Abstract
The COVID-19 pandemic has resulted in a significant disruption to all aspects of healthcare provision, including menopause care. Menopause service delivery as well as menopause education and training have both been affected. The suspension of non-urgent planned care during the earlier part of the pandemic resulted in services in both primary as well as secondary care offering, where it was possible to do so, some menopause consultations virtually (either by telephone or web-based video consultations). Menopause education and training was largely put on hold during the early period of the pandemic.
Subsequently, many elective healthcare services resumed in the summer of 2020. There was, however, an inevitable need to assess and review how non-urgent clinical services could be best delivered in the current climate, balancing the delivery of planned services with the demands on emergency services and also accommodating the social distancing requirements for safe service delivery.
The advice to minimise hospital visits where feasible resulted in a significant proportion of menopause consultations being provided remotely (by telephone or web-based video consultations). This pattern is likely to continue for the foreseeable future, and potentially beyond that. While such changes in service provision have brought many challenges, they also offered an opportunity to review and introduce adjustments that offer positive and workable change compared to our conventional structure of delivering menopause care. Virtual menopause consultations are likely to offer women more flexibility, less need for travel and result in less disruption to women’s work, family and social life.
The COVID-19 pandemic has also resulted in a detrimental impact on education and training in various medical specialties as well as menopause education and training. As a result, there was a need for modification to the way menopause education and training is delivered and for educational meetings to be delivered virtually.
Given that many NHS services both in primary as well as secondary care have already set up processes for virtual patient consultations, the virtual structure can also be considered to conduct training remotely. This could include three-way web-based video consultations involving the trainer, the patient and the trainee. Such remote training could also allow remote assessment with the trainer observing the trainee conducting a virtual consultation in their own practice. Any such pathways should have a clear process related to patient consent and confidentiality and may require piloting when first introduced to ensure feasibility of application and patient acceptability. It will also subsequently require validation against current conventional face to face methods of training.
The nature of menopause consultations and as a result menopause training lends itself well to a virtual structure of delivery as a significant majority of consultations are conducted without the need for a physical examination. It, however, remains essential that access to face to face consultations remain available where a physical examination is needed (e.g. pelvic or breast examination) and access to endometrial assessment (pelvic ultrasound/endometrial biopsy/hysteroscopy) for women for ongoing unscheduled bleeding on HRT. This should also be considered when delivering menopause training to ensure trainees are able to assess and decide when there is need for a face to face assessment. Any adaptations to the structure of menopause training is likely to be in line with that applied by other national educational bodies.
It is likely that in the course of the coming months and potentially beyond that an increasing proportion of educational meetings will be delivered virtually. It is also likely that some meetings that are scheduled to be delivered face to face will also offer the option of remote attendance.
After the enforced cancellation of the BMS Annual Scientific Conference in July 2020, the British Menopause Society moved to introduce an innovative and sustainable programme of virtual educational meetings for healthcare professionals to meet current educational demands. These included one-day women’s health meetings; the Women’s Health Concern (WHC) symposium and two-day course for the Principles and Practice of Menopause Care (PPMC) and the Cognitive Behavioural Therapy (CBT) training course. The BMS Annual conference originally scheduled for July 2020 was postponed and moved to July 2021.
Further, the option remains for some of the forthcoming study days to be delivered virtually or delivered face to face with an option of remote attendance. In addition, webinars and online educational resources (such as IMPART offered by the International Menopause Society) may offer additional educational resources that can be accessed remotely.
Setting up remote menopause consultations and training may require additional technical and administrative support including having web cameras and microphones linked to the PCs used by the clinical service, identifying secure software for remote video consultations that maintains patient confidentiality, and having administrative support to allow the communication of the clinical and prescribing plans to patients and GPs.
Similar adaptations will be required for delivering menopause education remotely. Virtual meetings with pre-recording lectures with live question and answer sessions as well as live webinars are likely to become part of how menopause education will be delivered in the foreseeable future and potentially beyond. Whilst this will bring its own challenges in arranging and delivering, it is also likely to open the door to a wider audience who rather than being constrained by whether a meeting is local to them or the practicalities of travelling to it, could attend a meeting virtually regardless of location. It is also likely to offer more flexibility with both organising and delivering meetings.
The above changes to practice should enable menopause education and training to continue in the current climate and potentially beyond. Given the potentially unpredictable nature of the COVID-19 pandemic, it is important that the provision of menopause services including education and training adapt to the current circumstances and pressures on health services to minimise patient hospital visits and face to face contact where appropriate.
