COVID-19 Pandemic and PGY-1 Preparation

Last week my Section Chief, Mike Downey, DPM, FACFAS, asked me if I had noticed that some of our current first year (PGY-1) residents seemed to lack some of the skills that we have come to expect them to perform with proficiency from day one of their residency. After giving the question some consideration, I had to agree. What I noticed was not a lack of didactic information; rather, a lack of “how to” or “hands on” knowledge arising from inexperience performing clinical maneuvers that, in the past, first year residents had performed with the speed and skill born of substantial prior clinical practice. In fact, I had come to expect that after four years of podiatric medical education, our first year residents could readily carry out a wide range of basic clinical procedures, such as nerve blocks, arthrocentesis, excision of skin lesions, and cast applications, to name a few. Thinking this through, however, it made sense to me that in order to prevent asymptomatic students from spreading the SARS-CoV-2 virus to patients, or having medical students contract the virus from patients, clinical rotations had to be altered or, to a substantial degree, cancelled. Social distancing requirements prevented students from gathering in small groups, lecture halls, clinical practice studios, and the clinic. As a result, some basic skills, like those that I mentioned above, never became routine and refined maneuvers for some of our new residents. Unfortunately, the COVID-19 pandemic necessitated the widescale adoption of video-based training and, to a substantial degree, cancellation of in-person, hands-on training, and, in my opinion, adversely influenced the preparation of our incoming class of residents, despite their enthusiasm and willingness to work, and, notwithstanding their book knowledge. Now, I have stepped up my clinical teaching in regard to these basic maneuvers, demonstrating the techniques that my new resident clinicians did not have the opportunity to practice before starting our program. As we go forward, however, and with the ongoing uncertainty associated with the COVID pandemic, I think that in order to better prepare our incoming residents for clinical practice, our medical schools will have to further adjust their curriculum and teaching methods in order to protect the well-being and advance the clinical competency of their graduating seniors. This is important, since it impacts the development of new practitioners and clinical investigators; which, in turn, influences healthcare delivery in the future. We want our new physicians and surgeons to be well trained, enthusiastic, and safe. The director of our residency training program, Alan J. Mlodzienski, DPM, FACFAS, informs me that these needs have been recognized by the medical schools, the Council of Teaching Hospitals and Health Systems, and residency training committees associated with the American Podiatric Medical Association, the American Medical Association, the American Osteopathic Association, and professional societies such as the American College of Foot and Ankle Surgeons. The long-term impact that COVID-19 has had on medical education remains to be seen. In the short run, however, we all have to pitch in and see that our students and residents get the training that they need.