The COVID-19 pandemic has changed our world in many ways, and for trainees in medicine, the new day-to-day experience of residency continues to adapt and take shape. COVID-19 has undoubtedly affected clinical experiences and educational curricula for residencies. Personal wellbeing for EM residents has become even more important with the new stressors of being on the frontlines. How has the resident experience changed in the ED? How are residents dealing personally and professionally with the new state of things? What strategies, interventions, and resources that residents are utilizing to combat burnout?
In this 2-part series on Physician Wellness in the COVID-19 Era, host Dr. Katie Rebillot (LA County-USC) discusses these issues with EM residents Dr. Jacqueline Furbacher (The Ohio State University), Dr. Sydney Beck (Harbor-UCLA), Dr. Sanida Lukovic (Jacobi-Montefiore), and Dr. Surriya Ahmad (SUNY Downstate/Kings County).
Drs. Furbacher, Beck, Lukovic, and Ahmad discuss how their ability to provide care in the ED has been impacted, how their training has been challenged in new ways, how their personal life has been affected, and what is being done at their residencies to improve physician wellness. Below are some highlights from the conversation.
COVID Challenges to Patient Care Experience
ED volumes decreased drastically in the wake of shelter-in-place orders as a result of patients avoiding the hospital, decreasing levels of accidental injury, and cancellation of outpatient and elective procedures. Residents are seeing:
- Less patients overall
- Decreased variety in patient presentations
- Drastic drop-off in exposure to pediatric patients
- An overwhelming number of potential COVID-19 patients
As a result of plans put in place to limit exposure and transmission, the team-based approach to care, a central part of EM, was disrupted. This has also affected the learning environment for residents.
- Teams have become smaller due to a limitation on the number of providers in the room.
- Junior residents are losing out on opportunities for procedures.
Educational Curriculum Changes
The transition to online didactics represented more than just a change in venue. Weekly conference had been a time for residents to catch up, bond, and check-in on each other. While online didactics allow for residents to stay on track with foundational knowledge instruction, there remains a lack of group-learning.
Despite feelings of COVID fatigue, residencies have utilized the challenging pathophysiology of COVID-19 to create new learning experiences on critical care. For instance, residencies with a simulation heavy curriculum have adapted to smaller group sessions and recordings for debriefing as a larger group.
Lost patient encounters have required educational supplementation of the existing didactic instruction. An emphasis on on-shift teaching during down-times, or dedicating education rounds to non-COVID topics can replace these lost learning opportunities.
Physician Wellness in the Time of Social Distancing
Shelter-in-place orders and social distancing have affected the feeling of connectedness that is often a large component of wellness in residency. Furthermore, limited interactions with family, friends, and co-residents have changed life outside of the hospital.
Approaches to maintain personal wellness in times of social distancing include:
- Being mindful of the positive side of new changes, like cooking more at home
- Taking advantage of the outdoors and finding a routine for physical activity
- Enjoying new or old hobbies: pets, cooking, reading, fitness
- Scheduling digital coffee or meals with friends/family online
Residency programs can contribute to trainee wellness by adopting:
- Zoom social hours
- Social Slack channels
- Prioritizing of Wellness Curriculum efforts like cooking classes or mindfulness sessions
- Transparency and frequent updates for COVID policies
- Snacks/Treats on shift
More Wellness Resources
Looking for more wellness resources? Check out ALiEM’s extensive wellness archives.
Want to hear about how other physicians are managing their wellness now (and in more normal times)? Check out the How I Stay Healthy archives.