{"id":2821,"date":"2020-03-05T13:59:32","date_gmt":"2020-03-05T18:59:32","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=2821"},"modified":"2020-12-21T20:30:19","modified_gmt":"2020-12-22T01:30:19","slug":"should-we-avoid-exposing-residents-to-coronavirus","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/03\/should-we-avoid-exposing-residents-to-coronavirus\/","title":{"rendered":"Should We Avoid Exposing Residents to Coronavirus?"},"content":{"rendered":"
\"Dr.<\/a>

Dr. Bressman is a Chief Resident in Internal Medicine at Icahn School of Medicine at Mount Sinai in New York, NY<\/p><\/div>\n

The arrival of the novel coronavirus to the U.S., and the inevitability of its eventual spread<\/a>, raises an interesting question: Should we avoid exposing residents to the virus?<\/p>\n

\"\"<\/a>Before we try to answer this question, we should start with some important qualifiers. While a good deal about this novel virus remains unknown, the majority of cases appear to be low risk<\/a>, particularly for the demographic of the average resident. Furthermore, if this outbreak does reach pandemic levels, exposure to healthcare workers of all levels ultimately will be unavoidable. Finally, even with the best of protocols in place, it will be impossible to triage out every potentially infected patient at the point of first contact.<\/p>\n

With all this in mind, COVID-19 may not be the best case study, but it’s an interesting opportunity, nonetheless, to pose a broader question regarding the role of trainees during epidemics and pandemics.<\/p>\n

History<\/b><\/h2>\n

Let\u2019s start with a brief historical overview of this question. Physicians have always been at the frontlines of deadly outbreaks, and as a result, were regularly infected by the same diseases as their patients.\"\"<\/a> The first century of U.S. history can be recounted in a sequence of epidemics, from yellow fever to cholera to typhoid fever. In an era of unregulated medical and graduate medical education, and limited understanding of the spread of these diseases, there was scarcely any thought given to the protection of students and trainees during these outbreaks.<\/p>\n

Graduate medical education evolved over the course of the twentieth century<\/a> from a mix of apprenticeships and a limited number of more structured programs, to a landscape of predominantly hospital-based internships, and eventually specialty-focused residencies with a unified accrediting body. Important questions that persist to this day were considered during this time, including the place of the resident on the spectrum from student to employee.<\/p>\n

The AIDS epidemic was likely the first major infectious disease outbreak during which the unique experiences of students(Health Educ Res<\/em> 1999; 14:1<\/a>)\u00a0and residents (Ann Intern Med<\/em> 1991; 114:23<\/a>) were explored, although the emphasis tended to be on the duty to treat<\/a> in spite of the fears and perceived risk. In the intervening decades, however, the vulnerability of the trainee has been reconsidered, and this has shifted the conversation. By the time of the 2014 Ebola epidemic \u2014\u00a0although different in scale and mode of transmission from HIV \u2014 much wider efforts were undertaken to protect trainees from potential exposure, prompting a healthy debate (Acad Emerg Med<\/em> 2015; 22:88<\/a>).<\/p>\n

Pros<\/b><\/h2>\n

We can entertain a couple arguments in favor of trying to protect residents from a potential pandemic exposure:<\/p>\n