How Coronavirus Has Impacted the Training of Medical Residents

Shifting Education Online

As residents sheltered at home, education quickly went virtual.

“We’ve had to rethink medical education that’s been traditionally based on didactics and in-person teaching,” said Sonya Malekzadeh, MD, academic vice chair, residency program director, and professor of otolaryngology at Georgetown University Medical Center in Washington, D.C. “The curriculum that was previously delivered in a very organized fashion is no longer possible. Now, we’re learning to incorporate virtual learning and digital telehealth into the resident experience.”

In March, three major otolaryngology consortia for residency training began. The Collaborative Multi-Institutional Otolaryngology Residency Education Program, called the West Coast Consortium or CMIOREP, launched first at the University of Southern California. Next came the Consortium Of Resident Otolaryngologic kNowledge Attainment (CORONA) Initiative in Otolaryngology, known as the East Coast Consortium, started by the University of Kentucky, and then the Great Lakes Otolaryngology Consortium for Resident Education (GLOC) began at Case Western Reserve University in Cleveland. In these consortia, otolaryngology faculty from more than 50 American institutions have presented 30 to 45-minute lectures with 15-minute interactive discussions, Q&As, and/or oral board-type case presentations. Education is available at different times of day, every day, for residents around the world to log in and learn from. While some lectures ended in April and others continued through June, all are still available to view online.

“While this has been an incredibly stressful time, and it has impacted the nation and the community deeply, it has also forced us to rethink how we educate our students,” said Dr. Kraft. “It revived that conversation about getting away from PowerPoint and traditional one-sided lectures. It forced us to get out of our comfort zone and realize we can do more, do better, and meet people where they’re at. It’s been a great opportunity, and I hope we carry that with us as we develop additional educational opportunities for residents.”

While this has been an incredibly stressful time, and it has impacted the nation and the community deeply, it has also forced us to rethink how we educate our students. —Shannon Kraft, MD

The consortia ramped up within days. “A potential positive that can come out of this is that it has expediated our learning curve on how we effectively educate residents, particularly in the virtual realm,” said Brett Comer, MD, residency program director and an associate professor in the department of otolaryngology–head and neck surgery at the University of Kentucky, and cofounder of the East Coast Consortium. “The consortia have had tens of thousands of hits on their recorded videos,” he said.

Sheltering in place and moving to virtual learning also have the potential to take a toll on the mental health and well-being of residents. “Isolation is really felt by our residents,” Dr. Hillel said. “To counteract it, they’ve made a strong effort to stay in touch and regularly get together virtually.”

The pandemic’s impact on well-being cannot be overstated, added Dr. Malekzadeh. Many residents are struggling with the very real issues of having insufficient PPE, dealing with inadequate leave policies, being unprepared for deployment or reassignment, having unfulfilled requirements for training or graduation, handling housing and transportation concerns, suffering from financial distress, and/or struggling with social isolation, she said. “Department and institutional support, as well as readily available resources, are critical during this time.”

Ultimately, what’s been learned through all this has value for the future of medicine in a world where crises will occur. “It’s been a very important educational experience,” said Dr. Ruckenstein. “It’s one that I wouldn’t like to replicate, but it was really important, with residents gaining much more significant experience compared to the month or two of surgical exposure that they lost.”