Medical Education During COVID-19: Perspectives from Postgraduate Residents

To the Editor,

The COVID-19 pandemic has significantly affected the lives of people worldwide. The frontline health care workers (HCWs) constitute a group affected the most during the pandemic. Depression, anxiety, and stress have been reported to be high in HCWs in various studies conducted in India and the world over.^1–4 In this context, a qualitative study was undertaken in a tertiary care center over a period of nine months from March 2021, to explore the psychological problems the HCWs experienced during the pandemic, after obtaining the approval of the Institutional Ethics Committee. In-depth interviews (IDI) and focus group discussions (FGD) were conducted with different cadres of HCWs, including the junior and senior residents of the institution, after taking informed consent.

Among the HCWs, the postgraduate trainee doctors or residents merit special attention because of many reasons. First and foremost, they are the foot soldiers of medical treatment—receiving, triaging, diagnosing, treating, caring, and supporting those who are suspected of having or have already contracted the disease. In addition, as trainees, they are expected to study their respective specialties in-depth to become specialists. For this, they have to work intensively with patients/lab specimens of their specialties. Moreover, they must complete a research project and submit a thesis to the university to become eligible to appear for the final examination. The problems the residents faced are unique compared to other HCWs, and we think this might apply to residents all over the country. This letter highlights the academic and workload-related issues that many residents expressed during the IDI and FGD. The assessment of psychological problems, which was the primary purpose of our study, merits detailed discussion and shall be covered in a separate paper.

A major concern detected was the often understated or ignored change in the course content. Residents from preclinical and paraclinical specialties were deputed to the triage or wards to attend to patients, a task far removed from the subject they chose to study. Also, those from surgical specialties (like ophthalmology, otorhinolaryngology, etc.) or subspecialties of general medicine (like dermatology, psychiatry, etc.) had to attend to cases outside their specialties. These residents felt overwhelmed when they had to manage complicated COVID-19 cases. The “loss of empathy” toward patients, losing the relationship with their parent departments, and even losing interest in the subject—which many of them took up as a passion—were their major worries.

Their academics have suffered drastically as they have been mostly managing only COVID-19 cases for the past two years. They felt that they did not know anything about the subject they had to learn. Especially, those from surgical specialties had not gained the skills they were expected to acquire during the course. “We won’t be good specialists when we go out,” opined one of the residents. Their thesis work has suffered the maximum—most of the residents could not recruit enough participants for their research work. Being from a government institution, they were concerned that their counterparts from private institutions, with whom their performance will be compared during the examinations, had greater opportunity to learn the subject (as they might not be as overburdened with COVID duties as those in the government sector).

They have experienced deficiencies throughout the pandemic, but the maximum felt need was for more human resources. The workload was not proportional to the human resources available. There was also a deficiency of materials, such as personal protective equipment, gloves, masks, etc., but by now they have learned to adjust with what they have. They were forced to strike work because of the extra workload and lack of human resources and for a hike in their stipend, ⁵ but they had to do the backlog work once they were back after the strike. Many of the strategies of the authorities to delay the settlement of their strike were perceived as tactics to “deceive” them. They felt that they were “cheap labor” and reduced to being handymen for data entry—data mattered more than patient care. Many residents stated that they were experiencing stress and psychological problems for which they needed psychological support; it was not enough to make them subjects of our research.

The resident doctors are our “frontline warriors” against the COVID-19 pandemic. It has been found all over the world that the deficiencies of medical resources—like human resources—can produce additional workload and negative feelings, including frustration and hopelessness, in frontline HCWs. ⁶ The deployment of resident doctors for COVID duty has affected their residency programs drastically, leading to a lack of exposure to clinical material, didactics, and educational conferences. Other studies have reported high rates of psychological symptoms in medical residents, especially junior residents, and have suggested that they require special attention during the pandemic. Wellness resources like individual counseling or support groups of residents, opportunities for continuous education, and other exposure to facilitate professional growth have been proposed to ensure the mental wellness of this population. ² Peer support programs, encouragement and support from colleagues and team leaders, and logistical support from the institution could be protective for their mental health and well-being. Supervisors should facilitate resilience in their trainees. ¹ More empathy and concern from the supervising faculty and administrators could allay the residents’ worries greatly. Psychological support must be provided to all the residents, and the opportunity for specialized care—either online or in-person—must be given to those who need it the most. The authorities should be morally responsible to remunerate their services appropriately, rather than leaving them to feel deceived. Moreover, adequate human resources have to be mobilized to ensure equitable distribution of the workload. For the lack of training that they suffered during the pandemic, the authorities can provide opportunities for optional continuation of senior residency for these trainees. Professional bodies can consider conducting special training programs for these residents to gain exposure to areas where they have deficiencies. If these residents enter the community as half-baked specialists, the health care of the general public can be affected. Hence, concerted efforts are needed to rectify the deficiencies in their training during the pandemic.

In conclusion, we would like to highlight that COVID-19 has put postgraduate medical education into a quagmire. Herculean efforts are needed from the administrators, faculty members, and professional bodies to salvage it. If we do not address this issue with the earnestness it warrants, not only future of these residents will be in trouble but public health may also be jeopardized.