Three months ago, I had no inclination that a global pandemic was about to wreak havoc on every aspect of our personal and professional lives. In January and February, I was following the news reports about the virus in Wuhan, China, as health officials in the country were trying to contain the spread. COVID-19 became front page news locally in Massachusetts following a Biogen leadership meeting in Boston that many of their executives from around the world were attending. This conference is considered a coronavirus “super spreader” as many of the conference attendees were unknowingly infected with the virus resulting in both a local and national/world spike in cases as they traveled home spreading the virus further (https://www.nytimes.com/2020/04/12/us/coronavirus).
As the COVID-19 virus unfolded in the region, the healthcare landscape within my institution and across the state began to change rapidly as the number of cases increased and a state of emergency was declared. St. Elizabeth's Medical Center is an academic teaching hospital of Tuft's University Medical School with multiple residency and fellowship programs. As a program director and Chair of the Residency Review Committee for the CPME, it is clear to see that coronavirus has impacted the usual implementation of postgraduate training and education across all disciplines. COVID-19 will likely lead to substantive changes in how we educate/train residents and treat patients for the foreseeable future.
In the early stages of the pandemic, training programs within the medical center were looking for guidance from national, state, institutional, and program accrediting/approval agencies on how best to balance resident education/program requirements with patient care. The residents were outfitted with personal protective equipment and instructed in its proper use and protocols when seeing COVID-19 positive patients in the hospital or during procedures in the operating room. The residents on our service were split into 2 teams to avoid spreading the virus to one another and insure social distancing within their office. Training on off-service medical and surgical scheduled rotations has continued for most other experiences.
Daily didactic activities such as journal club, chapter review, lectures, case review, and board review have continued but have been switched to a video conferencing application, such as Zoom, in order to include all residents. I have been amazed and grateful at the collaboration and contributions that educational organizations, medical device manufacturers, and residency program faculty from across the country have provided to facilitate residency training during the pandemic. Although elective surgeries have been cancelled until the surge of cases is manageable within the institution and local area, the residents continue to work on hand skills with simulated operative procedures within the institution.
Access to the office became more limited due to social distancing requirements which necessitated us to triage patient lists. This experience has introduced the residents and myself to telehealth visits which have become a vital part of the practice to assess who truly needs to be seen. It also allows us to stay in contact with some of our most vulnerable patients that are avoiding necessary medical attention for fear or risk of contracting the virus.
The psychologic impact of the pandemic continues to be a concern. The institution has provided various emotional support services for residents and staff. Within our institution we have seen fellow physicians, nurses, and staff stricken or in some cases succumb to the virus. The stress and anxiety are palpable within the hospitals as well as for our families and significant others who are often isolated at home.
I try to be cautiously optimistic that we will slowly start to regain some sense of normalcy for residency training experiences as the end of the academic training year approaches. It is difficult to predict how much COVID-19 will impact upon the new academic year at my institution, but I am sure there will be many new hurdles to overcome to ensure that my residents continue to obtain the training experiences that they desire and deserve.