We were inspired but not surprised by the way our residents rose to the myriad challenges posed by the pandemic – whether delivering hot meals to co-residents in strict quarantine, rapidly delivering an innovative virtual curriculum in collaboration with residency leadership, or oversubscribing as volunteers to join adult medicine colleagues on the COVID wards at Boston Medical Center. This page is intended to highlight the key elements of our response as a program to an unprecedented crisis.
A Commitment to the Health of Patients and Residents Alike
The well-being of our patients and residents drives every decision we make as a program. We worked hard with Boston Medical Center and Boston Children’s Hospital to continue providing top quality care to patients while remaining firmly committed to protecting our residents and their families, knowing that each and every person’s circumstances are unique and deserve individual solutions.
As the surge hit Boston in last Spring, Boston Medical Center stood at the city’s epicenter, bearing the brunt of its caseload from its position as a bedrock of the Boston community with an unwavering commitment to historically underserved communities. BCRP residents and faculty alike volunteered in solidarity with internal medicine colleagues to staff a team on the COVID-19 wards in rotating sprints into the summer.
Across the city, Boston Children’s Hospital opened its doors to pediatric patients from other hospitals who had closed their pediatric wards to make way for hospitalized adults with COVID-19, filling a critical need for sick children. Researchers at Boston Children’s Hospital refocused their resources and efforts to deliver important contributions to our understanding of COVID-19-related pediatric disease.
BCRP residents were encouraged to have frequent, honest, and confidential conversations with our leadership regarding personal health or family considerations. Our values and large size enabled us to customize approaches for each resident, arranging temporary leaves of absence or alternative assignments to low-risk services according to resident need.
Adjustments to Clinical Rotations During the Pandemic
In an effort to limit unnecessary exposure while maintaining an available pool of well-rested residents who could provide back-up for colleagues who might be prevented from working while ill or undergoing testing, we modified our team structure on rotations wherever safe and manageable to assign a smaller group of residents to staff services in short sprints, while giving respite to their peers. We communicated on an ongoing basis with residents and residency directors regarding fluctuating census and workload, and increased staffing dynamically in response to need.
Meanwhile, infection control considerations paired with a dramatic decrease in the number of patients presenting for care to ambulatory clinics initially triggered a temporary suspension of resident participation in clinics. But as the situation evolved and new opportunities emerged, we were able to devise new ways for residents to continue their ambulatory training and experience the 36 annual clinic sessions required by ACGME, including: expanding resident participation to include morning, afternoon, and evening clinic sessions; integrating uninterrupted blocks of outpatient time into existing inpatient rotations by having residents complete several consecutive full clinic days; and coordinating resident participation in the telemedicine visits that now comprise an increasing proportion of ambulatory visits overall.
A Sustained Focus on Resident Education
Shortly after social distancing measures were implemented in Massachusetts, a large and dedicated partnership of BCRP residents and faculty educators met to ensure that there would be no interruption to high-quality education for our residents. A committee investigated best practices in virtual education and created a one-pager that was disseminated to teachers to encourage interactive and engaging sessions. Our pre-pandemic curriculum of noon conferences on general pediatrics and subspecialty topics was transitioned to zoom, and augmented by an entirely novel series of afternoon “chalk talks”, in which Boston Children’s Hospital fellows with a proactive interest in resident education volunteered some of their newfound time at home to share favorite clinical pearls with residents in informal, 30-minute, high-yield sessions. OPENPediatrics, a national platform for digital learning around pediatric topics that originated at Boston Children’s Hospital, offered a variety of pre-recorded learning opportunities that were made available to residents through a BCRP-specific web portal. Moreover, members of the program’s basic science academy hosted recurring “Journal Club” sessions over Zoom to review novel literature around COVID-19 as it emerged and invited participation from multiple other pediatric residency programs across the country.
Advocacy Beyond Our Hospital Walls
Our residents built upon a robust track record of advocacy for the health of children and families to help those directly and indirectly impacted by the virus. Specific efforts included pressure campaigns targeted at local legislators to protect Boston residents from eviction, a successful twitter campaign to illuminate and publicize racial disparities in COVID-19-related cases and deaths, a pediatric resident Black Lives Matter pledge, and a newly grant-funded effort to address the worsening crisis in childhood food insecurity by partnering with a ride sharing app to deliver groceries directly to households under strict quarantine or with other transportation-related barriers to accessing food resources. In support of these efforts, the BCRP Advocacy Group sent out a weekly newsletter with opportunities for resident involvement at the local and national level, organized by expected time commitment from several minutes to several hours. Finally, residents led departmental discussion of COVID-19-related disparities at multiple Health Equity Rounds at Boston Medical Center.
A Culture of Communication and Feedback
While everything did not always go smoothly, our program worked hard to find solutions quickly and creatively. For example, when some residents reported that they were unable to attend our virtual curriculum from their workrooms due to frequent clinical care disruptions, so we reserved separate rooms to which residents could retreat to participate in conferences and seminars while maintaining social distance. When residents expressed serious reservations about a planned transition to an “X+Y” scheduling model, which had initially been intended to ensure compliance with ACGME requirements in the COVID-19 era, a task force of residents and faculty was rapidly assembled through our Residency Program Training Committee (RPTC) – an indispensable venue for resident-leadership dialogue – to solicit input from each class across the residency and make adjustments to reflect joint priorities.
Indeed, communication is constant in the BCRP, and this has perhaps never been more true than the present. A Google form was maintained as an open forum for residents to submit questions, concerns, and suggestions to program leadership on a rolling basis. These resident priorities informed daily zoom calls held in the early days of the pandemic, when new developments were emerging daily and even hourly, which were gradually spaced to once weekly as the pace eased. Residents were kept continuously updated with the latest information on our hospitals’ inventories of personal protective equipment, epidemiologic data on the course of the pandemic in our hospitals and region, and the residency approach to new dilemmas presented by the crisis, including changes to team structure and rotation schedules and out-of-stage travel restrictions.
Given the heightened importance of interpersonal connection during the pandemic, several initiatives were developed to address resident wellness. A calendar of virtual events was developed and featured online yoga and dance classes, trivia nights, online cooking classes hosted by beloved faculty, and book clubs. Events were publicized in “Wellness Wednesday” emails, which also took time to review mental health resources available to residents in a stressful time. Our Wellness Committee has continued to lead socially-distanced events outdoors, including picnics and kayaking, and virtual events, such as a recent poetry slam and open mic night. Several residents even produced a book of art to promote reflection and healing. Finally, we recognize that wellness activities are only partial consolation if daily logistics of life remain a challenge, which is why we developed car-sharing networks where residents could offer their unused vehicles for residents who needed a safe and reliable way to get to their rotations, tapped child care networks for resident parents with kids at home, and placed an emphasis on flexibility with residents in difficult circumstances.
A Time of Adversity but Also Growth
The COVID-19 pandemic has presented new challenges to the BCRP just as it has to nearly every organization across the country. But it has also strengthened our community and forced innovations in care and education that are likely to live on long after the crisis has passed. We are excited to share additional information regarding our pandemic response with any interested applicants.