COVID and Med Ed: Resident and Student Describe 'New Normal'

Cherie A. Fathy, MD, MPH; Ramie A. Fathy


April 10, 2020

'Everything Changed'

Ramie: What did you think in the weeks leading up to the spread here?

Cherie: When the first patient was diagnosed with COVID-19 in Philadelphia, I kept seeing clinic patients without much alteration to my interactions. When the early news came out of Italy, we questioned whether it was safe to host 24 residents in a Prometric testing center; but otherwise, we really did not anticipate a change. Then, of course, everything changed. We heard the news of the doctors in Italy and China giving their all and losing their lives. Stories surfaced of doctors forced to choose who gets a ventilator. Patients were dying alone.

I could see the signs that something was coming.

Early on, I wondered, Why aren't we doing more? On a local level, the initial response from the different levels of leadership seemed to focus more on "building morale" rather than providing concrete steps to prevent the spread or prepare for a pandemic. In talking to other residents across the country, this wasn't unique to Philadelphia. Obviously, it isn't easy to coordinate a massive shift in practice. But it was frustrating for us as residents because we craved definitive plans and guidance. I do have to commend my institution for their leadership now. We get daily updates on the situation at the main hospital, and at Wills, we follow AAO guidelines regarding scheduling only urgent or emergent patients and only doing emergency surgeries. We're still getting a few nonemergent visits that make me think that a teleophthalmology service could help prevent people from unnecessarily leaving their homes and potentially exposing themselves.

We are looking into telehealth opportunities for our nonurgent patients. However, it is quite new territory for us. In ophthalmology, much of our examination and management depends on a dilated eye examination or a magnified view of the eye using a slit lamp microscope. Televisits will certainly come with new challenges when it comes to definitively diagnosing and treating patients. It's an interesting challenge and one that we will hopefully be able to draw from as we employ teleophthalmology more in the future.

What happened with your rotations?

Ramie: I came back to Philadelphia for my rotations after studying for the USMLE Step 1 for a couple months at home in Tennessee. Ironically, one of the most widely used study resources to prepare for Step 1 started its section on the coronavirus with information about how rare the virus is. It actually stated that it was "not a super high-yield virus," implying that we wouldn't need to be too familiar with it.

In February, during my first rotation in pediatric dermatology, I could see the signs that something was coming. Patients started coming in with masks on. Hand sanitizer bottles quickly needed to be replaced. National conferences and invited speakers were canceled. Patients started to ask me whether they should stock up on their medications and for how long. Just 2 weeks after I had returned to the hospital, I received an email about the temporary suspension of clinical rotations. Initially the suspension was for 2 weeks. A few days later, it became an indefinite suspension. It may be months before I can safely take part in rotations again. Although I'm disappointed, these decisions make sense in order to protect our patients, staff, faculty members, and others.

Cherie: What are you doing if you're not on rotations?

Ramie: Many of us have left the city and are heading back home to be with family. The school has moved all preclinical courses and small groups online and developed online clerkship and elective modules to continue our education remotely. As you can imagine, it takes time to develop online educational materials to mimic the clinical experiences one has in the hospital. Our instructors are actively creating online, case-based video modules. The school has also been collecting and sharing a long list of research and volunteer opportunities for students to work on.


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