Gray Moonen is a PGY-1 in Family Medicine at the University of Toronto
Welcome to the Medical Residency Twilight Zone:
There are no medical students. Academic half-days are virtual. Research projects are delayed indefinitely. Your oral presentation at the conference is cancelled. The entire conference is cancelled. Oh, that’s because flights are also cancelled. Licensing examinations are delayed. Clinics are cancelled. Where did all the patients go? You can hear a pin drop in the emergency department.
My hands are raw. No, I am not moisturizing them during the day and, yes, they are showing cracks. I am turning reptilian. These masks make me so hot, I can barely breathe. My glasses are constantly foggy. Oh hey, I didn’t recognize you with the mask on. Leaving the hospital and coming home are newly ritualized. Wash hands (arms, neck?), then take off scrubs, then take off shoes, wash hands again, put street clothing on… wait did I miss a step? Did I contaminate myself? Will I contaminate my home? Get my wife sick? I don’t know. I have internal monologues about how often to sanitize my equipment. Is my cell phone going to survive all this virox? It is the least of my worries right now, but it would really suck if I broke it.
I end every email with “stay safe”.
I’ve been reading about how to stay resilient and accept the inevitable stress. The evidence is sound, but it seems distant. “Focus on the things you can control”…that’s part of the day-to-day challenge as a resident. We often lack the clinical knowledge, experience, and confidence to control our clinical encounters. We require evaluations; all our work and research projects are supervised and graded in some capacity. We require licensing exams to proceed to be independent practitioners. These are the many things out of our control that all draw on our attention and make a crisis like the COVID-19 pandemic even more anxiety provoking. Not to mention our most pressing concern – for the deluge of illness and suffering this will cause patients.
And yet…. what a privilege it is to be a resident.
We are guided by a seven-pillar competency-based framework: “CanMEDs” or “CanMEDs – Family Medicine”. Although it may seem like everything is up in the air, I think there are equal, if not greater opportunities to develop our competencies during this crisis compared to usual times. Instead of going through the motions of learning objectives, checking off an Entrusted Professional Act, receiving an In-Training Evaluation Report, instead we are actively motivated to do the things that need doing, because it simply needs to be done. Doing it well and thoughtfully, because it matters. A lot.
I have seen residents and staff physicians working side by side, tirelessly advocating for change at the individual, community and broader societal level. Grassroots campaigns are successfully encouraging people to stay home, and wash their hands; we’re advocating for PPE procurement. The trust, respect and unity being displayed across healthcare workers has enabled genuine collaborative efforts; “we are truly all in this together”. Residents are also liaising with public health, government agencies and the public to find innovative solutions, not to apply for a grant or win an award. It’s because this needs to be done.
I’ve noticed many residents become leaders and lean in to their voices, providing calm, measured and sound advice to their patients, peer groups, junior learners, family and friends, organizing systems to let patients know where to reach out to for help if they feel ill. Residents are stepping up and covering call shifts for ill or quarantined colleagues, offering to work COVID19 clinics or be redeployed to other services.
As developing professionals, we are sacrificing time, energy and our health in this evolving pandemic. Managing the competing demands of training such as patient care, evaluations, research and the stress of having academic requirements delayed or cancelled is unique, but I have observed grace inspired action rather than a compromise in integrity or overt displays of frustration.
As scholars we are staying informed on the emerging evidence and synthesizing this information for patients, peers and the broader public. As medical experts, we are not only maintaining many of our skills within our developing scope of practice, but actually expanding our skillset as we prepare to participate in more critical care, triaging, counselling and telemedicine.
Uncertainty and anxiety are undeniable. We are concerned we will not reach our training milestones or develop the competencies to practice independently. Yet, despite these dark times, I believe there are silver linings. We will all become better physicians and community members as a result of this crisis, and Canadians will benefit in the long term.