How COVID-19 Is Impacting Residency Education: The Directors’ Perspective

How are residency directors and administrators handling the COVID-19 outbreak with respect to maintaining residency education standards? Three residency directors share their insights and observations on the influence of technology, alternative learning environments and how to address resident stress and concerns throughout the pandemic.

Q:

What changes and/or processes are being implemented by your residency program in light of the COVID-19 outbreak? How has this changed your day-to-day activities as a residency director?

David Bernstein, DPM, FACFAS shares that all outside educational rotations have been cancelled and all residents have returned to the primary hospital. Residents are permitted to continue in local established practices, such as podiatry, rheumatology and infectious disease, where applicable. Although emergency surgeries such as infections and fractures persist, he relates an overall 90 percent reduction in surgical volume for his residency program. 

COVID-19 is also impacting academic meetings due to limitations on gatherings, says Christopher F. Hyer, DPM, MS, FACFAS. 

“At our residency program, participants at these weekly academic meetings include attending physicians, fellows, residents and medical student externs. To address the COVID-19-related restrictions and limit their impact on surgical education and training, our residency program quickly adapted to web-based virtual learning opportunities,” explains Dr. Hyer. 

Jeffery Alexander, DPM, FACFAS sees a silver lining to some of the necessary changes in residency education. He shares that moving didactic programs online has proven greatly beneficial and easier than previous methods. 

“In moving our academic programming online, technology has allowed us to reconnect with program alumni and get them involved,” says Dr. Alexander. “While I would never want this pandemic to happen, the changes we are making will improve (this aspect of) training for future residents for years to come.”

Q:

What concerns do you have from an educational standpoint about the impact of the COVID-19 outbreak in regard to teaching residents?

“We are fortunate that our senior residents have all already achieved their surgical requirements on Podiatry Residency Resource but that loss of extra experience beyond the requirements is so important,” says Dr. Bernstein. 

He continues to say that alternately, residents are spending more time working on coding, billing and research projects. 

Dr. Hyer agrees that the loss of the last portion of the third year of residency is uniquely concerning.

“These last few months of hands-on experience is typically an important time of ‘finishing school’ for the graduating residents and presents the opportunity to pass the torch to the second-year residents,” acknowledges Dr. Hyer. “Some of this experience really can’t be simulated or replaced.” 

Q:

As a residency director, how do you manage possible fears and/or anxieties of young residents, who are already dealing with the time constraints of residency and now may have concerns about the coronavirus as well. How do you keep up the spirits of the residents at this time? Do you have a specific example or two you can share?

Dr. Hyer acknowledges that this is a challenging situation on many fronts, citing the residents’ concerns about their training and the limited time in which to gain important experience. On the personal side, he says residents express worry about exposure and the health of family and friends. This is especially true for some residents that recently welcomed additions to their families.

“Information is evolving on a daily basis and similarly, the plans of the health system are quite active and dynamic,” says Dr. Hyer. “We are trying to provide as much up-to-date communication as possible to keep everyone on the same page.”

He also shares that the hospital is attempting to balance resident anxieties by splitting them into three groups for weekly intervals: one group continues to cover residency responsibilities; another group is on a “rest” week to limit exposure and de-stress; and a third group is available for redeployment to another department if necessary. 

Dr. Bernstein shares that his hospital system hosts weekly teleconferences designed just for resident health across every department. He also personally holds a weekly meeting for his residents and speaks personally with them daily. 

Dr. Alexander states that his hospital also introduced a rotating schedule. His residents are part of the “surge plan” and provide additional support to the health system when necessary. However, this rotating schedule allows this additional support to be more manageable and safer for them. 

“In addition to anxiety related to the disruption of their limited training time, current residents have to deal with the added stress of being on the frontlines of treating a pandemic,” adds Dr. Alexander. “Rush University Hospital offers tremendous support from this standpoint. There are counselors on call at all times if they want to discuss things. (The hospital) will provide residents lodging if they do not feel safe exposing their family or roommates. (The hospital also) provides food for nearly every meal to lift their spirits as well as various other types of social programs to keep morale high.”

Dr. Alexander also relates that he personally tries to offer individual custom messages of support to his residents and voluntarily serves on the frontlines of the aforementioned “surge plan” to demonstrate the team nature of this current time. 

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Bryn Mawr, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Dr. Alexander is the Director of the Podiatric Residency Program at Rush University Hospital in Chicago. He is a Diplomate of the American Board of Foot and Ankle Surgery. 

Dr. Hyer is the Director of the Podiatric Residency Program at OhioHealth Grant Medical Center in Columbus, Ohio. He is the Director for the Advanced Foot and Ankle Surgical Fellowship at the Orthopedic Foot and Ankle Center in Worthington, Ohio. He is a Fellow of the American College of Foot and Ankle Surgeons.