Residency Training in the COVID-19 Pandemic: Adaptation, Exhaustion, Opportunity

By Ecler Jaqua

As the COVID-19 pandemic advanced, many rapid changes had to be made in medical education. Residency programs had to be adaptive and creative to deal with the ever-changing CDC landscape protocols to educate residents in a restrictive in-person environment.

In a matter of days, our family medicine residency clinic had to change all the in-person visits to telehealth. Video visits were something that was being tested and executed in the faculty clinic, but nothing similar was done on the residency side. At first, it was very challenging to our residents, but especially to our patients who had no idea how to use the app for the video visits. Many appointments had to be changed to telephone visits instead due to technical issues and poor literacy. However, as time went by, most of the residents, faculty and some patients started to get more familiar with the current system. Telehealth is here to stay, and I don’t think it will ever leave us. On the positive side, telehealth has now opened up opportunities for patients who previously were unable to attend their doctor’s visit.

Unfortunately, the pandemic just not affected the way we take care of patients but also negatively affected the training of residents. It led to many modifications for safety reasons within the clinics and hospitals that resulted in decreased volume of procedures, simulation laboratories, face-to-face teaching, hands-on training, and skill-based teaching activities. Elective rotations had to be canceled, reducing interpersonal connections in favor of social distancing and home isolation. The residents’ clinical skills competence in doing a physical exam weakened as they no longer have access to patients under supervision. The conventional bedside teaching where residents and faculty can ask patient questions in real-time and have essential discussions as a team had to be discontinued. Numerous residents were unable to attend conferences, complete research projects, or participate in extra-curricular activities that could help them get a competitive fellowship or their dream job.

Several residency programs at my institution had to restructure their residency training and redeploy many residents to services in need. Due to these rapid changes, the hospital shifts were at times very exhausting for the residents – not only because of the long hours and multiple days working in a row but also the constant fear of spreading the virus to a loved one. On top of all these changes having to wear personal protective equipment (PPE) all the time can be very uncomfortable. Residents many times felt a mix of anxiety, fear, emotional and physical exhaustion during these extraordinary times.

The weekly didactic teaching sessions, a crucial component of residency training, changed radically with the pandemic. All the in-person lectures moved online through platforms such as Zoom. The advantage of having the didactic session online was the ability to have everyone attend from any location and being able to invite speakers from different institutions. Virtual rounding was also implemented in countless residency programs to keep the whole medical team safe. The virtual rounds involve a pre-round done by the residents and medical students, and the attending physician would join remotely to discuss the cases with the whole team. During this time, it is an excellent opportunity for the attending physician to teach, showing research papers and PowerPoint slides about the cases that are being presented. As soon as the virtual round is ended, the attending physician would see the patients by him- or herself and resume the virtual round in the afternoon to discuss their physical exam findings and any other pertinent information from the patients or medical staff. Although there is no replacement for the face-to-face bedside teaching and observation of the resident or medical student performing the physical exam, this model is efficient, delivers substantial educational value, maximizes patient care time, and provides a safe environment to both trainees and patients.

Residency programs across the nation adopted video interviews for virtual residency recruitment. One of the advantages of virtual recruitment is the amount of money and time saved during the interview season. Not having these expenses can be a relief to the medical students and the residency program, especially as the financial crisis precipitated by the pandemic led to budget cuts for recruitment in many programs. Virtual recruitment also allows the residency program to interview more applicants as more interviewers may be available. The downside of virtual recruitment is the limited opportunities to socialize with current residents and faculty. It may also cause video fatigue if an applicant doesn’t take a break or stays uninterrupted for more than two hours in an interview.

Although these are challenging times, we were able to reconsider our current resident education and welcome ground-breaking methods while providing a high quality of care. Even though the pandemic affected residency education, several research studies show that the level of knowledge and clinical practices with virtual learning was acceptable. I believe we gained an understanding of how to integrate technology with the current teaching modality without compromising patient care. We also learned how to improve health care systems and redesign curriculums to ensure appropriate training.  

In the near future, as the pandemic subsides, we will see a hybrid of these models. Learning telehealth skills along with classroom and bedside teaching, the flexibility to have lectures in person and virtual so that everyone can attend, and virtual interviews with an option for an in-person interview and visit the residency program site. These adaptations are still a work in progress, but I am hopeful that all the changes and discoveries we had this past year will positively impact medical education.

Ecler Jaqua, MD, DipABLM, DipABOM, FAAFP is a geriatrician and assistant professor of family medicine at Loma Linda University Health. She is the California Academy of Family Physicians Riverside-San Bernardino Chapter president-elect.

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