Training during a pandemic: Advice for incoming residents

When Tyree Winters, DO, was a resident a decade ago, a scary virus hovered over his day-to-day routine.

“I was a third-year resident during the time of H1N1, when it first emerged,” says Dr. Winters, who is now the associate program director for the pediatric residency program at Goryeb Children’s Hospital in Morristown, New Jersey.

“We didn’t know what was happening,” he says. “We would see people with the mildest of symptoms, or we would see people with the most horrendous outcomes.”

A decade later, another virus—COVID-19—is having an even greater impact on the health care system, and today’s residents.

Dr. Winters’ role has changed since the earlier crisis. As an associate program director, he now shepherds his residents through what can be a dangerous and challenging time.

Despite these difficulties, he says the pandemic also offers lessons that will serve residents well throughout their careers.

“This is still a unique opportunity for our incoming residents to not only learn the way the health care system is going to change, but also to shape and mold it,” he says.

Adapting to the pandemic

Richard Bryce, DO, says that soon after the pandemic hit the Detroit area, the family medicine floor at Henry Ford Hospital was full of COVID-19 patients.

“In a very short time—maybe a couple of days—the infectious disease floor was completely filled, and then we became the overflow,” says Dr. Bryce, who is program director for the Henry Ford Hospital family medicine residency program.

Every resident in the program helped treat COVID-19 patients, with some residents volunteering to join other hospital departments so they could contribute where the need was greatest.

“We really had to step up and figure out how were we going to work together as a team,” he says. “It has been incredible, the response of our residents.”

Residents in the program have had to adjust to many new challenges.
“There is a barrier when you’re having to wear all this PPE, or if you’re doing telephone visits or video visits,” Dr. Bryce says.

In addition, devoting large amounts of time to treating COVID-19 patients has made it more difficult for residents to get some of the clinical experiences that are the norm in less stressful times, he adds.

“As you can imagine, it’s been tough,” Dr. Bryce says. “But coming together as a team and remembering to give the best care to the patient, I think, keeps us motivated to do a good job. “

Dr. Winters says today’s residents are entering medicine during an “unprecedented, life-changing event.” That is changing how they experience residency.

For example, typically during residency, exposure to death is muted, Dr. Winters says.

“In a resident’s training, they encounter death, but they don’t encounter death or severe cases on a very continual basis,” he says. “It’s very sporadic.”

However, the emergence of COVID-19 means residents confront life-and-death situations far more frequently.

“Even though we’re starting to get flattening of the curve, we’re still in the midst of this,” Dr. Winters says. “It’s not going away.”

One resident’s experience

Amanda Ly, DO, is nearing the end of her second year as a general surgery resident in a Detroit-area community hospital.

“I never thought that I would be doing residency during a pandemic,” she says.

Dr. Ly says that in preparation for treating COVID-19 patients, her program director gave lectures on ICU management and ventilators to prepare the residents for what was to come.

Fortunately, the number of patients with COVID-19 has stabilized where Dr. Ly is working, but she says the pandemic has increased her awareness of the need for personal protective equipment.

“I don’t think a single person will ever look at masks, gowns, or ventilators the same ever again,” she says.

She also has a better appreciation for the role that everyone in the hospital—“from janitors, to nurses, physicians and everyone in between”—plays in making sure patients get the care they need.

Coping with residency during a pandemic

Dr. Winters encourages all residents to remember that their job is twofold. On one hand, residents take care of patients—and the need for such care can be substantial in areas where COVID-19 has hit hard.

However, residents also must remember that they are in the learning process. “It’s always a battle between service and education,” Dr. Winters says.

That push and pull between two different goals can be draining. When Dr. Winters was a resident dealing with the stresses of the H1N1 outbreak, he sometimes felt overwhelmed.

But with time, he also learned to be more flexible and to accept that there were limitations in terms of what he could achieve.

“It’s OK not to know, it’s OK to be scared,” he says. “It’s OK to not always have it together.”

He urges today’s residents to try to strike a balance that allows them to help patients while also avoiding burning out.

“You have an obligation to yourself as well as to your future patients to make sure that you’re putting your education to the forefront,” he says.

Dr. Ly says her heart goes out to those who will move quickly from graduation into the whirlwind of caring for patients during a pandemic.

“My biggest advice is to take the opportunity to focus on yourself and self-care,” she says. “I also encourage you to make your connections stronger to friends and family because time is rare in residency.”

In fact, Dr. Ly says that before starting her residency, she met with a counselor to learn how to decompress from both acute and chronic stress.

“I think that was single-handedly the best thing that I could have ever done,” she says. “Residency is a marathon, and learning how to prepare and take care of yourself along the way will be your biggest asset.”

Dr. Bryce says that although residency in a pandemic can be challenging, it also forges deep bonds among those who share the experience.

“It’s been a difficult time, but I can tell you that for our residents, this is the closest that we’ve ever been,” he says.

Related reading:

Where first-year residents train affects their risk of becoming depressed, study suggests

5 habits for residents to develop during residency