Residency during coronavirus disease 2019: A postgraduate’s perspective

Sir,

Coronavirus disease 2019 (COVID-19) has changed the definition of the daily routine for the general public. This holds true for the postgraduate residents as well, who are expected to undergo three years of rigorous training to gain enough expertise in the field of his/her choice. Dermatology is a branch where outpatient exposure is paramount for a resident to pick-up the required clinical skills.

With the onset of the COVID-19 pandemic, there has been a steep fall in the number of patients attending the outpatient department (OPD) due to patients’ fear of acquiring infection in the hospital, restricted means of transport, etc being a few of the many reasons. The number of dermatology patients approaching the emergency room has also reduced considerably. Most patients who are suggested admission in the dermatology wards for assessment and therapeutic purposes are apprehensive and request domiciliary management.

Examination of a patient to appreciate findings such as erythema, telangiectasia, scaling, etc is hampered by the plethora of precautions to be taken– maintaining social distancing, using a face shield, and difficulty in properly using a hand lens. Numerous innovations such as a selfie stick with cling film wrapped mobile phone,¹ to capture findings, have been aiding the postgraduates to deal with the same.

Due to low OPD attendance and reduced inpatients, residents have considerably more time left to build a rapport, not only with the patient but also with the teachers. The time thus obtained is utilized to examine the patient in much detail, and to discuss the particulars with consultants with elaborate ward rounds, thereby improving the quality of learning despite the reduced caseload. In the pre-pandemic times, procedures and interventions were commonly done over the face because of aesthetic concern. But now, both the patient and the resident are anxious while these procedures are done, due to the fear of acquiring the infection. Scarcity of protective gear and cumbersome protocol to be maintained while doing the procedures add to the anxiety, ultimately leading to lesser procedures being done when compared to the pre-COVID era, thereby affecting the “hands-on” skill of the postgraduate. Face-to-face seminars and CMEs have now donned a virtual cape, providing a wide platform to acquire knowledge from eminent clinicians pan globe. However, this cannot entirely compensate the conventional classroom teaching which offers better retention, demands unparalleled attention and provides an opportunity to get inspired by charismatic physical presence of the learned stalwarts.

Teledermatology is offering a compensatory and additional learning aid to postgraduate residents by exposing them to dermatoses beyond geographical limitations. Teledermatology facilitates the better exchange of information without the transmission of infection and can be used as a tool to evaluate residents as well. However, the healing touch of a doctor may be missed due to barriers in communication.² Doctors have been found to prioritize major lesions and miss out on smaller details due to “zoning,” preventing wholesome learning.³

First-year residents have been donning the role of junior residents (JR) 1 for additional months due to the delayed resident admission process pan India, while JR2 is perturbed about procuring the required sample size for completion of the mandatory thesis. The beginning of the pandemic had JR3 worrying about the uncertainty regarding the mode and time of their final examination, which is now being held either online or offline according to the prescribed norms of each university.

Due to the burden of COVID-19 cases in our country, doctors from other specializations have been roped in and are given rotational duties in both routine specialities and COVID care setup.^4,5

The psychological impact of COVID-19 on residents needs to be highlighted. Being the front line workers in public health crises, they are not impervious to the infectious nature of the virus they treat or the mental stress of the unexpected suffering and death of their patients and colleagues alike. While the dread of acquiring infection and carrying it back home remains, the inability to dedicate the valuable time of residency to gain adequate exposure and expertise in the chosen field triggers more apprehension about their academic future and career prospects. Encouragement and assurance from the mentors and positive interaction with the peers can help the residents to regain and reinforce their optimism.

It is worthy to mention that COVID-19 has stimulated the residents to look for the silver lining in the darkest clouds of dilemma and fear. This pandemic has brought back the forgotten extracurriculars and stress busters among residents and senior consultants alike. Residents are striving hard to make the best of the present situation and will definitely emerge as specialists with expertise in dermatology and COVID-19 alike.