From 5 Questions to 5 Reflections: A Residency Leadership “Sign-Out” During COVID-19—Part 2

Editor’s note: This is the second of a 2-part blog post. Read the first part of this blog post, with an introduction and the first 3 reflections, here.

4. A crisis reveals the flaws of how we assign value.

Scholarly output is an important part of what we do in academic medicine. We balance the tasks of running our program, caring for patients, and teaching with individual pursuits: research, curriculum development, implementation science, or quality improvement. During the pandemic, many of these academic efforts were necessarily placed on hold. This impacted some more than others, along the predictable lines of gender, promotion status, and time and resources outside of work.

As residency leaders, the COVID-19 pandemic challenged us in every aspect of our jobs. We worked tirelessly in an environment demanding agility, resilience, and reimagination. We spent hours in planning meetings, modeling outcomes in various scenarios, communicating with a traumatized workforce, fielding questions from terrified patients and caregivers, and confronting new clinical demands. Our focus shifted from publications to hospital policies. Although many of us fell short on traditional academic pursuits, there was no shortage of scholarly output. It was just occurring outside of the normal process. These career-defining experiences were powerful and meaningful but are difficult to represent on a CV. The academic medical system has long valued a specific set of experiences and output over others, but the needs of the hospital during the pandemic veered away from these. Perhaps there is a lesson here for the way we assign value to our work.

5. In times of uncertainty, you must rely on moral leadership.

In our Academic Medicine article, we focused on how to achieve a sense of normalcy. At that time, normalcy felt like an attainable end-goal to work toward as the pandemic raged around us. As the months have passed, we recognize that normalcy, defined as the way things were before the pandemic, is no longer achievable or even desirable. Too much has changed for our hospital, program, and residents. We are now leaning into the abnormal as our new standard, embracing that we have unique opportunities in these unprecedented times to drive important change. Yet, leading in an environment of uncertainty poses challenges and risks. Those we lead are facing seemingly insurmountable uncertainty in their personal and professional lives. They are experiencing unprecedented demands at home, threats to job security, and personal safety risks. There is no chief medical resident sign-out or leadership manual to prepare for this. In times of uncertainty and moral distress, there is no leadership roadmap.

These times require a different form of leadership: moral leadership. Moral leaders understand that during times of crisis and uncertainty, you cannot predict the future, no matter how much data you have at your fingertips. But you can continue to inch along by making the next right decision: that which focuses on taking care of each other. And at the end, when the fog lifts, you will have sculpted a new normalcy, where the means justify the ends and where the ends are more beautiful than the beginnings. Finding ways to redefine boundaries and put humans first will ensure our leadership will be able to continue to adapt and evolve to whatever future challenges we may face.

By: Shana Rakowsky, MD, and Kelly L. Graham, MD, MPH

S. Rakowsky is a former chief medical resident and current gastroenterology fellow, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

K. L. Graham is director, Ambulatory Residency Training, and director, Primary Care Track, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Further Reading

Rakowsky S, Flashner BM, Doolin J, et al. Five questions for residency leadership in the time of COVID-19: Reflections of chief medical residents from an internal medicine program. Acad Med. 2020;95:1152–1154.