CHESTCOVID-19: Voices From the CommunityTrainees on the Front Lines

Trainees on the Front Lines

By: Mauricio Danckers, MD, FCCP

Crowded emergency rooms, ICU units at maximum capacity with patients overflowing into non-ICU units, overhead airway team alerts, and long, exhausting clinical hours—one of our trainees approaches and asks, “How can I help, Dr. Danckers?”

Our trainees, who are a fundamental cornerstone of our profession, have been engrained in this adaptability process since the rise of the COVID-19 pandemic. They have been provided with a unique opportunity to learn and manage a novel disease, along with a firsthand look at how our health-care system can adapt to new challenges.

The stand taken by our residents and fellows is tangible, resilient, and inspiring. I have been proud and driven by their commitment. Our chief residents, with assertive restructuring of residents’ rotations, quickly created highly functioning COVID-19 backup teams. Their eagerness and readiness to jump in was riveting and heartfelt. As I grabbed the phone one weekend and called to emergently activate the backup trainee team, I heard back from the other end of the phone, “You tell us, doctor, when, and we will be there; we are ready”…and they were.

Our fellows quickly stepped in with their much-needed clinical expertise and on-point bedside observations. One of our fellows recognized the need for innovation early on and took the lead in providing the ICU team with an aerosol box for high-risk intubations. She wasn’t asked—she just acted on the need she saw.

Another fellow moved forward with coordinating ICU providers for daily manual proning sessions, which was a great team-building experience. Our trainees amazed their colleagues by leading, expanding, and revising COVID-19 respiratory management policies and implementing interventions on intubation and extubation practices to protect our own respiratory staff.

A very fruitful collaboration between our trainees and our hospital’s quality department allowed us to collect clinical data on our COVID-19 patients as we were treating them. It taught us so much about trends and clinical patterns, helping us to optimize the early recognition of clinical deterioration and implement prompt patient safety protocols. It has been the synchronous and devoted efforts among hospital leadership and graduate medical education that have allowed us to continue to stand still and strong day by day.

Another day during the peak of the pandemic resonated with me for different reasons. I remember walking into the ICU residents’ room on a typically busy afternoon to discuss some follow-up tasks. I had to stop and look around for a second. I saw residents lined up in front of their computers with phones in their hands, updating their patients’ loved ones, coordinating video conferences, and setting time frames for follow-up calls. The level of engagement, compassion, and care was compelling. This is one of the most important tasks of the day to perform, and they were shining at it.

The relationship between mentees and mentors has never been more important than during these unusual learning times. These circumstances have called for all of us to step in with them and step up for them.

Our trainees can relate to the feeling of continuous dichotomy between devoted clinical service and personal well-being that all health-care providers have experienced. “They need us at work; they need us at home as well.” When one of your own residents has sudden chills and fevers at work and seeks your guidance, you cannot keep your mind from racing. We are supposed to provide a protected environment that is conducive to learning. It can be challenging when you know so little about a disease and have so many questions piling up. A sense of fear weighed on all of us with the news, but was quickly followed by overwhelming support. Following proper hospital policies and procedures, our trainee underwent home quarantine, later returning to work perfectly healthy. It was a true joy to witness the genuine camaraderie from colleagues supporting the return of our trainee: one of ours was back and ready to go again. It is when we embraced uncertainty that we were able to thrive together and to seek opportunities for enrichment.

Together, we search for safe and creative ways to bring back our normalcy—but in an enhanced way. We motivate each other to take ownership of things we can control and seek answers for the questions yet to be solved. We continue to serve our communities, learn from our defeats, and share our successes along with our young colleagues on the front lines.

Mauricio Danckers, MD, FCCP

Mauricio Danckers, MD, FCCP, is the Medical Director of the Intensive Care Unit and the Critical Care Specialty Coordinator for the Internal Medicine, Transitional Year, and Emergency Medicine residencies as well as the Pulmonary and Critical Care Fellowship at Aventura Hospital and Medical Center in Aventura, Florida. He is also an Assistant Professor of Clinical Medicine at Nova Southeastern University’s Dr. Kiran C. Patel College of Allopathic Medicine. Dr. Danckers is the Chair of CHEST’s Training and Transitions Committee.