Berks County Medical Society Medical Record Summer 2020 - 23

Coronavirus Chronicles: Berks Responds

Medical Education
by Anthony A. Donato, MD, MHPE
Ryan P. Zimmerman, DO
Benjamin J. Lloyd, MD

A

s medical educators during the COVID pandemic, we will
remember this time for its tremendous uncertainty and the
rapid rate of change.
Just 5 months ago, residents and medical students joined
attendings at bedside and in clinics, making connections with
patients and identifying unusual physical findings. Teaching teams
came together at whiteboards and in conferences over meals to share
ideas; multidisciplinary teams exchanged plans on walk rounds.
Residents built rapport and long-lasting relationships with their
patients in longitudinal clinics, searched for best evidence and
tried to put this evidence in practice using quality improvement to
augment systems of care.
Then came COVID. An indiscriminate, highly infectious
illness overwhelmed our sickest. With no treatments, empiricism
dominated. We tried vitamins, zinc, H2 blockers, steroids, and
proning; we re-purposed old drugs, but even they got rationed and
sometimes hoarded. Tests were scarce and we did not know who
was sick; we ran into rooms to run codes and later found out that
those doctors and nurses fell ill. Protective equipment got rationed;
we needed help from community and family to get enough for our
trainees. We feared for our learners and worried about bringing
COVID to our own families. Social distancing became both the
catchphrase and the mandate; providers saw patients without their
teams, while masks and goggles obscured body language between
patients and fellow staff. Patients isolated in hospital rooms
without visitors often tragically died alone. Outpatient clinics were
shuttered, staff furloughed, and medical students were sent home.

We watched in horror as well-developed European medical systems
were overwhelmed and we made preparations for the worst.
In medical education, we went back to the basics. We made
sure everyone was safe and had PPE. We adapted the new ACLS
COVID guidelines and taught everyone how to apply them using
human patient simulators. Residents assigned to closed ambulatory
clinics devoured what evidence for COVID existed and rewrote
order sets from the hospital system, which they updated as new
evidence came available. Residents populated databases to try to
find trends in COVID that were not apparent. Outpatient teachers
pioneered video visits and prepared to backfill for an impending
inpatient overload. We learned almost overnight how to give and
participate in an online conference. We figured out how to use
remote stethoscopes and broadcast interviews to teams outside
rooms, and affixed pictures of ourselves to labcoats so patients
could see the face beyond the protective gear. We still have not yet
mastered how to drink coffee through a mask.
What will stay with us permanently as the result of the
pandemic? I believe the pandemic will accelerate our previously
slow uptake of telemedicine, as we learn which platforms work and
payors see value. Residents at satellite clinics will now be able to
learn from conferences from afar and catch up asynchronously on
ones they missed. However, the pandemic will also remind us that
despite all the advances in the science of medicine since 1918, the
relationships that we build-with our learners, our colleagues, and
our patients-are still the most important tool in the doctor's bag
in 2020.

SUMMER 2020

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Berks County Medical Society Medical Record Summer 2020

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