Residency Through COVID: How the Pandemic Affected Resident Experiences

The SARS-CoV-2 pandemic upended how we went about our daily lives. Work, home, play—every aspect was affected. For pathology residents in the midst of their training, the pandemic and ensuing stay-at-home orders for many meant that residency looked vastly different than it had in the past. The American Society for Clinical Pathology’s RISE Committee recently conducted a survey of residents during the Spring 2021 RISE Exam to learn more about how the pandemic affected their time in residency, and how it has shaped their training. Approximately 2,500 residents responded to this survey.

Challenges of the educational experience

Among the results, residents responded that in general the COVID-19 pandemic had a slightly negative affect on their pathology training and experiences, as compared to their training prior to the pandemic. Residents noted that they spent much less time interacting with faculty, other residents, and fellows because of the pandemic. Regarding remote training/work experiences specifically, 14 percent rated the quality of such training during the pandemic as excellent, 47 percent rated it as good, and 32 percent rated it fair.

Austin McHenry, MD, now a third-year resident at Yale, notes that while he and his fellow residents still came in every day, the number of specimens they saw dramatically decreased, which affected their educational experience. On a GI service, there were almost no specimens, he noted, which was highly unusual. “Our program director was very helpful in making sure that if we missed something we could make it up later,” he says. For example, Dr. McHenry says that he had initially missed a lot of exposure to cytology because of the pandemic, and so put extra focus on receiving that training when it was subsequently available. There was so much momentum in residency, and then when COVID-19 hit, he explains, that momentum just stopped. “It’s hard to get it back again, and there are a lot of things you need to learn, and you’re just not sure if you’ll get that time back.”

Hannah Wang, MD, a microbiology fellow, was a third-year anatomic and clinical pathology resident at Stanford when the pandemic started and was surprised to realize that working from home was not as beneficial as she thought it would be. “It ended up being really challenging in terms of isolation, and not seeing people in person,” Dr. Wang says. “Small talk, social interaction, and just seeing people in the hallway can not only enrich your personal life, but also in terms of learning new things and your academic life as well.”

For Joshua Klonoski, MD, PhD, who was a senior resident at the University of Utah, the pandemic greatly affected being on call, he says. With so many blood bank and platelet shortages, there was a significant increase in activity during overnight and weekend calls. And signing out cases on the anatomic side became more challenging logistically, as people worked both on site and remotely. Processes had to be changed to ensure that grossing and pathologist review could be conducted in a timely and efficient manner. Despite these challenges, Dr. Klonoski says, his laboratory’s pivot to digital pathology was swift, which greatly helped. “Overall, how fast people transitioned to deal with COVID was just amazing,” he says.

Dr. Klonoski also notes that he saw the effect the work from home orders had on first-year residents. While he and his fellow upper-level residents had already bonded over the first few years, incoming first year residents who were new to the health system and city started training at a time of increased distancing, and they therefore didn’t have the same types of opportunities to make in-person connections right away. Despite such challenges, “they did really well coping with that,” Dr. Klonoski notes.

Clinical and research responsibilities

According to the survey, 12 percent of residents also reported having participated in non-pathology clinical responsibilities within or outside of their facilities, such as in the emergency department, inpatient or outpatient clinics, or other direct patient care activities. Many residents reported, however, that while the pandemic did leave them with more independent study time, it was often a struggle to get research done.

Dr. Klonoski notes that for both the basic and clinical research he was involved in, delays in shipments of necessary equipment hindered his research. And typically, his healthcare organization organizes an annual research Grand Rounds, with many residents and fellows presenting, but in 2020, far fewer residents and fellows were able to participate. “It was a huge impact,” he notes.

Dr. Wang says that while COVID research projects were integral to her interests and her job, she did have other research projects that had to take a back seat during the pandemic. “My time was being devoted to COVID-related research,” she explains, “but also hospital resources were being distributed that way as well.” While it ultimately aligned with Dr. Wang’s career goals, since her research interests fell in line with COVID, she knows that wasn’t the same for other residents. What’s more, an increase in clinical demands, she notes, impacted the amount of research many residents could actually partake in, as did psychological demands—with stress and burnout levels high, she says, it was tough to get research done.

Pathology remains top of interest

Despite the challenges of the pandemic, the residents who responded to the survey noted that the COVID-19 pandemic didn’t decrease their interest in the field of pathology, with 84 percent noting that their feelings were unchanged, and 10 percent responding that the pandemic actually increased their interest in pathology. That may have been due in part to the spotlight the laboratory came under quickly in the spring of 2020, as COVID testing ramped up quickly, and both clinical colleagues and the general public turned to pathologists and laboratory professionals for information about the virus. COVID brought an elevated value to the laboratory, and for many residents, their work as part of the laboratory.

“As someone who is interested in microbiology and laboratory medicine, I really had the opportunity to participate in a lot of projects related to COVID testing,” says Dr. Wang. “For the past year or so I’ve helped work on projects like validating pooled testing, which we’ve been using to bring children back to school, and help develop an assay to screen for variants.” Being able to do that kind of work, she adds, to collect that data and stay one step ahead of COVID has been rewarding. “Pre-pandemic, I wouldn’t necessarily have had the opportunity, but right now, it’s an ‘all hands on deck’ mentality. This is some of the most rewarding work I’ve done in my entire residency. I definitely feel a sense of fulfillment that is deeply gratifying.”

Dr. Klonoski adds that at his facility, the fact that the lab could help screen patients for surgery meant things kept moving in the hospital, and patients could still be cared for. That was one way the value of the laboratory was really highlighted to clinical colleagues and patients alike. “Our system supports many community hospitals, and there was a huge recognition of what pathology did for our hospital system,” Dr. Klonoski explains. “Getting people into surgery, and not having the hospital come to a standstill was a big deal for everybody.”

The COVID-19 pandemic affected how residents experienced pathology training over the past 18 months, and will undoubtedly continue to affect new and established residents in the coming months and years.