{"id":3091,"date":"2021-01-12T14:21:26","date_gmt":"2021-01-12T19:21:26","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=3091"},"modified":"2021-01-13T14:08:28","modified_gmt":"2021-01-13T19:08:28","slug":"vaccine-rollout-reactions-in-support-of-residents","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/01\/vaccine-rollout-reactions-in-support-of-residents\/","title":{"rendered":"Vaccine [Rollout] Reactions \u2014 In Support of Residents"},"content":{"rendered":"
\"Dr.<\/a>

Dr. Braunthal is a Chief Resident at the Cleveland Clinic Foundation in Cleveland, OH.<\/p><\/div>\n

During the first week of the U.S. national vaccine rollout, news outlets reported a protest after a major medical center\u2019s initial COVID-19 vaccine distribution list did not include almost the entirety of their house staff<\/a>. Less publicly, I have heard about additional instances across the country where trainees as a whole have been or felt excluded from receiving a dose from the first shipment of vaccines. A common trope among the stories in which the slight was accidental has been that, somewhere along the line, nonmedical staff misunderstood the role of medical trainees in patient care, did not know where they belonged administratively, or in one case, did not know the difference between residents and fellows and inadvertently left the former off the communication, even though a substantial number actually were due to be vaccinated.<\/p>\n

Hearing about such clerical errors reminds me that the hierarchy of academic medicine is not intuitive to those outside of the field. For the most part, the result of this is fairly benign, and usually results in explaining things to friends and family (such as the difference between residency and fellowship, or that, as an internist, I haven\u2019t delivered a baby since medical school). For patients, not understanding the hierarchy can create confusion and even frustration. They want to know why they need to wait to meet the attending physician in a teaching clinic, or why they can\u2019t get a medication refill after discharge by the resident who took care of them in the hospital.<\/p>\n

\"doctor<\/a>

Doctor at Walter Reed National Military Medical Center receives a COVID-19 vaccination. Dec 14, 2020. (DoD photo by Lisa Ferdinando) CC BY 2.0<\/p><\/div>\n

Residents and fellows can also be negatively affected by others misunderstanding their role. Their confidence can be shaken when a patient demands, \u201cI want to see the doctor,\u201d when they enter the room (not knowing that they had been mislabeled as a student); or they might feel alienated if they don\u2019t have a workspace on a rotation because they are not formally employed by that department. Building up over time, these types of seemingly harmless encounters make many trainees feel like they do not belong or are not appreciated in the place to which they devote so much of their lives. Unfortunately, these perceptions were amplified for those who were not included in the COVID-19 vaccine rollout, no matter how unintentional the slight(s) may have been.<\/p>\n

So, what will help trainees trust that their programs, institutions, and patients value and respect them? After reflecting on my own and my peers\u2019 experiences in their programs, transparency, equity, agency, and recognition appear to be fundamental. Some suggestions of ways to implement these principles include:<\/p>\n