4/29/2020
Impact of the coronavirus disease 2019 pandemic on resident doctors in India :Ravi Jaiswal, Cancer Research, Statistics, and Treat…
RESIDENTS CORNER
Year : 2020 | Volume : 3 | Issue : 5 | Page : 87--89
Impact of the coronavirus disease 2019 pandemic on resident doctors in India
Ravi Jaiswal
Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
Correspondence Address:
Ravi Jaiswal
BIACHRI, Hyderabad, Telangana
India
How to cite this article:
Jaiswal R. Impact of the coronavirus disease 2019 pandemic on resident doctors in India.Cancer Res Stat Treat 2020;3:87-89
How to cite this URL:
Jaiswal R. Impact of the coronavirus disease 2019 pandemic on resident doctors in India. Cancer Res Stat Treat [serial online]
2020 [cited 2020 Apr 29 ];3:87-89
Available from: http://www.crstonline.com/text.asp?2020/3/5/87/283304
Full Text
The world right now is in the grip of a highly contagious mystery virus, severe acute respiratory syndrome coronavirus 2 (SARSCoV-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.
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Impact of the coronavirus disease 2019 pandemic on resident doctors in India :Ravi Jaiswal, Cancer Research, Statistics, and Treat…
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?
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Impact of the coronavirus disease 2019 pandemic on resident doctors in India :Ravi Jaiswal, Cancer Research, Statistics, and Treat…
Replacing traditional examination assessments (face-to-face/clinical examinations) with online assessmentsPredicted 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.”
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Wednesday, April 29, 2020
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