What new residents may face at programs in former COVID-19 hot spots

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

AMA Chief Experience Officer Todd Unger speaks with resident physicians and graduate medical education experts on how residencies in former pandemic hotspots continue to be impacted by COVID-19. Learn more at the AMA COVID-19 resource center.

Speakers

• John Andrews, MD, vice president, AMA GME Innovations
• Zoran J. Pavlovic, MD, ob-gyn resident physician, Rush University Medical Center
• Pratistha Koirala, MD, PhD, ob-gyn resident physician, Danbury Hospital

Unger: Hello, this is the American Medical Association's COVID-19 update. Today, we're looking at how COVID-19 is impacting residencies in former hotspots. I'm joined today by Dr. John Andrews, AMA's vice president of GME Innovations in Chicago, Dr. Zoran J. Pavlovic, a soon-to-be fourth year resident OB-GYN physician at Rush University Medical Center in Chicago, and Dr. Pratistha Koirala, a soon-to-be third year resident OB-GYN physician at Danbury Hospital in Danbury, Connecticut. I'm Todd Unger, AMA's chief experience officer in Chicago.

New residents are starting their programs within days and some will be treating patients within weeks. Dr. Pavlovic, Dr. Koirala, how have your residencies changed since COVID-19?

Dr. Pavlovic: Yeah, there have been a lot of changes of residencies across the board, anything from downsizing teams in inpatient services so that we could have a float pool and have residents available to help in ED and the ICU, which are new units for us, especially in OB-GYN, to canceling elective surgeries, which in order to allow, again, people to help out in other units. But that takes away with a little bit of the training. And then of course, moving forward towards didactics and grand rounds all being done via Zoom which is a new experience I think for everyone. So those kinds of changes, I think, have swept my residency and residencies around the country and across the board.

Unger: Dr. Koirala, safety's always a top priority, are you taking any different safety precautions than you were before COVID-19?

Dr. Koirala: Yes, we are using a lot more PPE. We're using our gowns and gloves just like we used to do for all deliveries. And in addition, masks for our deliveries and using face shields as well. This is sometimes challenging because when we are coaching patients through pushing, for instance, that can be three, four hours at that bedside talking to a patient the entire time. But it's kept us safe. So none of us have gotten sick, and we hopefully will keep it that way.

Unger: Dr. Pavlovic?

Dr. Pavlovic: Yeah, similar situation here. Use of PPE much more than you were used to before. We did a great job at this hospital having teams come around and train the residents and the staff in how to appropriately wear the PPE, have educational modules, making sure that everyone's up to date on best practices. So the transition was pretty smooth. It was just getting used to all the equipment and then of course being diligent about not bringing medical gear home or making sure that you wash your hands leaving to and from work and in and out of patient rooms. And I would like to say the other big thing that I've noticed in terms of changes in residencies for COVID patients is how much do you emphasize early on, especially with pregnant patients, about how much we didn't know exactly about protocol, how we're going to treat them, what the next best step is in terms of their management because there was so little information.

And that information was changing almost daily. And that can be very frustrating for patients and the fact that they're getting new information each day. And they're very fearful about what's going on with them and, of course, their child. And so I thought the best way that we were able to manage that is just clear communication, letting them know what we know and what we don't know and that it's changing every day. And having that open conversation both with patients and their families has really kind of helped bring everyone into the fold.

Unger: Well, it's already a high anxiety time, and I'm sure that's a challenge. Dr. Andrews, how are program directors preparing for new residents coming on board in June and July? What are they doing differently?

Dr. Andrews: Well, a lot of the orientation to residency that medical students experience when they make their transition is social. Some of it's social in the sense that they're getting to know their peers, and some of it's social in the sense that they're gathering for collective activities to prepare for the clinical demands of residency. And all of that's been disrupted by the response to the pandemic. I've talked to some program directors who have actively reached out to their matriculating residents through vehicles like Zoom to have small group discussions and to orient them to what arriving at residency was going to be like. And actually, program directors view that very positively and wonder in some respects why they haven't always done that. The opportunity to reach out in advance of their arrival at the residency to give them a little more information about what they'll be facing has been quite welcomed.

I think that when people do arrive, the orientation would probably be similar, although more virtual than it has been in the past. And importantly, there'll be a heavy emphasis on the use of PPE, making sure that arriving residents are well-trained in donning and doffing PPE and the situations in which it's necessary to use that. So there will be some modifications to typical orientation that are arriving in terms of experience.

Unger: Well, Dr. Pavlovic and Dr. Koirala, you're well into your residencies now, but you have a whole new crew coming on board that may be very worried and anxious about starting their careers in the middle of a pandemic. What advice do you have for them?

