As senior internal medicine residents approaching our graduation this summer, my classmates and I have experienced a very different final few months of training, thanks to COVID-19. Far beyond not being the calm coast to the finish line that I had personally hoped for, this final quarter of residency will undoubtedly prove to be one of the most memorable and challenging times of my – and likely many of our – careers. Within just over a week, nearly every aspect of our “normal” resident life was disrupted, and I do not believe the disruptions will cease any time soon.
We have not yet been faced with the full impact of the pandemic, but the preparations have made it abundantly clear that it is marching towards us full speed ahead. Within the span of a few days, all of our upcoming conference presentations were cancelled, our education sessions were transitioned to virtual streaming only, our clinic visits were transitioned to exclusively phone or video and, finally, those of us on non-essential rotations (such as outpatient subspecialty clinic, consult services, etc.) were pulled off of our clinical duties. Instead, we were asked to stay at home, waiting to be called in to the hospital if and when colleagues fall ill. As we say frequently these days: it is all very surreal.
While self-isolating at home is certainly a restful break, it is unsettling in its own way. The necessity for us to so drastically alter our rotation schedule underscores just how serious the situation really is. And moreover, being away from the hospital without the distraction of our clinical work leaves plenty – and in my opinion, sometimes too much – time to focus on just how upended our current lives are. But in any case, those of us at home will undoubtedly be called to the frontlines soon enough. In the meantime, participating in virtual education sessions, journal clubs, committee meetings and happy hours with our colleagues helps to provide somewhat of a routine and framework for our new normal.
In the midst of this abrupt and disturbing change, I have taken note of what types of information my co-residents and I find most helpful and, to be quite honest, comforting, from my institution and in particular our residency leadership. Here are a few of the highlights. These will vary based on your program and institution and are sometimes changing on a daily basis. Nonetheless, I think the basic ideas can apply to many of us in currently in training, as we work to succeed in our residency programs and going forward into our professional careers.
- Specific information about how your institution is preparing for the pandemic
- What steps is your hospital taking to accommodate for the projected increase in patient volume? Our hospital, like many nationwide, has cancelled/postponed all elective surgeries and in-person clinic visits. In anticipation of a COVID-19 spike, surge plans including increased medicine services, PCU/ICU beds, etc. have also been made.
- What is the plan for PPE? Are there current policies, for instance, regarding re-using masks? At our institution, we have also started utilizing telemedicine for hospitalized COVID-19 patients, allowing providers to see and speak with patients multiple times per day without requiring a great deal of PPE.
- Are they planning to assign COVID-19 patients to resident services?
These are just a few examples, but most of us in medicine feel strongly that knowledge is power, and the more informed we feel, the better.
- What to do to protect yourself and your loved ones
- What should you do if you or someone you live with is particularly high risk (e.g., immunocompromised, elderly, etc.)?
- Are there protections in place for you in this situation? For example, at our institution we are advised to reach out to Occupational Health and our primary care doctors who will take the lead in making necessary accommodations for us.
- What do you do if you feel sick with COVID-19 symptoms? Who do you contact regarding getting a test?
- What is the policy regarding sick days for this time period if you test positive? How long do you need to stay out of work?
- Clinical pearls about COVID-19
- What is the most typical disease course that we are seeing in our institution? Our Infectious Disease division is following every hospitalized patient with COVID-19 in order to assess progress and better characterize the clinical syndrome in our patient population.
- What do the more severe cases typically look like? What proportion of your local cases are severe? What is the local case fatality rate?
- What is our hospital’s current standard practice for treatment? We have an institution-wide treatment algorithm that is widely available to both inpatient and outpatient providers, and nearly every patient is being followed through some sort of clinical trial. Knowing how to locate such resources at your hospital can be invaluable.
None of us obviously learned about this virus in medical school – we want to know at least the basics of what has been seen thus far to ensure we’re providing the best possible care.
Our residency has handled communication about COVID-19 with trainees primarily through a daily update email from our Chief Residents, which has been very positively received. However your program is handling things, I recommend that you inform yourself in these particular areas. The unknown, after all, is often the most ominous part of crises. Armed with knowledge, I am very optimistic that we will get through this together.