Ethical Issues in Residency Education Related to the First Wave of the COVID-19 Pandemic: A Narrative Inquiry Study
Creators: name: Kassam, Aliya
Publisher: name: Cumming School of Medicine
Year: 2022
Subjects: subject: Resident physicians
subject: Ethics
subject: COVID-19
subject: Postgraduate Medical Education
subject: Public and Social Welfare
subject: Biophysics--Medical
subject: Epidemiology
subject: Health Care Management
subject: Medicine and Surgery
subject: Occupational Health and Safety
subject: Public Health

description: Background: Around the world, the unprecedented COVID-19 pandemic has increased the demand for, and on, healthcare workers as it also continues to strain healthcare systems. Ethical issues that arise during pandemic health emergencies understandably impact such individuals as healthcare providers who have responsibilities to the public. Residency programs were faced with new challenges to provide care and educate junior doctors (resident physicians) while ensuring learner and patient safety and resource allocation amidst the suspension of standard in-person learning opportunities. We sought to understand both the positive and negative experiences of first-year residents during the first wave of COVID-19, as well as to describe potential ethical issues from their stories. Method: We used narrative inquiry (NI) methodology to explore resident physicians’ experiences. A semi-structured interview guide was utilized and included questions pertaining to ethical principles as well as both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio-recorded and transcribed. Three members of the research team coded transcripts in duplicate to determine themes surrounding experiences as well as observations of ethical principles and arguments. To describe resident experiences of both the positive and negative aspects of the pandemic, a composite story with threads was constructed. Discrepancies were resolved through discussion to attain consensus. Results: Eleven residents participated from Internal Medicine (n=2), Family Medicine (n=2), Ophthalmology (n=1), General Surgery (n=1), Pediatrics (n=1), Diagnostic Radiology (n=1), Public Health (n=1), Psychiatry (n=1), Emergency Medicine (n=1). Resident stories had three common themes in which ethical issues were described: 1) Intersecting healthcare and medical education systems, 2) Public health and the public good, 3) Health systems planning/healthcare delivery. Junior’s journal entry became the composite story of the eleven participants. Three key narrative threads of the story were: 1) Engage us, 2) Because we see the need for the duty to treat, 3) And we are all in this together. Discussion: While residents identified lack of autonomy as they straddled roles as both novice employees and learners across intersecting systems, this was not unique to the pandemic. The pandemic, however may have exacerbated the lack of autonomy experienced by resident physicians. The notion of public health and the public good at times eclipsed individual wellbeing for residents and patients alike, leading to consequences in health systems’ planning/healthcare delivery. Despite these challenges, there were positive aspects to the pandemic such as teamwork and collaboration as well as the feeling of altruism to help achieve what was best for the public good. Conclusion: Efforts to understand how resident physicians can be engaged in their own education as well as how they can navigate public health crises with respect to ethical principles could benefit both residency education and healthcare delivery.