Amid pandemic, medical trainees describe fear, pride

NEJM paper relates survey respondents' candid expressions of distress and admiration, among other emotions.

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The COVID-19 pandemic poses challenges not only for front-line caregivers but also for healthcare workers in training. Reflections of more than 300 medical students, residents, and fellows at the University of Washington School of Medicine have led to a paper published today in the New England Journal of Medicine.

In their Perspective, UW Medicine Drs. Thomas Gallagher and Anneliese Schleyer discuss how these students and trainees expressed confronting many of the same anxieties faced by more seasoned healthcare workers, and offering help nonetheless in the care of patients with COVID-19. 

Wrote one student: “It was challenging [to] ask myself how important is it to protect myself? How important am I in the medical team? Should I let others use resources such as masks, and use less for myself?”

pictures of Thomas Gallagher and Anneliese Schleyer
Co-authors Gallagher and Schleyer praised trainees' fortitude and conscientiousness.

Gallagher, a UW professor of internal medicine and of bioethics and humanities, said he “was struck by the degree to which these medical students and trainees were aware of how their decisions affected not only patients, but their housemates, their immediate and extended families, the colleagues who might have to cover a shift for them, and members of the public they might contact in the grocery store.”

Schleyer, a UW associate professor of general internal medicine, thought trainees’ comments reflected diligent efforts, amid unprecedented complexity, to define their roles and contributions to the cause.

“In the midst of uncertainty and a rapidly changing world, the voice of UW students and trainees emerged clearly, as one of strength, compassion, commitment, and leadership,” she said. “I am further gratified to see physicians-in-training at other institutions also stepping forward to meet these unprecedented challenges.”

Near ground zero of the first U.S. COVID-19 patient case, the UW School of Medicine was among the first nationwide to remove medical students from clinical rotations, on March 16. (It has since canceled clerkships through spring.) The next day, the Association of American Medical Colleges recommended that member schools suspend clinical rotations for medical students for at least two weeks (recently extended through at least April 14).

The directives disappointed one student, who noted that, while they understood the rationale for taking students off clinical rotations, “I think that I could learn more from this pandemic being out there than staying at home.”

Resident physicians and fellows have experienced varied degrees of involvement in COVID-19 patient care. Assigned rotations and patient surges have put some trainees on the front line.

“Decisions to isolate or test a patient are now massive decisions,” wrote a survey respondent. “The decision to not-test puts an entire floor of healthcare providers at risk - the decision to test uses a ton of PPE (personal protective equipment) which is in high demand.”

The potential ripple effects of decisions, in a time of so many unknowns and ad-hoc policymaking, seemed to weigh heavily on trainees, Gallagher said. He suggested several steps medical educators could take now to support students with the dilemmas they are facing.

Gallagher and Schleyer conclude their paper by noting, “Watching our students and trainees step up to care for the sick during the COVID-19 pandemic despite their fears gives us hope that the profession’s future is in good hands.”

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