Residency

Entering residency in a former COVID-19 hot spot? What to expect

The run-up to residency in the midst of a historic pandemic has presented a number of unique challenges. But those are likely to pale in comparison to what new residents may encounter when they begin training—particularly if they are entering an area that has felt a significant burden from the virus.

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New York was ground zero in the fight against the COVID-19 pandemic. For the time being, the virus’s effect has lessened on America’s most populated city.

Still the reality for medical residents who are beginning practice in locations like New York, particularly in primary care specialties, will be a different one than what it would have been in February. With training slated to start in mid-June at most institutions—and residents seeing patients on July 1—here is what new residents destined for a former COVID-19 hotspot should expect.

PPE use as a competency

Both inside and outside care facilities, stopping the virus’s spread has been the nation’s top priority. Programs also have the added emphasis of keeping their trainees safe. For new residents that means understanding how to properly wear personal protective equipment (PPE).

Patrick Cocks, MD, is director of the internal medicine program at NYU Langone Health (NYU). Having utilized early graduates in the months when the patient load was the heaviest, NYU has done a dry run, of sorts, integrating new physicians into the work force.

NYU plans to make PPE use one of the focuses of its orientation for new residents when they arrive on campus.

“In real time, everyone who will be caring for potential COVID-19 patients will have a donning and doffing buddy,” Dr. Cocks said. “Someone to watch them put on and take off their gown until they have demonstrated competence in that.”

Added Christopher Clifford, MD, a second-year emergency medicine resident at Mount Sinai Health and Elmhurst Hospital Center: “In terms of giving advice to incoming residents, the biggest advice I have is be sure to take your own safety into account. It’s kind of a weird thing. We’ve never been taught to do that in the past. The virus, everyone knows at this point, can affect young people.”

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A different type of patient

New York’s COVID-19 case load has fallen in recent weeks, and because of that the types of patients physicians are seeing are more diverse than they were in the virus peak.

“For two months we were essentially COVID-19 hospitals, where the patient mix was minimal, if any. We are now starting to see a broader array of illnesses,” Dr. Cocks said. “Some of them are the routine illnesses we would typically see, some are unexpected illnesses of individuals who delayed care because of fear of getting to the hospital during the pandemic—perforated appendices, chronic gallbladder [conditions], disease processes we might have seen earlier in their course.

“The other elements of disease we are starting to see are the chronically, critically ill COVID patients. Individuals who came in and have been stabilized and have been in the hospital for 30 to 40 days. There are unique medical challenges caring for that patient population. That will be an important part of our clinical and educational experience.”

Focus on a second wave

Summer may slow the spread of the coronavirus a bit, but it will be back by fall with a second wave that looks a lot like the first wave, according to a leading epidemiology researcher. Hospitals and physicians are preparing for that second wave, and this time around—Dr. Clifford believes—they will have a better understanding of what they will be dealing with.

“At times during the first wave, it felt like we had no idea what was going on,” Dr. Clifford said. “We were testing maybe one in 20 people that had the virus because we didn’t have enough testing capability. We were only testing people who were coming into the hospital. We had no idea what the virus was doing, where it was going and who it was affecting.

“It sounds like there will be a second wave. But we will do better. There’s more testing capability. For new residents, you are seeing cases blow up and you might know what is happening first.”

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An emphasis on research

With so much about COVID-19 still unknown, resident physicians who are interacting with patients who have the virus will have the chance to share their observations and participate in research, Dr. Cocks believes.

“There’s opportunity to share observations that might lead to treatment interventions,” he said. “It’s real-time research and the chance to impact patients in a much greater scale than residents in years past. Some of our residents are partnering with faculty members, and some can be part of the group that makes a difference in this whether it be through improved therapies or even a vaccine.”

The AMA has curated a selection of resources to assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.