If you’re worried about how to prepare for psychiatry residency in the face of the COVID-19 pandemic, you’re not alone, as medical students across the U.S. have similar questions and concerns. In fact, this outbreak has transformed more than how psychiatrists are being trained, reverberating throughout the delivery of psychiatric services as a whole.
At a time of accelerated change, understanding how healthcare has had to adapt to the current situation can make you more comfortable as you embark on — or continue — this crucial stage in your medical career.
For Students Transitioning to Residency
The American Psychiatric Association (APA) notes that medical students transitioning to residency should be aware that the pandemic has impacted training. Many students who have heard that clerkships and clinical electives have been canceled worry about not getting sufficient hands-on experience in their field.
The good news, however, is that psychiatric services (including outpatient and consultative services) and educational case conferences will continue, albeit in online formats. Audiovisual technology allows students to continue to gain important clinical psychiatry skills while getting comfortable with telehealth. Trainees are also participating in psychiatric care in other important ways, such as participating in phone wellness checks, scheduling telehealth visits and liaising with family members.
Students who are worried about insufficient training can also take charge of their own learning. Start by asking about helpful educational materials and resources, and take advantage of medical journals like the Journal of Psychiatric Practice or Current Opinion in Psychiatry to stay abreast of current developments in psychiatry.
What If You’re Already in Residency?
Current psychiatric residents (and those in related fields like neurology) have already felt the changes that have been implemented in response to COVID-19. In a Neurology blog article, one resident wrote about some of these changes, mentioning how daily schedules were revised and reevaluated frequently. Residents worked in “skeleton teams” to limit exposure to the coronavirus while a backup team of residents remained on call to take over if needed; residents on elective rotations were automatically placed on reserve. Given these kinds of changes, the resident noted with obvious relief that the American Board of Psychiatry and Neurology (ABPN) has made changes to support residents at this time. For example, the ABPN announced that it’s now accepting virtual clinical skill evaluations, or CSEs.
In some cases, changes to psychiatric residency have been even more dramatic. According to Dr. Rana Elmaghraby, MD, writing in Psychiatric News, many psychiatry residents continue to provide services via telehealth, but others have been reassigned entirely to medical, emergency or ICU departments or placed on on-call backup teams. Challenges facing residents in these situations can include the violation of duty hours or lack of access to adequate personal protective equipment.
I’m now in my third year of residency, and I can definitely say that my residency experience has changed as a result of the pandemic. The biggest change for me has been that most of my clinical visits with patients are now virtual. While I’ve appreciated the experience with telepsychiatry, I do worry that these virtual formats sacrifice the interpersonal contact that takes place during face-to-face visits — contact that can be therapeutic for patients struggling with mental health issues.
The Bigger Picture of Mental Healthcare and COVID-19
It’s apparent that this pandemic has changed psychiatric practice more broadly. Psychiatry Research notes that in the United States, the COVID-19 pandemic has impacted access to psychiatric care, the quality of care and the delivery of care. For example, the inpatient setting faces particular challenges due to the proximity of possibly infected persons to other patients and staff. To make things more difficult, psychiatric patients may refuse to wear a mask, and some have hygiene issues that can increase the risk of infection. As a result, some facilities have suspended visits or group activities and have tightened admission criteria. For outpatient settings, regulations surrounding telehealth have been relaxed, allowing psychiatrists to replace face-to-face visits with telephone consultations and “virtual” visits via technologies such as Zoom and Google Hangouts.
The APA has established guidelines designed to assist psychiatrists during the pandemic. They include guidance on telehealth services, treatment of substance abuse disorders and precautions to follow for vulnerable inpatient clients.
So whether you’re a medical student figuring out how to prepare for psychiatry residency or are a current resident, you’ve probably already felt the impact of the adaptations medical schools have made to protect students from exposure while at the same time offering the valuable clinical experiences residents need to grow as physicians.