Dr. Pavlovic: I would say my biggest piece of initial advice is to be confident in your abilities, your knowledge and your skills. You're definitely not alone in this situation. There's those of us who've been in this for months now. And that statement that you see all around society that's we're in this together, I don't think it's any more evident or true than in health care because everyone should help you navigate anything from new protocols to how to keep safe at work and at home. And that, besides, is an ever changing situation. So you may have some fears and some doubts, but those fears and doubts and those feelings are present from all levels of training in our attendings and program directors. And so you're definitely not alone in it. And never feel afraid to admit if there's something you don't know or you want clarification or need some support because that's what we're all here for, for each other to do that. And so I know incoming residents may be a little fearful, but I think that they should have confidence that they'll do well and they'll be taken care of and we'll help them out.

Dr. Koirala: So I think that feeling of, oh my goodness, how did I get here, I am not ready, is something that every single incoming intern feels every single year. It's not something that's unique to this year. Obviously, there are a lot of things that are different in this orientation and onboarding process than there have been in the past. I think that one of the best pieces of advice that I was given and that I'd like to pass along is remember that there are people that you can trust. There are a lot of patients who are looking to you, and they're trusting you with their lives. In the case of OB-GYN, they're trusting us with their baby's life. But there are people who have your back. Your seniors are going to be there to guide you. We are here to answer the questions that you have. And every single day, you're going to learn something new. And every single day, you're going to learn all the things that you didn't already know. And that's okay. It's okay to recognize that you don't know everything. And it's okay to ask for help.

Unger: Dr. Andrews, from a program director perspective, how would you advise?

Dr. Andrews: Well, I can only endorsed what Dr. Koirala and Pavlovic have already said, which was that you have to recognize that as you join a residency program that you have a voice. And it's always a difficult transition for students to go from a learning environment in which they're really relatively passive absorbers of knowledge to one in which they're actively participating in their own educations and have autonomous responsibility for the care of patients. And that autonomy extends the need for them to raise issues when they see them, to advocate for themselves and for others and to recognize that there's enough uncertainty, that their contributions will be valuable alongside those of their peers.

Unger: The AMA has some resources prepared specifically for residents. Do you want to talk just a little bit about that, Dr. Andrews?

Dr. Andrews: Sure. Yeah. In response to the pandemic, the AMA has produced a variety of resources. We have a guide for those engaged in medical education at the medical student resident and faculty level. If you look for the AMA COVID-19 medical education resource guide, you'll find it easily on the internet. And there are variety of resources there that relate to well-being, that relate to the response to the pandemic and relate to the ongoing delivery of education in this environment.

Unger: So last question about wellness. The pandemic has taken a tremendous toll on physicians, residents included. Dr. Pavlovic, Dr. Koirala, how do you advise new residents on what they have to offer at this moment and how they take care of themselves in this kind of pandemic scenario?

Dr. Pavlovic: I think that now more than ever is the time it's important to find time for yourself and for the things you're passionate about. And that's true throughout residency before the pandemic, absolutely. But especially now, it's really important to find the things that you enjoy, whether that's exercising, walking outside or playing music. Whatever it could be, finding some time to go into that. Step away from both work and from thinking about the pandemic to give yourself an ability to recharge and take that break. I think that's extremely, extremely crucial for all residents to do, and especially now during the pandemic. And these are new residents coming in, but we're extremely excited to have fresh minds and fresh faces because we've been working on these situations all together for months now, but a new perspective and new eyes is the only way that medical innovation moves forward. So never hesitate, again, as Dr. Andrews said, to bring thoughts and ideas and perspectives forward because your ideas could definitely make impactful change in health care. And so myself and everyone here, I'm sure, is extremely excited to have these new residents come in and bring enthusiasm and energy and newfound strength.

Dr. Koirala: Actually, at my program, we have printed out pictures and little bios of all of our incoming residents, our interns, and they're posted everywhere. And the nurses all know your names already. We know your names already, and we're so excited to have you. One of the things that's been incredibly challenging for so many of us at this time is how isolating things can feel. A lot of us as residents live alone. Just that's the nature of where we are in our professional lives. And with COVID and social distancing, many of us found ourselves alone at home working surprisingly fewer hours than we would normally. And that had the cost of not being around other people very often. So I really want people to remember that putting an emphasis on your mental health and your well-being is something that we should do every year but especially this year. Reach out to your peers. They're going through what you're going through.

And even if all you can figure it out together is a Zoom happy hour, have the Zoom happy hour. We are missing out on a lot of the social aspects of what helps each and every single one of us survive residency. And we're working on figuring out how to replace those traditional things with things that are safer at this time. And then finally, if it ever does cross a point where it's more than just feeling isolated or overwhelmed by residency, remember that it's okay to ask for help. There are people who are ready and willing. It's all of our jobs to help each other out. And the last thing that we would want is to lose anybody. Medicine is incredibly hard. Residency is one of the most challenging times that you can go through, more so now than ever before, and it is okay to ask for help.

Unger: Well, Dr. Koirala and Dr. Pavlovic, best of luck to you as you return to your residencies. Dr. Andrews, thanks for being with us here today. That's it for today's COVID-19 update. We'll be back for another segment tomorrow. In the meantime, check out ama-assn.org/COVID-19 for resources on COVID-19. Thanks, and take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.