Training Directors Strive to Maintain Educational Mission Under Extraordinary Conditions

The hardest challenge for psychiatry training directors around COVID-19 has been managing the redeployment of psychiatry residents to medical settings, according to Melissa Arbuckle, M.D., Ph.D., president of the American Association of Directors of Psychiatric Residency Training (AADPRT).

Associated with this challenge are concerns that the residents may not be adequately prepared for the roles they are being asked to do, “whether it is limited skills in critical care—which they were not trained to do—or the possibility of insufficient personal protective equipment.”

She added, “We are also critically aware of the psychological toll our residents are facing, as they see firsthand the devastating impact of this disease and its casualties. We are concerned about the risks our residents are taking for themselves and their families.

“Our communities desperately need every doctor available. Our residents understand how medical teams work. They understand the language and the culture and have worked in medical settings before. They are smart people who are capable of learning new things quickly. I have no doubt that they will save lives.”

She said training directors around the country and across specialties are grappling with these complexities, uncertainties about the future, and whether the new medical school graduates will be able to begin training in June on time. “It’s hard to imagine what everything will be like in June and July.”

Certainly, New York City has been uniquely overwhelmed. In areas where COVID-19 has not resulted in a surge of patients, some training directors reported little change outside of the transition from outpatient services and educational activities to telehealth and online technology. In Detroit—among the hottest spots in the country at press time outside New York—Richard Balon, M.D., director of training at Detroit Medical Center (DMC)/Wayne State University School of Medicine, said that psychiatry residents have not yet been deployed to care for COVID-19 patients in medical settings. But a list of residents who had volunteered to serve has been submitted to the Graduate Medical Education Office of the DMC, and some psychiatry residents have voluntarily gone to ICUs to provide emotional support and counseling to ICU residents and to help with contacting and talking with families.

Arbuckle noted that training directors are also faced with providing emotional support to a cohort of residents experiencing a wide range of normal reactions, including fear, sadness, and anger. “And it’s not just about work—our residents are also in quarantine, social distancing, homeschooling children, and losing loved ones,” she said.

She said that after COVID passes, “a mental health tsunami” is sure to follow. “Psychiatry will be more relevant than ever as our communities struggle with social isolation, the sorrow of lost friends and family members, the financial instability of a crippled economy and vast unemployment, and the trauma faced by essential workers on the front lines of this crisis.”. ■

Resources created by AADPRT members for teaching psychiatry online and implementing telepsychiatry, as well as practical tips for addressing the psychological stresses associated with the COVID-19 crisis, are posted on the AADPRT website.