Residency Has Changed; What New Docs Must Do Now
Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.
For medical students, the spring after fourth year has traditionally meant riding a spectacular high after The Match. But for this year’s graduates, the temptation of enjoying “the last break they’ll ever have” will be tempered by the reality of having matched during an ongoing pandemic.
Instead of the expected nervous butterflies, many are wondering whether their first year as a doctor will even come close to the learning experience they pictured. With COVID-19 still dominating, can residents get the broad knowledge they need to be well-rounded? Forging relationships with faculty and finding new mentors were already a challenge. How will that work when everyone is (even more) burned out and hidden behind masks?
The good news, say faculty and current first-year residents who survived the pandemic experience last year, is that although some learning opportunities have changed, new ones have popped up for young doctors who have the savvy to access them. Expert advice from teachers and learners with experience on the COVID-19 front lines can help new residents survive — and perhaps even enjoy — a one-of-a-kind first year as a medical professional.
Tip 1: Forget Big-Name Faculty, Find Young Mentors
With so many face-to-face encounters going virtual, making genuine connections with other residents and senior physicians can feel like an uphill battle. With the pandemic adding to an already massive workload, it is only natural for new doctors to worry that it will be harder to cultivate the formative relationships they’ll need throughout their career.
Given the challenges the pandemic poses, the best time to start laying social groundwork is right away, during the spring and summer downtime, says Gus Godley, MD, a first-year general surgery resident at the University of Chicago. “My co-interns and I made an effort to get on a Zoom chat about once a month before we came to the program. It helped to have some familiarity with who everyone was.”
Everyone is Zoomed out these days, but new residents must resist the temptation to turn off their screen or camera during these chats, says Michael Melia, MD, an associate director of the Johns Hopkins School of Medicine’s Osler Medical Residency Training Program. “Make the connection between the face and the name,” he says. “These meetings are more engaging when you can see everybody, rather than talking to a bunch of black boxes with names in white font.”
Once they arrive on site, residents may discover that in-person connections with colleagues come more naturally than they had expected — even with two sets of N95s between them. “People look at each others’ faces more carefully, because you only have the eyes to assess someone’s expressions,” says Kitae Chang, MD, a first-year anesthesiology resident at Emory University School of Medicine, in Atlanta. “People have made arguments that because you can’t see people smile, you may lose some of the human connection, but I have not found that to be the case.”
And although connecting with big-name faculty may be high on new residents’ priority lists, program directors say that what helps most at the outset is bonding with younger mentors, especially others who joined the medical community during COVID-19. “Lean on residents for their thoughts about how they managed the realities of the pandemic,” Melia says.
Jeremiah Tao, MD, director emeritus of the University of California–Irvine’s ophthalmology residency program, agrees — especially because residents’ current experience is vastly different from what many established doctors experienced during their training. “The people who just were at your position are going to be your primary resource,” says Tao. “No faculty or upper-level trainee knows what you’re going through as well as somebody who’s 1 year ahead.”
Tip 2: Don’t Hide Burnout
With its standard 60- to 80-hour workweeks, the first year of residency was notorious for burning out trainees long before COVID-19 came on the scene. These days, new doctors must adapt to the grueling rhythm of day-to-day practice while also navigating the emotional minefield of watching patients succumb to a novel virus.
Without the right support, residents say, it can feel impossible to stay afloat while confronting the human impact of a pandemic that has claimed more than 500,000 lives. “The best way I’ve heard this described was by one of my senior residents — ‘No one is OK right now. Everyone is varying degrees of not OK,’ ” Godley says. “We all are carrying levels of trauma with us right now.”
The usual remedies are still the ones most experts suggest: meditate, engage in self-care practices like yoga, and make sure to get as much sleep as possible. But residents who have faced COVID-19’s horrors close up say the best defense against pandemic burnout is to be open and honest with colleagues. “Reach out to others around you,” says Marina Haque, MD, a first-year anesthesiology resident at Detroit Medical Center. “COVID-19 has put everyone in the healthcare system through the same wringer.”
Godley says he and his fellow residents drew strength from one another to get through the most difficult pandemic days, whether that meant grabbing coffee for a few minutes outside or making time for an end-of-day phone call to vent.
