Redefining Residency

The coronavirus pandemic is upending everything about day-to-day life, and the way in which dermatology residents apply, learn, and matriculate is no exception.

With every challenge comes new opportunity, and while residency will shift, some of these changes may be for the better and benefit residents and their future patients, says Adam Friedman, MD, FAAD, Professor and Interim Chair of Dermatology and Residency Program Director at George Washington University (GW) in Washington, DC.

From 150 accredited dermatology programs in the US and nine programs in Canada, approximately 530 dermatology residents graduate each year, according to the American Board of Dermatology. Unfortunately, many of this year’s class will likely miss out on the celebratory graduation experience as calls for social distancing are unlikely to lessen any time soon.

“Derm residents put in blood, sweat, and tears to get to this point and a good number of, if not all, graduations will not be live,” Dr. Friedman says. In place of the traditional cap and gown fetes held in auditoriums packed with loved ones, many 2020 graduations will be online, he says. Dr. Friedman is in the process of creating a virtual graduation event for his residents.

The New Hybrid Care Model

New residencies should start in late June and early July, but many clinics may only be open for essential visits, and there could be a shortage of personal protective equipment.

“We may relax some social distancing by mid-summer or early fall, but I can’t imagine it will be what it was anytime soon,” Dr. Friedman says. Instead of seeing dozens of patients, new residents will likely see patients on a staggered schedule and will have to hit the ground running when it comes to telemedicine, he says. “We are a high-volume specialty with jam-packed waiting rooms,” he says. “We are really going see a hybrid model of telehealth and live visits.”

Residents will be fluent in this new construct early on, which is a plus. Telemedicine has the potential to expand access to patients who would normally wait months to be seen, he notes.

Online Learning Removes Barrriers

Meetings, journal clubs, and other in-person gatherings will look different in the post COVID-19 world, Dr. Friedman says.

Virtual technologies make it easier for more students and faculty to attend these meeting from anywhere. “Virtual meetings can extend audiences across the country, increasing collaboration in a way that wasn’t possible due to geographic barriers.”

Teaching will also morph more toward online learning, he predicts. WebEx lectures will proliferate. “It is really easy if you have the right platform and bandwidth, and we can extend access to other trainees and faculty and forge a strong community, even though we are not physically together.”

We Got This

Part of dermatology residency involves learning to be comfortable, confident, and efficient when performing a physical exam and establishing a differential diagnosis, Dr. Friedman says. The art of diagnosis should not suffer, due to the advent of telemedicine and reduced patient volume. At GW, Dr. Friedman initiated “Krazy Kodachromes” to sharpen students’ diagnostic skills. During quarterly sessions, faculty members give one-hour kodachrome lectures to residents from GW and neighboring institutions; these lectures are streamed online. “We videotape discussions of faculty and residents looking at pictures and describing what they see to make a differential diagnosis,” he says. “This program really captures how we make differential diagnoses. We’ll need more of this if we can’t do it in the clinic.”

The resident and fellow application and recruitment process will also undergo transformation, according to the National Resident Matching Program (NRMP). They recommend that fellowship programs conduct at least initial screening interviews for the upcoming Match season virtually. NRMP is urging institutions and programs to make more electronic information available about their programs. As it stands, dermatology fellowship websites are accessible for the most part, according to a recent study by Dr. Friedman and colleagues at GW (data unpublished), but many lack key information on the program and application process.

The big picture for the specialty is bright, he adds. “Above all else, this crisis has been an opportunity for the dermatology community to demonstrate our mettle and quickly adapt to maintain the highest level of care through telemedicine adaptation and education through innovative digital platform. We got this!”