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    Starting residency during a pandemic: What will change? What will stay the same?

    The first year of residency is always intense, and that’s even truer now. We asked experienced trainees for tips on getting through it. From the simply practical to the profoundly philosophical, here are their deepest experiences and savviest insights.

    Scene of doctors in a hospital hallway

    The first year as a medical resident is never simple. It brings seemingly endless shifts, vast new rules, unfamiliar electronic health records, and many profound responsibilities. And it’s certainly more complex this year.

    But it also can bring tremendous joys and extraordinary achievements.

    In the coming weeks, thousands of medical school graduates across the country will head into hospitals to begin several notoriously intense years of training under guided supervision in their chosen specialty. At the same time, they are heading into a new world of medicine shaped by a devastating pandemic and increasing national awareness of racial inequities.

    We asked experienced residents to reflect on their own experiences — from talking through masks to resuscitating their first patient — and share some of the most valuable insights they’ve gained.

    Training during a pandemic

    Entering a medical residency program during a global pandemic brings major challenges as well as opportunities to contribute.

    “[This incoming class] will require more flexibility and adaptability compared to prior years. Everyone in the hospital is struggling to adjust,” says Logan Jones, MD, an internal medicine resident at Oregon Health and Science University, but he encourages self-confidence. “You made it through a tough four years of medical school. Know that you can make it through this as well.”

    Some moments will be scary, acknowledges Karen Cyndari, MD, PhD, an emergency medicine resident at the University of Iowa.

    “It’s easy to let fear hold you back from doing a physical exam or from staying in the room when your patient is coughing and febrile,” she says. “You have to be smart about it, but you have to do your job well, too.”

    Caution is an obligation, she notes. “Decontaminate tools like your stethoscope after every patient, or use a disposable one in the room. Do NOT be self-conscious about asking questions about personal protective equipment. You are the first line of defense against accidental exposure.”

    You are also the first line of defense in ensuring that COVID-19 does not enter your own home. “Designate a dirty area immediately inside your property,” says Cyndari. “Your clothes go right into the washer. Shower immediately. If you have symptoms, get tested and self-isolate. Many hotels offer free rooms for providers who are worried about exposing family, so ask your program coordinator for more information.”

    “[This incoming class] will require more flexibility and adaptability compared to prior years. … You made it through a tough four years of medical school. Know that you can make it through this as well.”

    Logan Jones, MD
    Internal medicine resident, Oregon Health and Science University

    Safety isn’t the only concern for incoming residents. There’s also a swirl of fast-changing information about COVID-19 and related guidelines.

    “Billing, infection control policies, and other rules and regulations are now sometimes changing overnight,” says Jones. “As long as you remember that your job is to care for patients in a safe, cost-effective, and team-based way — and not letting frustrations cloud that — you will do fine.”

    Pick a few sources to stay up to date, suggests Gabriella Aitcheson, MD, a University of Miami internal medicine resident. “Try to subscribe to one credible publication like JAMA or NEJM that sends email updates about new studies, or if you’re more of an audio learner, check out their podcasts.”

    But, she adds, “Don’t be afraid to reach out. Some senior residents will have more energy than others, but ultimately, part of our job is to support you.”

    Best steps to destress

    There are many unknowns in starting residency, but experienced residents say one thing is clear: stress is unavoidable, especially now.

    “Everyone has felt some pangs of anxiety during this pandemic,” says Aitcheson. “As a black female, the stress of the pandemic has been compounded by the events surrounding the deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor. I have felt more than ever the importance of taking a moment to re-center myself.”

    Squeezing out time for oneself can be tough, but Aitcheson considers it essential. “Sometimes you have to allow yourself a cathartic cry or a simple moment to breathe, so you can then reset and focus on taking care of your patients,” she says.

    Residents often recommend talking with fellow trainees to combat stress — even if that requires yet another Zoom call. “They understand what we’re going through, and we can just be real with each other,” says Brent Schnipke, MD, a second-year psychiatry resident at Wright State University.

    But Schnipke also suggests connecting with nonproviders to gain a bit of perspective. For him, that often means building block towers with his 3-year-old son. “It’s very freeing for me not to think about medicine at times,” he says.

    "Sometimes you have to allow yourself a cathartic cry or a simple moment to breathe, so you can then reset and focus on taking care of your patients.”

    Gabriella Aitcheson, MD
    Internal medicine resident, University of Miami

    When asked for his best tips for combating stress, Jones holds up five fingers.

    The thumb — the most important finger — represents sleep because it’s central to both wellness and clearheadedness. “If you can get an extra hour or two of sleep, it can really change your whole day," he says.

    Next up is healthy food. “You’ll be tempted to eat junk food, so pack healthy snacks that aren’t going to make you feel gross at the end of the day.”

    Finger 3 stands for exercise, and finger 4 represents emotional support, which sometimes includes professional counseling.

    And then there’s the pinky.

    “It’s the smallest part, but it’s important,” he says. “We need to recognize that a not insignificant number of residents are depressed at some point, and medication should not be looked down upon. We provide this kind of help all the time for our patients,” he adds. “We should make sure that we are advocating for ourselves, too.”

