Dr. Kimberly Baker-Genaw, the director of medical education at Henry Ford Hospital in Detroit, remembers the moment in early March 2020 when Gov. Gretchen Whitmer temporarily closed all surgical clinics and shut down all elective hospital procedures in Michigan. “All our medical education activities ceased that day as we shifted to COVID care,” says Baker-Genaw, who oversees some 700 medical residents (most in their mid-to-late 20s) in 83 different programs at the downtown hospital. “It was all hands on deck.”
For teaching hospitals across the country, particularly those in urban areas, the start of the pandemic in March 2020 was also the beginning of an intense period of innovation. Many of the solutions and strategies medical educators adopted — increased virtual learning, collaboration, and wellness resources — they feel are sure to affect medical training in the future.
For the medical faculty at Henry Ford, the biggest initial challenge of the pandemic was how to care for the onslaught of COVID-19 patients in metro Detroit while also continuing to train residents with all clinics and surgical procedures shut down.
Fortunately, the Accreditation Council for Graduate Medical Education — the nonprofit organization that sets standards for U.S. graduate medical education for residents — accepted Henry Ford’s request for Pandemic Emergency Status and waived all curriculum requirements for 30 days. Baker-Genaw was then able to quickly pull roughly 200 surgery and anesthesia residents into the intensive care unit and emergency rooms to help doctors — many of whom would normally be doing elective procedures — care for COVID-19 patients. “Every bed was filled. We had over 500 COVID patients,” she recalls of that first wave.
Knowing a second wave would eventually happen, Baker-Genaw put a structure in place. “Our residents had a lot of educational concerns, so we created a very organized plan for the next wave,” she recalls, explaining that they looked at every resident’s level of training to see who could be of help with COVID patients in the future, while also making sure all residents would continue to be carefully supervised by medical faculty. Residents with little ICU and ER experience, such as ENT and dermatology residents, could help with COVID nasal swabbing, as most had done during the first wave. “We continue to pull up our plan and update it, as we are doing now, expecting yet another wave of the unvaccinated,” she said in August.
Dr. Eric Scher, the chair of medicine, who runs the Internal Medicine Residency program at Henry Ford, thinks the medical field may see a shift in career choices due to the pandemic. “Students might gravitate into different residencies, and residents might choose different fellowships depending on the impact this has had on their personal and professional lives,” he says.
The pandemic also forced a new kind of teaching for the likes of Dr. Bob Rabbani, who runs Henry Ford’s cardiology fellowship program. While a doctor might normally teach residents a body of knowledge already in existence, residents instead witnessed attendees trying to learn, battle, and treat a brand-new disease.
Dr. Geneva Tatem, director of the Pulmonary and Critical Care Medicine Fellowship, supervised teams of up to six residents and two fellows in the ICU from the beginning of the pandemic, when little was still known about the disease. “We doubled the beds we normally have in the ICU to about 150 within a week and a half,” she says. “Everyone had COVID, but not everyone was presenting the same way or having the same clinical course or outcome, and we did not know how to manage the disease.”
Tatem recalls suffering from “information overload” from the Centers for Disease Control and Prevention and from other hospitals offering best practices. “There was no time to critically think,” she says. “We were learning about COVID at the same time as the residents. We were just working and collaborating together but recognizing there is a way to come up with good answers and be solution-oriented even if you don’t know if it’s the right answer.”
Adds Tatem, “Collaboration through science and education across healthcare systems and academic medical centers has had substantial positive change in medical education that I hope continues in the future.”
Medical faculty at Henry Ford also expanded the hospital’s mental health resources to help support their youngest providers. Behavioral health experts offered check-ins, referrals, support groups, and even an internal website (called the COVID Diaries) where everyone could share experiences.
“We worry about their mental health as much as their physical health,” Scher says. “Think about what you’re supposed to be doing in your mid-20s: going out, hanging out with friends, dating. None of them could do any of that in the prime of their youth. Instead, they’d come here every day to take care of sick patients and then go home to be alone.”
Worse yet, that cycle is not ending. “We hear ‘hero to zero’ from the frontline staff who are discouraged by the ongoing pandemic despite vaccines, increased knowledge of the disease, and ineffective/unused personal and public prevention strategies,” Baker-Genaw says, noting how community support for medical professionals has dwindled.
She has, however, been impressed by how residents have coped. “Many adopted or found personal wellness and resilience strategies. I suspect this focus will likely bring increased awareness/attention to work-life balance to future physicians and increased resources for personal and emotional health for providers.”
In the late spring of 2020, as soon as it was possible, Baker-Genaw resumed the residents’ normal curriculum. “We spent a lot of time and resources pivoting into virtual telehealth and didactic virtual experiences,” she says, adding, “I think that there will be continued pressures to increase virtual learning in both undergraduate and graduate medical education with new educational strategies to provide the required skills and knowledge to transition to and from virtual to in-person patient care.”
All three doctors are quick to point out that situational learning — in-person care that takes place at the bedside — must continue to be a priority. “That knowledge cannot be replicated in a virtual environment,” Tatem says. “It impacts how residents and fellows continue to develop the behaviors that demonstrate care, kindness, and emotional connection with patients. Cultivating interpersonal and communication skills along with medical knowledge is essential for excellent patient care and vital for the growth and development of today’s trainees into committed, compassionate physicians of the future.”
In June, Scher attended the in-person graduation of 36 internal medical residents. In his commencement speech, he told them he could not be “prouder of how they responded to the greatest crisis of our lifetime.” He also knew his job was done.
“I always tell them at the start that residency is about more than just learning a set of skills and fund of knowledge,” he says. “It is about forming a professional identity. Not just acting like a doctor but feeling like a doctor. If there is a silver lining to this pandemic, I think it truly reaffirmed why they went into this profession.”
Each of the physicians featured in this story made our 2021 Top Docs list. See who else made the list here, and find more stories from the October 2021 issue of Hour Detroit magazine in our digital edition.