Grief, Chaos, and COVID: How Medical Trainees Can Cope

Jillian Horton, MD, FRCPC

Disclosures

April 18, 2020

Accept That There Will Be No Quick Answers

Worrying about what the pandemic means for your future is not disrespectful to those currently on the front lines. Calling COVID-19 a "disruption to your education" feels woefully inadequate. Clerkships are on hold indefinitely. Board and fellowship exams in most countries have been suspended or canceled. For learners with massive  debt, no budget could factor in the impact of a natural disaster  on the economy. The match result that was your biggest concern weeks ago now probably seems much more trivial.

You've spent years planning your path to becoming a doctor, so it is only natural to ask: What is next for your education?

I'd like to reassure you with specifics. The truth is, nobody knows. They likely won't know for quite some time. Licensing bodies and medical schools don't have a pandemic playbook, although they have issued guidance as they are able. Be assured that every institution and organization is working to sort this issue out in real time.

I have heard some demands for quick resolutions on social media and elsewhere. I know that the interruption to training and career advancement is dizzying. It can be hard to remember that everyone's life is unfathomably interrupted right now. The doctors who run the medical schools are scrambling with childcare and elder care, clinical duties, and health fears. Our expectations for how quickly questions about education can be answered during a pandemic may simply not be realistic.

One of the lessons that I learned during the SARS outbreak: The people who make decisions about our academic future are still just people, and they are dealing with lives of their own that have turned upside down.

 Another lesson I took from my experience is that we can look to patients as a model for a path forward through uncertainty. Every day, we push patients toward a future filled with questions and then usher them out of the room. We can't tell them whether their cancer will come back. We can't tell them how long they might live. We can't tell them what tomorrow will hold. They live with not knowing. We can too.

Embrace Your Old Nemesis

This kind of chaos is hard for trainees to accept. Becoming a doctor is a scripted path. Medical education is a long phase of our lives. When that is finally behind us, we often experience a deep sense of closure. When our chosen path is set on fire, our entire concept of the future goes up in flames. It is okay to be frustrated and to grieve for the loss of your plans. You will need to come up with new ones that cover the more immediate future.

At the top of the things that can help you feel like you are moving forward, an old nemesis is one of them: studying. Do not discount the value of its familiarity and structure. During times of extreme disruption and unrest, you need that structure more than ever. To the degree possible right now, I would urge you not to abandon studying.

It is okay to be frustrated and to grieve for the loss of your plans.

If this advice feels silly, think about the deeper message you send to yourself when you carry on with plans for the future. I can only begin to imagine the distress and uncertainty of those whose graduation or fellowship exams may be delayed for months or longer. During the SARS crisis, I didn't feel much like studying. But when I did, it centered me because it was one of my rituals. Don't abandon the rituals you can still maintain. Rituals keep us from the abyss.

That said, you may need to change what you are studying. You won't be alone. Many of us are learning about ventilators and procedures we never expected we'd find ourselves doing again. Still, don't abandon your exam notes or your board study groups unless or until it's absolutely necessary for you to do so. These routines provide us with comfort; they remind us of both the life we had before and the life we will return to when this is over. They signal to us that not everything has been lost.

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