    Dealing with death

    For Cyndari, the toughest part of the job is the devastated families.

    She still recalls one emergency department patient who deteriorated quickly, losing liters of blood in a minute. “The worst was the family member screaming in the room, begging us to save the patient,” she says. “It can eat you up if you take that home with you.”

    Now, pandemic-related rules against visitors can add to patient and provider stress, says Jones. “I recently used my own cell phone to FaceTime a family member of a dying patient. The patient got to say goodbye for the last time. Even though they aren’t as meaningful as a face-to-face encounter, these small gestures can mean a lot to patients and family.”

    How do residents handle so much loss? “I try to remember that there are simply things out of my control,” says Cyndari. “If you don’t admit that to yourself, you’re going to feel guilty for something you never could have prevented in the first place.”

    “The worst was the family member screaming in the room, begging us to save the patient. It can eat you up if you take that home with you.”

    Karen Cyndari, MD, PhD
    Emergency medicine resident, University of Iowa

    Jones says that one of his most painful memories is the first time he had to resuscitate a patient. “It’s a graphic thing to experience,” he says. “It’s one thing to watch it, and it’s another thing to live it. The tactile sensations in that moment, the adrenaline in the room, and just trying to figure out what you do, is something that shakes you to the core.”

    Afterward, Jones recalls, he had to go out into the hall and cry for several minutes. Just a few weeks later, he was able to perform resuscitations without significant distress — but he found that adjustment itself distressing.

    “What a lot of people struggle with in their residency is having an experience that would usually shake them, but it actually doesn’t,” explains Jones. “You’re just so worn out and stressed, you kind of become a bit numb.”

    He therefore advises taking pauses to reflect. “Finding a way — whether with a colleague or on your own — to think about those losses and what they mean to you is important. It can prevent a kind of moral distress that a lot of us suffer.”

    Finding inspiration

    Cyndari remembers the utter chaos when one critically ill patient arrived in her hospital’s trauma bay prior to COVID-19: 10 different providers, multiple teams, all scrambling to address the patient’s horrible burn wounds.

    “I was an intern, so I couldn’t do much,” she recalls. “But the one thing I could do was speak with the patient and the family. I explained what was going on step-by-step, so they understood that we were going to use all our abilities to help and do so in ways that fit with their wishes.”

    Ultimately, the patient’s injuries were quite severe, so the family requested compassionate extubation — and Cyndari was asked if she could be present. Being there was an honor, she says, and one of her most meaningful moments.

    “A big part of my advice to interns is to not forget why you’re here,” says Cyndari. “It is not simply to fix disease. It’s to provide compassionate care for the people you’re treating and their families.”

    That’s still feasible during the pandemic, residents say. “You may be limited in your facial expressions, but you can express empathy through your actions,” notes Cyndari. “This is a terrifying time for patients, so consider letting them have control over the conversation. If your patient feels at ease, you do too.”

    “I always try to learn something from hard times, whether a medical fact or a behavior change, so it isn’t just suffering for nothing.”

    Colleen Beatty, MD
    Dermatology resident, West Virginia University

    Schnipke notes that some of his greatest joy has come from training future physicians. “It’s important to me to pass along to students some of the skills that were passed on to me, to share what I’m passionate about, and to model what I hope is good patient care,” he says. “When I work with students, I always feel uplifted and encouraged.”

    These days, Schnipke adds, he’s inspired by the increased focus on racial justice in American society and the opportunity to promote better care for all. “Medicine has long known about racial disparities, but this has not always translated into actionable change,” he says. “We need to make major improvements, and I’m excited to do my part in advocating for equity.”

    Simple steps, big gains

    Sometimes, new residents just have to get through the day without losing or forgetting anything.

    Cyndari — who showed up one day early on without her stethoscope — offers some logistical wisdom. “Establish an area near your front door that is for your doctor supplies only,” she says. “That way, when you have to leave the house at 4:30 a.m., you’re not running around in panic mode searching for what you need.”

    Aitcheson puts in a plug for checklists. “Make a pre-rounding list to check for each patient,” so you remember what questions you want to ask. “Then make a new list of checkboxes during rounds so you make sure you do everything that winds up in the care plan.”

    Cynthia Glickman, MD, chief internal medicine resident at Cooper University Health Care, recommends setting aside time each day to respond to emails. “It may seem tempting to ignore messages because you’ve got things that feel more pressing,” she says. But if you do, you risk missing something essential, such as a message from your program director.

    Of course, everyone inevitably stumbles at some point. When you do, says Colleen Beatty, MD, a West Virginia University dermatology resident, “try to turn an unpleasant scenario into a learning opportunity because that’s really what residency is all about, your training. I always try to learn something from hard times, whether a medical fact or a behavior change, so it isn’t just suffering for nothing.”

    Perhaps above all, residents recommend remembering that medicine is ultimately a team effort.

    One of Aitcheson’s favorite points comes from a line in an email a chief in her program sent before the start of residency. The chief had bolded it, put it in red, and used all caps. It simply said: “You are never alone.”