In 2020 the world became united with a single focus—and it was not on the destruction of our planet from climate change. A zoonotic coronavirus, SARS-CoV-2, moved from animal to human hosts and unleased infections and deaths in every continent except Antarctica. In this issue of the Journal of Graduate Medical Education, we include articles from diverse sources on topics that we hope will help the graduate medical education (GME) community balance education and clinical service during this stressful time—a time that also provides rich learning opportunities.
As a geriatrician with the “oldest old” clientele, I care for patients who have experienced the Great Depression, World War II, and, early in my career, the Spanish-American War and World War I. Growing up, parents of my friends were Holocaust survivors. Either from learning through hardship or because those with poor coping skills generally do not survive to late age, these older adults nearly always face new adversities with equanimity. They are usually generous in their thoughts of others, including those of different backgrounds. Although vastly heterogeneous in their own values and health status, they are much more homogeneous in their approach to difficult times: take pleasure in small things, take care of each other, be hopeful.1
The clichés that have been used to describe the pandemic—unprecedented, dire, devastation, tragic—and health care workers—heroes, saints—may actually be true. Tough times bring out the best in many. For medical educators, it is critical to remain mindful that we are role models for our professions. We are still educators, despite the disruption of rotations, conferences, assessments, and required competencies. Trainees are absorbing what we do more than what we say. Learning opportunities abound, even in these unprecedented times—which have been preceded by similar health events, such as HIV/AIDS and Ebola, that many physicians remember well. Similar to the emergence of HIV/AIDS in the 1980s, attendings, residents, and medical students have opportunities to display the best and worst in professional behaviors and advance the development of professional identity formation.
Where are these opportunities? They can be found in minor as well as more consequential actions.2 The faculty member who finds reasons not to participate in a call center from home, which could free others to work in test centers and emergency rooms. The healthy critical care fellow who decides this is a perfect time to take time off, rather than complete his current intensive care unit (ICU) rotation. The medical student who skips checking her medical school e-mails, despite multiple requests from her advisers, as there is no grade for e-mail responses. Contrast these acts with the attending physician who swiftly switches clinic care to telemedicine and patient home visits, as needed, so that clinic staff can shelter at home. The medical student who volunteers for COVID-19 data entry so public health experts can focus on critical tasks. The retired physician who deploys to New York City to supervise residents in a busy medical inpatient ward. The surgeons, eyeing empty operating rooms, who organize to relieve ICU clinicians.
How do we model the highest level of professionalism at this time? How do we balance protecting patients versus protecting students or residents? Do we dare take the time to study the results of our ongoing decisions about GME and trainee roles? Each day there are opportunities to educate, role model professionalism, and tactfully question unprofessional actions when observed. The special COVID-19-related articles in this issue represent early attempts to prepare for, assess, and improve GME during this difficult time.
Emotional and physical stress are handled differently, such that each of us must also monitor our own tolerance and responses to a dire situation. As my 99-year-old patient tells me (by telephone), “Just be kind, honest, and work hard, and we'll all get through.” Let's model our best, while we get through.