For anyone in the medical field, the start of the new year isn’t January — it’s July, when the new residency year at most programs begins. For current residents, this means that it’s the mark of being one year closer to being done, to finally reaching the status of “attending physician.” For newly graduated medical students, however, it marks just the beginning of your residency journey. While knowing how to prepare for residency is a daunting task for any incoming intern, the COVID-19 pandemic has filled this upcoming year with more unknowns than ever before.
No incoming intern class has been faced with the task of starting their residency training in the midst of a healthcare crisis like this one, so advice from upperclassmen might seem a little dubious. Still, after speaking with several other physician friends across the United States, I found that many of them had experienced similar challenges because of COVID-19, regardless of their specialty. If July 1 marks the first time you’re introducing yourself as “Doctor” to a patient, keep these words of advice in mind.
1. Assess Patients Without a Full Plan
“Be ready to give a diagnosis without being able to provide a solution right away” was the advice I got from a fellow physical medicine and rehabilitation (PM&R) resident about preparing for residency at this time.
Although many states have started various phases of reopening, the continued rise of COVID-19 cases means that most practitioners aren’t fully opening their schedules for all elective procedures yet. Medical school prepares you to make a diagnosis and to formulate a treatment plan (the A and P of your SOAP note); it does not, however, prepare you to make a diagnosis without being able to offer a patient treatment, even when that treatment does exist.
Specifically, for practitioners in fields associated with pain procedures (PM&R, orthopedics, neurosurgery and so on) until operating rooms are running on a regular schedule again, you’ll likely be telling your patients that they need treatment you can’t offer them right now. If you’re an incoming resident, be ready to offer empathy for your patient’s back, knee or hip pain in addition to offering a delayed procedure date.
2. Expand Your Role
On a similar note, policies banning visitors from attending medical appointments mean that often your patients will lack the comfort of a close confidant during their most vulnerable moments. Despite all the empathy training your medical school might have included in your curriculum, your role as “comforter” during the pandemic may be needed more than ever.
“Be extra gentle,” advised a current OB-GYN chief resident. “You chose a specialty that brings you into most patients’ happiest moments, but it can also involve a lot of grief. COVID-19 makes that grief extra isolating. Be ready to really be there for your patients, even if you don’t think of yourself as the ‘comforting type.'”
3. Be Flexible
Chances are, if you chose to pursue a career in pediatrics, you aren’t particularly interested in working with adult patients. COVID-19, however, might change the patient population you serve this coming year. Be ready (and willing) to work with patients other than the ones you thought you’d be serving. COVID-19’s severity of infection in adult patients has forced many medical centers to convert their PICUs into temporary housing for adult patients or their general pediatric units into overflow units for non-COVID-19 adult patients.
One med-peds senior resident described to me how he and his co-residents prepared a “crash course in adult medicine” for pediatric residents at their major academic medical center, as the hospital made plans to temporarily convert floors in their children’s hospital into adult units. This theme was echoed during other conversations with residents in surgery and psychiatry, as hospitals redistributed their residency workforce to address the surge of pandemic patients. Regardless of the specialty you’re entering, be prepared to work wherever your hospital may need you.
4. Acknowledge Your Own Medical Conditions
“I never feared my patients getting me sick until COVID-19,” an internal medicine resident confided in me as we discussed the impact of the pandemic on our respective residency experiences. With his own past medical history of asthma, he knew that he could be in the high-risk population for the disease, despite his age.
Fearing patients isn’t typically part of the medical practice, but incoming residents may be forced to face their own medical conditions in ways they might not otherwise have considered. Residency is hard enough without worrying about your own health, but this novel coronavirus means that not worrying is virtually impossible. “Take the precautions you need to in order to protect yourself appropriately,” he advised. “You can’t take care of patients if you’re sick yourself.”
Knowing how to prepare for residency in the midst of COVID-19 can easily feel overwhelming. You’re not alone in this; even though other classes of interns haven’t faced the start of their residency career in the face of such a daunting disease, July 1 has always marked the start of a season of uncertainty for incoming interns. Those interns made it through to become upperclassmen in your residency program, and they’re still there for you, even in the midst of the challenges of a pandemic.