What does readiness for residency look like? What does it feel like for a student making the transition? Do these things change in the middle of a public health emergency?
Those questions were posed to a panel of educators and learners—entitled “Learning from a natural experiment: Revisiting the 2020 cohort of early medical school graduates serving during the COVID-19 pandemic”—during the AMA ChangeMedEd® 2021 conference. Here’s a look at some of the key takeaways from the event.
The decision
As the pandemic raged in the Big Apple in the spring of 2020, New York University (NYU) Grossman School of Medicine became the first medical school in the country to give its students the option to graduate early. Gabriela Ulloa, MD, then a fourth-year medical student, was faced with a decision: should she begin work on the COVID wards or wait two and a half months to begin her pediatrics residency at NYU as scheduled?.
“What I was deciding on at that time was, one, if I was going to be able to contribute in a way that was going to be helpful,” she said. “Because I think a lot of people in that time in that position as a medical student wonder if it would be more of a burden to the residents than it would be helpful having to orient and train me. Hopefully, I did end up helping.”
“I was also thinking about my husband and my family. I was thinking about how this would affect him, so I was not going to be making the decision by myself. It was going to be me and my husband making the decision together … he was amazing about it and told me he knew I was going to do it.”
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The transition
Readiness for residency isn’t something you can set your watch to.
“We know it’s a gradual process to develop wonderful complex doctors,” said Martin Pusic, MD, PhD, associate professor of pediatrics at Harvard Medical School. “For a while the med ed community has realized this—that the older, more simplistic competency readiness models don’t work for our new aspirations. We want doctors who can thrive in the complexity of modern health care. So, simple benchmarks like, ‘it’s July 1st you’re ready’ or ‘you scored 72% on your final exam you are ready’ have some information in them, but we think we can do better.”
Getting early grads ready, presented its own set of challenges, according to Patrick Cocks, MD, director of the internal medicine residency program at NYU. Early graduates required additional training in areas specific to COVID such as PPE and a knowledge base about the virus that wasn’t part of their med school curriculum. They also would require additional supervision early on which NYU provided with residents from other areas, such as research rotations or other nonclinical rotations.
“We thought about [it] while they were starting during a COVID pandemic; we also had to be mindful that [it] was truly their day one of residency,” he said. “And while it was not July 1, we had to be mindful of the fact that they had attendant responsibilities of a July 1 intern. After they went through a series of workshops, seminars and simulations we were lucky that we had a period of time where they were added almost as a redundant member of the team—a ‘super acting intern’—which allowed for a more gradual transition to clinical care.”
Gain insight on the ways the pandemic has complicated the transition to residency.
The aftermath
While COVID remains present nationally, it isn’t where it was at its peak in New York. The aftereffects of that surge have caused significant mental health consequences for those on the front lines. That, Dr. Ulloa believes, is true for early graduates as much as any other health care worker.
“Usually, the end of fourth year is the time to relax and prepare yourself for life in residency,” she said. “A lot of the people with whom I graduated early lost that period of time. That was difficult. A lot of us in trying to recollect that time period—it feels like a blur to us.
“I wouldn’t say I know anybody who regrets their decision [to graduate early] at all. We all learned something different. There are aspects of it we could do better processing with.”