Over the years, medicine’s culture has compelled many doctors to hide burnout and mental health struggles. But Melia, at Johns Hopkins, sees evidence that the culture is changing for the better, particularly in response to the challenges COVID-19 has posed for young doctors. “Programs have had experience at this point with the realities of the pandemic, the moral weight and exhaustion and fatigue,” he says. Melia adds that new residents should quickly become familiar with the mental health services and other support programs that are offered.
Feeling safe in your work environment provides another strong line of defense against burnout, say experts. If a situation doesn’t pass the sniff test, make sure to discuss it with a trusted supervisor. “There were a lot of transgressions against healthcare providers and trainees when COVID-19 first broke out,” Haque says. These included such things as providers being sent to work with inadequate PPE.
Haque notes that in most health systems, these problems have been resolved, but it is still important to be vigilant. “Your safety as a resident takes priority. Whenever you feel uncomfortable, just speak up.”
Tip 3: Level Off the Steeper Curve
Incoming residents have always faced a steep learning curve as they round out their skills through the day-to-day rigors of practice. COVID-19 has made that learning curve even steeper, experts say. Some students have already developed pandemic-related knowledge gaps during their final year of medical school, and coronavirus-heavy patient caseloads may make it more difficult to fill those gaps on the wards.
“What COVID did was hog some attention, especially in the emergency room or ICU,” says Emory’s Chang. Whenever viral transmission levels spiked, a lot of patients came in with the same kinds of symptoms, and as a result, he says, “learning gets a little bit catered.”
On a positive note, this year’s new residents are likely to spend more time with patients than last year’s did. As healthcare systems have refined their safety and PPE protocols, most rules that restricted clinic time have been lifted. Still, for some specialties, the array of patients may remain COVID-heavy for some time to come.
To broaden your knowledge base, the University of Chicago’s Godley recommends seizing every opportunity to learn from senior mentors in a distanced, small-group setting. He says not to rely solely on Zoom meetings, in which it can be more tempting to zone out and miss key concepts. “It definitely was easier to pay attention to important and relevant information when we were in person,” Godley says.
If a COVID surge limits real-world training time, residents should take matters into their own hands, advises University of California–Irvine’s Tao. For hands-on specialties and surgical specialties in particular, Tao stresses that it pays to log extra hours in the wet lab, where you can brush up on your procedural technique using artificial organs or animal tissues. “Get in there and practice,” Tao says. “It’s a physical profession. Repetition and hand-eye coordination matter.”
Tip 4: Take the Long View
Above all else, mentors urge young doctors to think long term. In the middle of a pandemic, not to mention the major life change of starting residency, looking 10 to 20 years down the line might not be at the top of one’s mind. But that’s exactly what many say to do. Not only will being clear about future career goals provide a respite from a pandemic-obsessed mindset, it will help with choosing where to allocate energy when everyone is stretched to the limit.
For those who envision academic research as part of their professional calling, Tao recommends taking time before residency to think about research directions to pursue. “It seems like it’s way off in the future, but it comes up quick,” he says. “Why not start that process now?” Once in the throes of an 80-hour workweek, big-picture thinking time is a rare commodity.
Soon after arriving at residency location, residents should work on forming habits that establish them as a contributor to the medical community. One smart move is to stay on top of new findings in the medical literature and share them regularly with colleagues, especially if they provide insight into COVID-19-related issues or other challenges teams may be struggling with.
“There’s an assumption that everyone who’s senior to you already knows everything, which is completely false,” Tao says. “Bringing articles in is a powerful way to show everybody that you’re moving the needle.”
Despite all the challenges, entering practice during a pandemic also offers a unique opportunity to develop a compassionate, patient-oriented approach that will carry doctors through the years ahead. “The director of the ICU made it kind of a rule that we included patients’ families on our rounds,” Emory’s Chang says. In phone and video chats, he says, “we would summarize what our plan was and translate that in ways that the family can understand. This would lend them some comfort, knowing that we were always present for their patients.”
Above all, stresses Robert Johnson, MD, dean of Rutgers New Jersey Medical School, make a point of accepting and quickly adapting to new practical knowledge — even when it arrives in unexpected ways. “Strike the right balance between maintaining a level of humility while growing and gaining confidence,” he says. Doctors who hone this flexible, responsive mindset will be equipped to serve patients and families to the utmost throughout their careers, long after COVID-19 has receded.
Elizabeth Svoboda is a science writer in San Jose, California. Her work has appeared in the Washington Post, Discover, and elsewhere. She is also the author of What Makes a Hero?: The Surprising Science of Selflessness.
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