To the Editor:
Residents occupy a unique position in our health care landscape. We are practicing physicians yet also still learners, governed by specialty boards and required to fulfill competencies and meet program requirements. We provide clinical care in exchange for modest pay and the learning opportunities afforded by caring for patients under attending supervision. Amid the COVID-19 pandemic, our role as trainees raises a number of questions: What are our duties to provide care? And what should our institutions do to support us?
The oaths many residents took upon graduation from medical school—namely to place the needs of patients above our own—are worth recalling at a time when we may feel at risk or confused about our obligations. Whereas medical students do not have the same responsibility to serve the suffering that is inherent in the social contract between physicians and society, residents have duties and privileges that necessitate our involvement in providing care, including on the frontlines. Meanwhile, we must recognize the lessons we learn through providing care during this time of crisis, including those of preparedness, response, diagnosis and treatment, leadership, interdisciplinary teamwork, and resilience.
To support residents, hospital leaders should be transparent about events occurring at the institutional level, provide data about the number of infected patients and staff, formulate clear protocols, and specify actions residents should take if we get sick. Cutting resident salaries and benefits should be avoided, as many of us have distant support systems, significant student loans, young families, and spouses who may be more vulnerable to layoffs on account of being less established. Residents should be invited to join discussions occurring at the institutional level, as we lend useful perspectives and participation provides additional learning opportunities. Program directors can help by sending frequent updates regarding changes within departments; reminding residents about available mental health resources; hosting remote check-in sessions to discuss concerns; reorienting educational activities to focus on skill sets and knowledge pertinent to the venues in which residents are deployed; and accommodating scheduling needs for those with fellowship and job interviews, sick family, or children who are out of school. Finally, specialty boards should postpone standardized tests and work with programs to ensure on-time graduation.
These ideas can help guide our institutions so we may succeed in meeting the challenges at hand. As we adapt to significant changes in the way we practice, learn, and live, we also should remind ourselves of our unique privileges as physician–learners.