phone contact with COVID-19-infected house officers while they were under quarantine. The Internal Medicine Chief Residents undertook the task of altering rotations with little notice, to fill gaps in patient care coverage. House officers very professionally adapted to these changes in their schedules. A few faculty also contracted COVID-19. Fortunately, no house officers or faculty had any significant lasting negative outcomes and all were able to return to their rotations at the end of their respective isolation or quarantine periods. During this pandemic, internal medicine residents and interns have been affected by the pressures of medical care of patients with COVID-19 and changing rotation schedules as well as social distancing, isolation, and stigma. 10 Previous published reports suggest that residents can be psycho- educated about the possible range of psychological responses associated with the COVID-19 pandemic. 10,11 Risk factors for burnout during the COVID-19 pandemic include worry about reduced learning opportunities, post-training job opportunities, loss of social interaction, and fear of own health and well-being. 12 Self-care such as adequate sleep, maintaining social connections, and work-life balance should be emphasized. 11 We also ensured a long term commitment to the well-being of our residents and interns through communication and feedback. There were several outreaches to boost and maintain the morale and wellness of front line workers in our hospitals inclusive of the internal medicine programs house officers. During the initial peak of the COVID-19 pandemic, several local restaurants brought food to the hospital that was distributed to the front line workers by a “BWELL” coordinator. The hospitals ran campaigns that included signage inside and outside the hospital declaring that front line workers were heroes in their fight against COVID-19. UMC created a “Wellness Room” in their conference center that had low ambient light for relaxation and meditation. They also placed several thank you notes that had been written by school children who were supporting the efforts of the front line health workers. Another wellness initiative created by the leadership at UMCwas “Coffee Talks”, a forum for house officers to discuss their clinical learning experience during the pandemic. The LSUHSC Psychiatry department offered a “Virtual Psychological First Aid Group”. Other wellness initiatives included a twenty-four hour emotional support line staffed by professionally trained mental health experts and a LSUHSC Campus Assistance Program. These efforts highlight the positive impact of synergy provided by both the academic health sciences center and the hospital administration in regards to resident well-being. RESIDENT EDUCATION
participated in daily morning reports or noon reports at each hospital site, weekly medicine grand rounds, weekly resident education conferences, a monthly journal club, and monthly guideline lectures. The Section of Hospital Medicine had bi-monthly hospitalist lectures and the Section of Comprehensive Medicine had monthly primary care lectures. There were previously very limited virtual lectures, virtual educational experiences and no virtual scholarly activities. By the third week of March 2020, all didactics were cancelled due to concerns about social distancing. We did continue to meet at each hospital site to review COVID-19-related issues that affected patient care and physician well-being. Our discontinuation of structured scheduled medical education sessions was similar to that seen with many other residency programs during this pandemic. 13 As the initial peak of COVID-19 resolved, we re-instituted structured lectures but used Zoom as a virtual delivery platform. We also re-started our morning reports and noon reports at our hospital sites. Touro and OKMC moved their morning reports to larger rooms to allow for social distancing. The noon report at UMC continues to be presented by Zoom for those who do not wish to attend in person. Although Zoom offers a safe alternative to in-person lecture attendance, there is evidence that learners find in-class lectures provide more effective engagement with presenters and peers. 12 A majority of learners in this study noted decreased attention with online conferences. Learners reported performing other activities simultaneously during the conferences. 14 Enabling webcams to provide visual feedback may lead to improved attention during the lecture. A comparison of the internal medicine program’s resident education pre- COVID-19 and through the pandemic is included on Table 2.
Another area of resident education that has changed for the moment is the scholarly activity associated with scientific and professional society meeting attendance and presentation. Our departmental research day was changed to a virtual meeting. Our residents and interns will be participating in several other regional and national meetings that have converted to a virtual format. RESIDENCY RECRUITMENT Residency programs across the country conducted virtual interviews during the 2021 match process. Furthermore, medical students were unable to do “away” clinical rotations with different programs. Our approach to introducemedical students from outside LSUHSC to our residency program was to host three virtual “Meet and Greet” sessions on Zoom during the months of September and October. We invited 150 students from local and regional medical schools to participate. During the sessions, the program director and chief residents provided an overview of the residency 40
Prior to the COVID-19 pandemic, residents and interns
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