Residency training in the time of COVID-19

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A few days ago, a good friend revived an email thread that routinely circulated among our social cohort of 17 aspiring doctors during our final two years of medical school. The subject line read: qThurs HH. Translation: happy hour every Thursday.

Back then, the goal of the email was to establish a standing opportunity for any available recipients to vent about 5 am rounds and difficult attendings or to share stories of fascinating cases and patients that had touched our lives. Typically, attendance was around 2% due to the demands of our educational schedules, but hey, we tried.

“While it may not be the best time for happy hour,” my friend wrote from Philadelphia this past Sunday, “[I] thought this felt like an apropos time to touch base. Just to have a place to share experiences, ask each other questions, see what is happening across the country.”

After graduation, the qThurs crowd dispersed to hospitals near and far, in more than 12 distinct specialties. Respectively, we learned how to use spinal needles, rapid intubation kits, cognitive behavioral therapy, and bone saws. We learned how to be efficient without sacrificing our empathy. We learned how much we still do not know.

Now, with less than two years of doctoring behind us, we are facing an unprecedented public health crisis that has left even our most articulate mentors at a loss for words, one that no large-scale emergency simulation drill could ever have prepared us for.

Almost immediately after I received my friend’s initial email, responses began to flood in: stories of mask shortages, limited COVID-19 testing capacity, and co-residents who had fallen ill with the virus. While recounted experiences varied somewhat based on geography and field of medicine, one theme began to emerge right away: many residents did not feel that their programs were doing enough to confront the virus, or to communicate with and protect their trainees.

At a time when most people’s lives have moved away from the physical workplace, allowing them to take refuge from the threat of contagion in the comfort of their own homes, many health care workers are being asked to give more than ever, in an environment where information – and protective gear – are sparse. Furthermore, doctors-in-training, who are often sleep-deprived on account of 80-hour work weeks and overnight calls, are risking exposure to multiple patients with the virus in a single day, making them particularly susceptible to infection.

“We are getting completely pulled off our outpatient/elective rotations so that the entire residency can serve as backup,” one resident wrote.

“I ended up in the MICU covering for a colleague and had exposure to 4 patients who tested positive (and potentially many more whose results are still pending),” wrote another.

Reading through all of the emails I have received, I must admit that I feel very lucky. My own program has been clear and consistent in its determination to keep residents safe and informed, and many members of our faculty have gone above and beyond to ensure that, during these extraordinary times, our mental, physical, and educational needs are being met.

However, not everyone has been so fortunate.

“The hospital has not publicized the issue of asymptomatic spread to health care workers, has not canceled elective surgeries, and has no telemedicine infrastructure in place as of now (although they are working quickly on it),” wrote a different resident.

“Of note, there was one day when there were no N95s available to us,” reported another.

Like other members of society, residents may have co-morbid health conditions that make them vulnerable, family members that they are intent on keeping safe, and financial obligations that cannot be ignored. They are entitled to barrier equipment and PTO, should they become ill or need to quarantine. At a time when they are sacrificing more than ever, no resident should be met with obstinacy and inflexibility from their higher-ups. What all residents need – and deserve – now, more than ever, are guidance, leadership, and support.

“While I understand that as doctors, we are on the front lines, it seems like all the decisions have been reactive rather than proactive,” concluded the final email I have received. “I think [my hospital] was thinking that it wouldn’t hit as hard or just wasn’t thinking.”

None of these dedicated physicians is a stranger to sacrifice, and each of them is more than willing to step up in difficult times. We all understand that the policies and procedures manual for this situation are being written and revised in real-time. But no doctor-in-training should have to feel that they are being placed in unsafe situations or coerced into working without appropriate protections in place because their home institution insisted on hedging its bets for far too long, in spite of the perfectly legible writing on the wall.

Ultimately, every hospital in the United States should be taking this crisis seriously and working tirelessly to provide optimized conditions for every type of health care worker, at every stage of their careers. We will not be able to help our patients if we are misinformed, exhausted, exposed, and sick. If your own institution isn’t doing enough to stem the COVID-19 outbreak and keep staff safe, please do not remain silent. Demand facts, plans, and proper safeguards.

And I will see you all at happy hour when this over.

Adina Wise is a neurology resident.

Image credit: Shutterstock.com

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