|Year : 2020 | Volume
| Issue : 5 | Page : 87-89
Impact of the coronavirus disease 2019 pandemic on resident doctors in India
Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
|Date of Submission||07-Apr-2020|
|Date of Decision||08-Apr-2020|
|Date of Acceptance||08-Apr-2020|
|Date of Web Publication||25-Apr-2020|
BIACHRI, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jaiswal R. Impact of the coronavirus disease 2019 pandemic on resident doctors in India. Cancer Res Stat Treat 2020;3, Suppl S1:87-9
The world right now is in the grip of a highly contagious mystery virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that has led to the coronavirus disease 2019 (COVID-19). It has shaken the world with exponential deaths, crashed the economy, and broken the health-care system. India, with a population of over 130 crores, has been caught unprepared with a sloppy initial quarantine, giving the virus room to spread. Now, as the virus is spreading like wildfire, our health-care system is overwhelmed. The soldiers in this war, standing on the frontline, are the health-care workers, and among them are we, the resident doctors, who form the backbone of any health-care system. In India, at any given point, there are approximately 1–1.5 lakh resident doctors receiving training across various specialties and superspecialties. We are the ones who primarily attend to the patients and for the longest possible duration; without us, the entire public health-care system would come to a halt. As Mahatma Gandhi had said, “The best way to find yourself is to lose yourself in the service of others.” This aptly describes our commitment.
| Impact on Resident Doctors|| |
Residency training is demanding with an average of 80 hours of work per week, no holidays, and new challenges emerging every day. It is a commitment of the highest standard towards the welfare of patients. We are taught early in training to serve the interests of the patient above our own. To this day, the medical profession is considered noble, and we have opted for it out of sheer choice. However, it comes with a lot of sacrifices.
Our generation is facing a pandemic for the very first time, and young trainees are being tested with a deadly viral illness very early in their career. I interviewed residents across India this week, trying to understand the impact of COVID-19 on them; to my satisfaction, the majority consider this unprecedented crisis a privilege and an opportunity to serve the patients and humankind. At the same time, they are terrified about the potential risk of acquiring COVID-19 and the risk they pose to their loved ones by carrying the virus home despite precautions.
Adding to our misery is the acute shortage of masks (N95), gowns, personal protective equipment (PPE), and training programs, which are essential to protect oneself from the virus. Crowded outpatient departments and the lack of staff to ensure physical distancing are worrisome in many places. The poor public health-care infrastructure is exposed again, particularly in the rural areas, which are likely to be the worst hit as the pandemic travels across villages in the coming days. Lack of decisive leadership, poor infection control practices, and lack of communication are some of the other shortcomings. This has resulted in a state of anxiety, panic, fear, frustration, and helplessness, leading to low morale. We find ourselves in a unique position amid the pandemic, as it is possible that if the outbreak is not controlled in time, it may stretch for months draining us physically, mentally, and emotionally. Some of us are getting infected, and it will be heartbreaking to hear that some of them succumbed to the disease while caring for patients. Despite all shortcomings, we are proud that none of us have fled from the responsibility of treating COVID-19 patients.
Luckily for some of us, our institutes have changed the working schedule to 1-week-on and 1-week-off, in the hope of ensuring an adequate reserve capacity, which should be considered a welcome step. It is important to address this at the earliest, as we need to protect our soldiers and prevent the collapse of the health-care system. We acknowledge that participating in this crisis management will be a transformative learning experience, provided we are adequately trained to manage COVID-19-specific illness, for which the authorities should gear up quickly.
Remember, if you are a patient in any major public hospital in India and need help at 2 AM, a resident will be the one you will depend on to save you.
We are not just doctors but also have families – parents, spouses, and kids – depending on us. Most of us are geographically separated from our families. As I write this today, I think of my 7-month-old daughter who is a 1000 km away. During these challenging times, as residents we require individualized consideration, a mentor who is easily approachable and provides emotional support, and a society that is compassionate and acknowledges our efforts.
| Impact on Resident Education/training|| |
Residency often requires balancing between delivering health-care and structured learning activities. Educational activities include daily patient rounds, academic hours, group activities, research, and assessments. They are all essential to ensure that we learn the core components of the curriculum.
Social distancing measures have circumvented the traditional doctor–trainee bedside teaching, which is considered the essence of medical learning. The regular rotation across other specialties which gives us an in-depth understanding of the core subspecialties has been affected as some of us are missing out on core rotations that are important to our future careers. Clinical case presentations, conference sessions, weekly lectures, grand rounds, and seminars stay cancelled for over a month now.
To mitigate this loss, the majority of case presentations, seminars, and lectures could be conducted online using platforms for teleconferencing and screen sharing with applications like Zoom. There are also various digital learning resources for trainees offered by individual educators, institutions, and professional societies, which provide alternatives to in-person teaching. This should be made readily available to us, free of cost. However, all of this is easier said than done; even the premier institutes in our country have not accepted the challenge of this newer format, and precious time has already been lost.
| Impact on Residents Appearing for Examinations|| |
Thousands of Diplomate of National Board (DNB) residents have completed their mandatory training and written examinations in December 2019. However, face-to-face assessments (practical/clinical examinations) have been postponed for over 5 months now. Similarly, for thousands of MD, MS, DM, and M Ch. residents, the upcoming examinations scheduled in May 2020 will undoubtedly be delayed if the pandemic is not controlled. Delayed graduation and credentialing would impact the starting time for incoming residents in the academic year 2020–2021. The anxiety and stress following these disruptions, on various fronts, and the hard work already put in for the preparation of examinations are unparalleled.
| Can This Be Addressed? What Are the Possible Solutions?|| |
- Replacing traditional examination assessments (face-to-face/clinical examinations) with online assessments
- Predicted grades based on written examinations alone and promotion of the candidates who fulfill the qualifying criteria.
This will be uncharted territory for both teachers and students, and the assessment will be a challenge. Such challenges demand extraordinary leadership. Do we have that? Although this has not happened before, it is important to remember that we are all fully trained doctors who have completed our training and passed the written examinations. Therefore, we should be allowed to practice medicine and care for patients. We constitute a valuable resource in this tough time of need, and this should be capitalized on, on an expedited basis.
| Social Relationships, Stress, and Coping|| |
Social distancing should not result in social isolation. It is important for us trainees to remain connected with peers and friends via online portals to exchange ideas with each other through social media (e.g., Twitter and WhatsApp) and hospital public forums. Time away from work should be utilized for nurturing personal relationships, eating a healthy diet, deep breathing, and simple home exercises compliant with social distancing.
| Impact on Residents' Futures|| |
Many of my friends and colleagues have applied for clinical fellowships at prestigious institutes in India and abroad; some had plans to study further, and some had already been granted research fellowships and acceptance letters from universities. All these dreams seem to have been shattered for now. As the situation becomes grim, time has simply frozen.
Thus, the impact of COVID-19 on us residents has been profound and continues to rise as the patient load increases. It is important for all of us to stay informed and compliant with measures to contain COVID-19 without complacency or panic. I would also request our senior doctors and unit heads, whom we look up to as our role models, to understand that extending your support in this time of crisis will exponentially augment our performance. The authorities concerned should empower us legally by promoting us and providing us with all the necessary tools to fight this pandemic. Good communication and strong leadership, which are the principles of effective crisis management, should be incorporated. A simple “Don't worry, we are here for you” will boost our morale, and the storm that lies ahead will be tackled with courage.
Remember, “Tough times never last, but tough people do.”
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Conflicts of interest
There are no conflicts of interest.