When the COVID-19 pandemic struck last spring and temporarily forced Duke’s clinical operations to be limited to essential personnel only, the more than 1,000 residents and fellows in the Graduate Medical Education (GME) programs at Duke stayed put.
Residents and fellows are both learners and employees of the Duke University Health System, and, as essential workers, they remained at their posts. Many trainees helped care for COVID-19 patients when the numbers of positive cases at Duke’s hospitals swelled. Others helped with testing and contact tracing and continued to see non-COVID-19 patients, either in person or virtually via suddenly in-demand telehealth services.
Just as it did across campus and the medical center, the pandemic presented the training programs with a host of challenges that forced Catherine Kuhn, MD, associate dean for graduate medical education, and her colleagues to rapidly revise procedures and operations.
When clinical volumes dropped, most GME programs had to adjust rotation schedules; a number of them organized their trainees into “platoons” that stayed together in groups and alternated schedules in order to continue to gain requisite clinical experience and to minimize the impact of infection. To preserve limited supplies of personal protective equipment in the initial stages, GME programs turned to alternatives such as live video platforms so trainees could see patients and accompany attending physicians on rounds virtually.
All GME rotations in other states and countries were suspended due to travel and safety restrictions, and program leaders quickly crafted opportunities within North Carolina to make up for some of those lost experiences. Recruiting and interviewing moved to virtual platforms, and some standardized tests were postponed because national testing centers were closed.
“Our trainees are trying to complete training and achieve board eligibility, and of course a lot of them have been thinking, ‘Will losing a month of a rotation cost me my board eligibility, or will I require extra training?’” Kuhn says. “The medical boards and accrediting agency have been flexible and helpful, and so far we’re not seeing any major problems. Of course, everything depends on how the pandemic plays out in the long run.”
Routines are returning to something closer to normal, Kuhn says. Clinical volumes are up, the COVID-19 patient population is down, and most trainees have gone back to relatively normal rotations. However, everyone feels the loss of opportunities for socialization and connectedness with their colleagues, both at work and at home.
“Most of what we’ve lost in patient experiences is recoverable fairly readily as long as we don’t have another big surge or shutdown,” Kuhn says. “We’ve learned a lot over these last six months. Some days it’s hard to remember this, but the pandemic presents opportunities as well as challenges. We’ve discovered that we can do a lot of things that we thought were not possible.”