White Coat, Black Art

These medical residents are learning to be better doctors during a pandemic

Medical residents across the country have faced unprecedented challenges as residents working in a pandemic. And that has an effect on patient care.

Medical residents across the country have faced unprecedented challenges working in a pandemic

Residents Larissa Albino and Christopher Charles said there have been limited opportunities in some aspects of their residency because of the pandemic. (Submitted/CBC News)
What is the lasting impact of the pandemic on learning for tomorrow's doctors? Especially those who are doing their hands-on residency training. Dr. Brian Goldman talks to residents Larissa Albino and Chris Charles talk about becoming doctors during COVID. 26:30

Larissa Albino was prepared for her first year as an internal medicine resident to be tough. 

Residency is a notoriously rigorous part of a new doctor's training, known for its long hours and steep learning curve. 

"And then you throw a pandemic in the mix and that just adds so much more to that experience," she told White Coat Black Art host Dr. Brian Goldman.

Albino and other medical residents across the country have faced unprecedented challenges related to the pandemic. Some have had fewer mentoring opportunities with staff physicians busy battling coronavirus, and as in-person patient visits have migrated to phone and video calls, fewer opportunities to practise their bedside manner, too.

Working in the midst of a global crisis only heightens the stress and burnout so common among residents.

Unfortunately for Albino, whose residency at the University of Alberta started last July, the situation was made worse when she contracted COVID-19 in January while covering shifts in a nephrology ward with an outbreak.

"I started having headaches and feeling quite fatigued, probably for about one to two days, which I didn't think much of because that essentially describes residency," said Albino.

"We were doing a lot of covering for other residents so that people could still have some time off for the holidays. It actually didn't cross my mind right away that I could have had COVID."

She brought it home and her partner got sick. They both tested positive for the virus but had only minor symptoms and recovered after a few days. 

"It opened my eyes to the things that can happen in the hospital and why it's so important to be careful," she said.

Others, like Christopher Charles, a fifth-year resident at the University of Toronto in anesthesiology and pain medicine, have had fewer opportunities to practise skills. 

Christopher Charles, a fifth-year anesthesiology and pain medicine resident at the University of Toronto, said it's been hard pivoting to different departments during his last few months of residency. (Submitted by Christopher Charles)
 

As an anesthesia resident with knowledge of resuscitation and critical care — skills needed for COVID-19 patients — Charles was reassigned to help out on intensive care units, which has disrupted his training to be an anesthesiologist.

"For myself, I've had a number of goals that I set out at the beginning of this year, things that I wanted to gain more experience doing in the operating room. That has really been strained," he told White Coat, Black Art.

"I haven't been able to meet many of those goals because I've been busy providing care in alternate ways and that's been challenging to try to navigate."

Changes to patient care

Residency provides new doctors the opportunity to work on and refine the skills taught in medical school in healthcare settings with patients.

That includes learning bedside manner and other soft skills that are part of the job. 

But the pandemic has limited and changed many of those patient interactions. 

Larissa Albino, a first-year internal medicine resident, has been speaking to a lot of patients over the phone or through video conferencing platforms like Zoom. (Submitted by Larissa Albino)

Virtual care, while a convenient and safe option during COVID, has presented new challenges for residents like Albino.

"Especially on the phone, you miss a lot of the visual cues that you tend to rely on, like seeing how a patient reacts to a question … and then ultimately laying your hands on the patient and really getting a good sense of what you hear, what you see and what can help direct what your investigations and plan going forward will be," she said. 

"I do think a lot of that is really lost by going to the virtual aspect."

Early research into the effects of the pandemic on medical education and training shows that things have changed, in ways both good and bad, according to authors of an August 2020 article published in the Canadian Medical Association Journal. 

Teaching moments with a staff physician and a group of residents — critical learning moments for residents — can't happen now. 

"It's hard to justify having six, seven, eight people all putting on PPE to walk into a room when you know that you're concerned about shortages and that there's always still an element of risk," said co-author Laiya Carayannopoulos. 

Resident burnout

Even in ordinary circumstances, burnout is a real concern for residents; research shows burnout can take root during medical school and continue into residency and practice.

A 2006 study of University of Pennsylvania School of Medicine residents found that half of the surveyed internal medicine residents met the criteria for burnout at the end of their first year. 

A 2018 Canadian Medical Association survey found that rates of burnout, positive screening for depression and suicidal ideation were higher among residents than physicians. (Shutterstock/Syda Productions)

Charles, who is now in his final year of residency, has experienced episodes of burnout as he navigated the pandemic, work and studying for the written and oral Royal College of Physicians and Surgeons of Canada certification exams.

[Burnout] is a very real scourge to the health-care system that we work in. And certainly the pandemic has amplified it.- Christopher Charles, fifth-year resident

"It's no secret that working as a doctor, working in our hospitals, is incredibly tiring. We work really long hours and we're often forced to experience some of the most difficult times in people's lives over and over and over again," he said.

"And we often don't have that opportunity for reflection, for discussion and the opportunity to really think about what that means to us as individuals. It's a very real scourge to the health-care system that we work in right now. And certainly the pandemic has amplified it." 

A University of Alberta study is looking at the pandemic's impact on the health and well-being of 5,000 health care workers across Canada. (Massimo Pinca/Reuters)

A 2018 Canadian Medical Association survey found that rates of burnout, positive screening for depression and suicidal ideation were higher among residents than physicians.

Residents were 48 per cent more likely to report burnout and 95 per cent more likely to screen positive for depression than all other physician groups, according to the survey.

Dr. Colm McCarthy, a co-author with Carayannopoulos on the 2020 medical education study, said mental health and the stress of being a physician is something that is still largely unspoken. 

"In medicine, particularly within surgery, there's this stoic culture of 'I can deal with this, I can bear these burdens,'" he said.

"But unfortunately, unlike other areas of life, like sports, where if you're being very macho and carrying the weight of the team or whatever else, it's not just you that suffers from those shortcomings. It's your patients; it's your peers, your community."

Continued challenges

As many provinces face a third wave of the COVID-19 pandemic, residents continue to grapple with ongoing challenges the coronavirus has placed on their training. 

Residents Larissa Albino and Christopher Charles both have said that there have been learning opportunities as a result of the pandemic. (Submitted)

Although there may be gaps in training that could take a while to overcome, said Charles, going through residency during such a trying time has been an exercise in resiliency. 

"Even though residency will end soon, the learning will not. And that's an expectation of this job moving forward," said Charles.

"I know that for the next 30 years of my career, I will encounter things that I won't have seen — whether that's because of the pandemic or whether it's because just sheer luck that I never saw it in the past. I know that I have the skill set to find the right answers to provide the best care for that patient." 

ABOUT THE AUTHOR

Stephanie Dubois is a journalist with CBC Edmonton. Share your stories with her at stephanie.dubois@cbc.ca

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