Tracking the Experience of Residency Leaders

One Year Later...

For the past year, residency leaders have faced the extraordinary experience of coping with the COVID-19 pandemic. Several of them took the opportunity to document their experiences, challenges, and lessons learned. As we launch the new academic year, it seems fitting to revisit these experiences and invite others to contribute their own reflections.

Maintaining Program Culture in Primary Care Residency

One group at Beth Israel Deaconess Medical Center developed a structured approach to teaching residents through this uniquely challenging time. Internal Medicine chief medical residents were determined to maintain and sustain the integrity of their program. To do this, they crafted five questions to focus their approach and support their residents¹:

1. What are our program's core values and how do we maintain them?
2. How do we manage communication?
3. How do we maintain community?
4. How have our roles as chief residents evolved?
5. How do we create a sense of normalcy?

Adapting An Approach to Hybrid Teaching

While teachers around the world took on remote learning, adapting programs for medical students carried a unique set of needs. A team of pediatric residents from Rutgers Cancer Institute and Columbia University Medical Center worked together to identify a common set of challenges and solutions, a subset of which we’ve captured here:²

Challenge: Substantial changes to the structure of rounding, plus limitations to in-person visit volume, resulted in fewer opportunities to actively engage with residents and students at bedside.

Proposed Solutions:

• Share physical exam findings using Zoom with one learner in the patient room and the others watching virtually
• Implement a “learn it and teach it to the next” approach

Challenge: The level of acuity of patients seen on the floor may have also changed, necessitating a renewed focus on escalation of care skills.

Proposed Solution: Residents lead simulation exercises and worst-case scenario preparation for other residents.

Challenge: The necessity for physical distancing disrupts classic resident teaching forums.

Proposed Solutions:

• Implement hybrid curricula for residents working remotely.
• Use dynamic, asynchronous modalities, such as online game-based learning platforms… to engage residents and students.

Emergency Medicine Residents at Epicenter of the Pandemic

In areas hit hardest by the initial U.S. COVID-19 pandemic surge, Emergency Medicine residency program directors (PDs) faced novel and rapidly evolving organizational, educational, and resident wellness challenges.³ Despite variations in residency size, hospital setting, and patient population, PDs from eight residencies in “the epicenter” (New York & New Jersey) found uniformity in many of the lessons learned:

1. The situation evolves rapidly
2. Communication is key
3. Resident illness occurs early
4. Balancing current and future ED staffing needs requires tradeoffs and guessing
5. New educational opportunities emerged
6. Stress, anxiety, and wellness need close management
7. Off-service residents cannot replace ED residents but can still perform critical tasks
8. Socioeconomics determine effects on hospitals
9. The media will come

Rabin et al's³ article not only details all of the above lessons learned, but also details things health care leaders within Emergency Departments can do now to prepare for a surge.

As you reflect on your own experience during the past year, what were some of the most effective ways in which you guided your medical students and residents through the onslaught of patients and the demand for ingenuity and flexibility on a daily basis? Enter your comments or send us an email with your thoughts.

References

1. Rakowsky S, Flashner BM, Doolin J, Reese Z, Shpilsky J, Yang S, Smith CC, Graham K. Five questions for residency leadership in the time of COVID-19: Reflections of chief medical residents from an internal medicine program. Academic Medicine: 2020 August; 95(8):1152-1154. https://doi: 10.1097/ACM.0000000000003419.

2. Moerdler S, Costich M, Redwood EA, et al. Boots on the ground, both hands on the keyboard: Harnessing the power of resident as teacher hybrid teaching skills in the midst of the COVID-19 pandemic. Medical Science Educator. 2021; 31(2):873-875. https://doi.org/10.1007/s40670-020-01185-8.

3. Rabin E, Willis J, Alexander D, Steinberg E, Chung A, Kulkarni M, He C, Parikh S. Residency leadership lessons from the epicenter of the COVID-19 surge. AEM Education and Training. 2020 August 19. https://doi.org/10/1002/aet2.10523.