Since the beginning of 2020, COVID-19 has upended our lives in a turn of events that, just months ago, would have only seemed possible in a science fiction movie. What is traditionally an exciting time of year for medical trainees has instead become a time of tremendous uncertainty and fear.
Our clinics have grinded to a halt. As residents, we rely heavily on our patients to learn our craft; each patient has something to teach us. In my specialty, first-year ophthalmology residents find themselves in a position in which, just as they’re starting to feel competent in a field many knew little about a year ago, their source of learning has nearly dried up. Amidst this setback, they will soon assume a substantial increase in responsibility as a new year of residency begins. The challenge for senior residents is equally daunting. Our elective surgeries disappeared overnight, freezing our cataract volume mid-stride and depriving us of several critical months’ worth of surgical supervision before dispersing out into the world alone. Furthermore, the rapid and steep financial downturn that has compounded the worst public health crisis in a century has left us wondering: will there be a job for me?
Moreover, it is not lost on us that we see patients at risk to our own safety and that of our families. In the face of this adversity, I am proud of the resolve my co-residents and attending physicians have demonstrated to continue to care for our patients. I also appreciate my institution’s commitment to resident safety. But despite being well-armed with personal protective equipment, we go to work and wonder … what if?
This became personal when I was abruptly awoken one morning by my partner’s panic-stricken voice: “I have chills and a fever.” In the COVID-19 era, fever comes with a new set of implications. The anxiety of the disease was enormous for both of us. Worst-case scenarios danced endlessly through my mind. We live around the corner from my hospital’s emergency department, and I could not shake the image of hoisting him over my shoulders and carrying him there in the middle of the night. It would be quicker than an ambulance, should the need arise. Thankfully, it didn’t.
Although it is hard to avoid becoming emotionally worn, positive developments have arisen from dire circumstances. First, I am inspired by and deeply grateful for the courage and selflessness of healthcare workers caring for COVID-19 patients in emergency departments, medical wards, and intensive care units across the country. Their bravery elevates the profession of medicine for all of us. For me, it is also a reminder of the power we, as doctors, have to help people. It goes without saying this is a core tenet of the call to medicine, but I admittedly lose sight of it sometimes in the thick of residency.
Second, we have been forced to rapidly adopt new technologies to provide care for patients whose vision-threatening diseases refuse to acquiesce to the threat of a global pandemic. Telemedicine has quickly proven to be a valuable tool in our armamentarium. It is easy to imagine how its utility extends beyond COVID-19 – for patients with limited mobility or lack of transportation, for instance, but also those with busy lives for whom traveling to an appointment is burdensome. From a public health perspective, perhaps we can employ telemedicine to reach people with limited access to eye care. Doing so may help us mitigate utilization disparity, which remains a major threat to population eye health.
Third, COVID-19 is an invitation to reflect on how we can improve medical education. The adoption of telemedicine has coincided with the rise of virtual education. I recently watched a recording of my co-resident’s cataract surgery on my laptop in the first web-based cataract conference held at my residency. I felt that my ability to appreciate intricacies of the case was superior to a lecture-hall based approach. A product of my generation, I took a photograph of my screen and posted it to a social media account with a caption stating so. I was surprised to receive so many messages from other residents, both in and out of ophthalmology, saying, “I agree.” Virtual learning may be new to many of us, but its value has been previously recognized.
In that vein, the spirit of collaboration I have witnessed among physicians since the pandemic’s onset has been remarkable. As COVID-19 spread through New York City, the city’s ophthalmology residencies joined forces to collaborate on virtual core lectures. Anecdotally, I have attended virtual grand rounds, surgical conferences, and didactic sessions hosted by other institutions. At least one ophthalmology society recently hosted the first in a series of freely available virtual sessions in substitution of its annual meeting. As a trainee, I find these learning opportunities invaluable. In the very recent non-virtual past, they would have been inaccessible to me. I believe – and hope – this will be a paradigm shift in medical education.
In addition to changes in formal didactic curricula, this pandemic is an invitation to reflect upon other ways that residency training can be improved. For example, many ophthalmology residencies reserve intraocular surgery for the final year of residency. A pitfall to this approach, as we are learning, is that an unanticipated interruption in the ability to operate during that year disproportionately impacts residents’ overall surgical experience. Earlier intraocular surgery may enhance ophthalmology training well beyond the pandemic. Although each medical specialty faces its own challenges, we can all co-opt this opportunity to refine our training models.
As we move forward, we will face more hardships and be forced to make further adjustments. The practice of medicine will emerge permanently changed. Yet, I am inspired by the innovative ways my peers and mentors have rapidly adapted to unprecedented circumstances. If we continue to harness this flexibility and creativity, we can ensure that part of COVID-19’s legacy will be an enduring improvement in our ability to care for our patients and train our successors.
Joshua H. Uhr is an ophthalmology resident.
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