, most of the residents have continued to participate in this wide variety of activity as detailed. Additionally, with the approval of the COVID vaccines, residents in training have participated in myriad aspects of the planning, distribution, monitoring, observation, assurance of equity in access and determination of eligibility, and managing of adverse responses for the populations near their training sites.

Residents in PH/GPM and OEM are well suited for pandemic response activities because of the competencies they acquire through the unique blend of training they receive in public health, epidemiology, the care of patients and populations, and emergency preparedness/risk communication.

Here are some (but not all) of the ways they responded to the earliest phases of the COVID-19 pandemic.

1. Screening/testing

Residents organized testing sites at Veteran Affairs Medical Centers, local public health departments, health systems, academic medical centers, hospitals, community-based organizations, and long-term care facilities. Some of their responsibilities included developing standard operating procedures, monitoring inventory, screening and testing individuals, and developing tracking tools and testing.

2. Contact Tracing

Residents implemented contact tracing for employee health occupational medicine services; returning travelers and deceased cases (through next of

kin); participated as part of a state epidemiology team performing outbreak investigation; and staffed surge teams that performed contact tracing at state and local health departments, health systems, and academic medical centers.

3. Surveillance

They monitored cases and deaths; tracked test results and managed data for long-term care facilities; organized a surveillance system for health care workers; assisted with implementation of CDC’s state-based hospitalization surveillance system; automated information sharing; and completed case reports for multisystem inflammatory syndrome in children.

4. Data analysis

Residents performed statistical modeling to predict cases and death rates; analyzed system-level case data; analyzed data on hospitalized patients to identify racial/ethnic disparities; and contributed to COVID-19 research studies.

5. Incident command

They participated in incident command for health systems and health departments; designed and implemented shelters and clinics for persons experiencing homelessness; established hotlines (at a state or health system level); and participated in state-level response addressing COVID-19 in nursing home facilities.

6. Provider support

Residents provided educational presentations to health care providers; developed handouts for clinics on testing; developed online support services; supported human resources by developing materials for job modifications due to high-risk medical conditions; developed a new pandemic response rotation; developed materials to support clinic/providersʼ transition to virtual care; participated on “strike teams” to perform site visits to skilled nursing facilities; served as consultants to public health teams for medically complex patients; performed a survey of best practices for persons experiencing homelessness; developed guidance for dentists; and developed personal protective equipment guidance.

7. Reopening

They provided technical assistance to various community organizations on infection prevention/control and steps to reopen; served on a task force for travelers going out of country; developed materials to educate employees on safe reopening practices; developed plans to allow visitors in skilled nursing facilities; participated in briefings for local phased reopening; supported an American Academy of Pediatrics chapter on school reopening; served on a task force for safe reopening of outpatient practices; developed guidance for schools and summer camps; and developed prevention processes with unionized grocery workers.

8. Direct patient care

Residents provided telehealth visits for patients with COVID-19 symptoms; developed COVID-19 risk-reduction measures for primary care and specialty clinics; increased time in regular primary, specialty and inpatient care; provided testing and isolation monitoring; provided employee health and return-to-work guidance after testing/screening; and reported test results to patients.

9. Education

They presented webinar/training on personal protective equipment and motivational interviewing for other medical trainees; supervised and developed curriculum for other medical workers and staff; developed Web platform, technical assistance and care protocols for congregate living; developed testing and return-to-work question and answer guidelines for clinicians; developed written and Web-based patient education materials; and advised clinicians about COVID-19 risk reduction.

10. Risk Communication

Finally, residents developed employee communications; provided risk education for special populations; provided manager and employer training on reopening safety; provided new refugee education on COVID-19; provided medical direction and risk communication for isolation hotels; and participated in media communications.

In the first six months of the COVID-19 pandemic, HRSA-supported PM residents assisted with screening/testing, contact tracing, surveillance, data analysis, incident command, provider support, reopening, direct patient care, education, and risk communication. Residents’ response activities were in multiple settings, such as state, local, and federal health agencies; hospital systems; long-term care facilities, academic centers, local businesses and labor unions, Federally Qualified Health Centers, homeless shelters, and clinics.

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These are only some of the programs and activities residents took part in to help mitigate negative health outcomes associated with COVID-19.

To learn more, read the Workgroup’s article “The SARS-CoV-2 Pandemic: Real-Time Training and Service for Preventive Medicine Residents” for FREE in a special supplemental issue of JPHMP, HRSA’s Investment in Public Health.