How I Practice Now: Rachel Salas, MD, on Providing Sleep Medicine Care from Home

Neurology Learning Network Section Editor Rachel Salas, MD, discusses her experiences in caring for her patients with sleep disorders via telemedicine, how medical education is changing during the pandemic for her neurology students at the Johns Hopkins University School of Medicine, and the benefits of practicing strengths-based psychology during this time. Read the transcript here.

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Rachel Salas, MD, is an associate professor of neurology at the Johns Hopkins University School of Medicine.

Additional Resource:
Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): for healthcare professionals. https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html Page last reviewed April 7, 2020. Accessed April 15, 2020.

Transcript:

Christina Vogt: Hello everyone, and welcome back to another podcast, I'm Christina Vogt, associate editor for the Consultant360 Specialty Network. I'm joined by Dr. Rachel Salas, who is a sleep neurologist and associate professor of neurology at the Johns Hopkins University School of Medicine. Thank you for joining me today, Dr Salas.

Dr Salas: I'm glad to be here. Thanks for inviting me.

Christina Vogt: Today, we'll be discussing how the ongoing COVID-19 pandemic has affected Dr Salas in her practice, as well as some strategies she's utilizing for herself, her patients, and her students during this time. So, Dr Salas, could you discuss how the pandemic has affected your practice? Are you using telemedicine, and if so, how did you roll that out?

Dr Salas: Yes, we are using telemedicine. We actually rolled out the telemedicine portion of our practice maybe about a year before, and with COVID-19, that certainly has ramped up dramatically. So, all of our clinicians are now doing all of our visits by telemedicine.

Christina Vogt: How has the pandemic affected your neurology students and your role as a professor?

Dr Salas: So, it's been pretty much a day-by-day evolution. Initially, the students were pulled from live groups of more than 25 people or more, and then that quickly switched over to having students pulled from any clinicals, and that was mostly to protect their safety, the patients’ safety, and also to help with the limited PPE that were available.

And so, what we've been doing over the last month or so is really trying to offer new opportunities virtually so that students could take these electives and continue to accrue credit to apply for their graduation. And then, what we've been doing for the core clerkship students in neurology is, those have been halted at least for now until the end of May, and we're trying to decide how we're going to roll these out.

So, in the meantime, we've been working with other educators at Hopkins to figure out what's the best way to kind of reinstate the core clerkships, and how are we going to do this? Is it going to be predominantly virtually? How are we going to provide clinical opportunities for students?

So, what our group did in neurology is, we put together a 2-week virtual elective that allowed us to become a little bit more familiar with telemedicine in terms of having the students be part of that. So, we've recruited some of our attendings to act as virtual attendings, and so they've been engaging students, either with patients that are in the hospital right now …, as well as recruiting faculty that have patients that would willingly be able to speak with our students so that they could perform a history and even a neuro physical exam via telemedicine, so that we not only get experience with this in a formal curriculum, but also allow our attendings to have more practice and then kind of see what the students’ response and perspective is with these opportunities.

So, I'm hoping that we're going to be able to be well prepared when we finally do roll out the neurology core workshops, and we'll be able to offer, now, telehealth opportunities, whether outpatient or inpatient.

Christina Vogt: Could you discuss your experience with strategies like strengths-based psychology and the benefits of using this kind of strategy during this time?

Dr Salas: Yeah. So, strengths I was exposed to a few years ago and was really fascinated with strengths-based psychology, and while it might not be a cup of tea for everybody, I've certainly really found it to be very helpful, especially in my practice, so much so that I actually got certified in this.

At the end of the day, when I see patients, we talk about their sleep issues or sleep disturbances and whatnot, but I really don't get a 360 view of the patient, all the other circumstances that are affecting that patient's life, and ultimately their sleep. And so, what I've been doing over maybe about the last year and a half has been talking to patients and kind of gauging their interest, if they were interested in using a strengths-based approach, not only for me to better connect with them and better understand them, but also in their management. So, I've been using the strengths-based approach with patients, for instance, with insomnia.

So, insomnia–sometimes, patients can have issues with kind of turning their mind down, and that's been a bigger problem with the pandemic. People are just kind of more worried, they're not getting out as much, and when people aren't getting outside as much, they're not getting that sunlight exposure, and all of these things can actually impact in a negative way a person’s sleep.

So, by me using the strengths-based approach, I can dig a little deeper and find out what … motivates the patients, what are their natural tendencies, and really try to work with them using that to really set things up for success.

Christina Vogt: What key takeaways do you hope to leave with neurologists and other healthcare practitioners about your experiences so far with the pandemic?

Dr Salas: I think I speak for everyone at this point in time–it's really a day-by-day thing. I think the best we can do, whether it's in our practice or whether it's working with students or for ourselves, and you know, when everyone's … struggling with keeping our own wellbeing and staying resilient, is really to take it day-by-day and really try to leverage our own strengths so that we can adapt to the ongoing changes, because I think that even though, at some point, things are going to kind of start to go back to normal, … I think we're going to still see the consequences of this pandemic for a long time after that.

And I think what we can do is … take one thing at a time, look within to harness our own strengths, and really try to see how we can help others, and identify people that that might need additional help, and really try to unite together, build a community so that we can share resources and whatnot. I know that's something that we're trying to do at the medical student level not only at our institution, but at the national level with the American Academy of Neurology. I'm working closely with other education specialists across the nation to see how we could really unite and not duplicate either resources or efforts, but instead come together and develop better resources that could have maximum potential and reach more learners than ever before.

So, there are some positives that I've already seen coming out. But I think that the key here is to take it one step at a time and really seek out others to really build a team, and then at the end of the day, really kind of look within to leverage your own strengths. I think that's all we can do.

Christina Vogt: Thanks again for joining me today, Dr Salas.

Dr Salas: It’s been a pleasure. Thank you.

Christina Vogt: For more podcasts like this, visit Consultant360.com.