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Working in a pandemic: Physician-scientist trainees describe challenges and important lessons learned

Wednesday, July 29, 2020
By Lindsay Key
Anna Williams; Muath Bishawi; Jordan Pomeroy; Aaron Vose

When the COVID-19 pandemic hit the United States in late January, and then began to impact North Carolinians in March, students, staff and faculty across the Duke University School of Medicine and Duke University Health System found their lives and daily activities upturned. 

Physician-scientist trainees—residents and fellows in the School of Medicine who work as medical doctors and also research scientists—had to pivot, too, during what is often a very critical time in their careers.

“This is a unique population of biomedical trainees that are balancing clinical and research training and are on a short timeline for getting their independent careers started,” said Sallie Permar, MD, PhD, associate dean for physician-scientist development in the Duke University School of Medicine. “It is a career path with many challenges even without the hurdles that arose in this pandemic, including carving out protected time to develop their research niche and obtaining funding at critical junctures in their career. Moreover, after addressing the clinical impact of the pandemic on their patient population, this group is extremely well-poised to rapidly advance the research that will be required to end the pandemic and all its health complications. Thus, this group of trainees will require special considerations for support so we do not lose a generation of physician-scientists to this pandemic.”

Below, four physician-scientist trainees describe their lives and careers and how they have made the most of opportunites presented by COVID-19:

Anna Williams, MD

Resident, Department of Pediatrics

Who am I?
I am a pediatric resident preparing to start my fourth year during which I will primarily be working on my longitudinal research project as part of the R38 Research Pathway. Prior to COVID-19, I was completing my core rotations which included a mix of inpatient, acute care, and outpatient experiences. In the inpatient setting, daily activities included serving as the team leader for junior residents and interns in both the general pediatrics wards and intensive care nursery (ICN).  While I did not serve as these patients’ primary doctor (or first call), I was always physically involved in patient care.  In the acute and outpatient settings, I spent more one-on-one time with patients and their families listening to why they presented to care, helping perform diagnostic tests, and spending time talking with families about their children’s diagnoses and the plan of care.  

The reality of the pandemic
My daily activities have changed drastically since the start of the COVID-19 pandemic.  Some of the changes are not directly the result of the pandemic, as I started to transition into my dedicated research time in late March. This means that I now have limited clinical responsibilities and devote approximately eighty percent of my time to my research. Fortunately, my research is largely qualitative and does not require me to work in the lab or even on campus, so it has not been greatly impacted by the pandemic. I am able to continue my project remotely and have only had to make a few changes to my protocol as a result of COVID-19.  When I am scheduled for my clinical time, I have noted that the day to day aspects in both the inpatient and outpatient settings are, indeed, very different since March Rounds haven taken on new formats to limit team sizes and the number of providers that participate in bedside, family-centered rounds.  In the outpatient setting, we have quickly implemented telehealth for some acute visits and call into exam rooms to take the history before entering to briefly perform the physical exam and wrap up the visit. I am pleased by how everyone throughout the hospital system has adapted to the changes.  I love my colleagues, I love my job, and I love working at Duke!

Muath Bishawi, MD, MPH

Resident, Cardiac Surgery, Department of Surgery

Who am I?
I am a cardiac surgery resident at Duke who is an aspiring surgeon scientist.  For the past four years I took some research time during my residency to work toward obtaining a PhD in engineering. I had anticipated giving my postdoctoral defense in June, after which I would return to clinical rotations. My doctorate work focuses on studying the effect of radiation on cardiovascular function using human cells, tissue-engineered micro physiological systems (MPS), and small animal models. Part of the work is with NASA to examine the effect of unique space radiation scenarios on long-term cardiovascular function.  

The reality of the pandemic
When COVID-19 hit, I was in a critical part of my PhD studies, completing experiments and wrapping things up to get ready for my defense. This complicated my transition back to clinicals, and the completion of my PhD. Thankfully, I successfully defended my PhD and I am back on clinical rotations now. During that time, I also was able to apply some of my engineering training to work with other collaborators to devise a ventilator splitter system, which makes sharing ventilators between patients safe and more efficient. One of the early needs to emerge during the pandemic was the need to ventilate patients, and the volume of ventilators needed has stressed many health care providers around the world. Our team’s new innovative system uses biocompatible 3D printed parts to control the amount of air being pushed to each patient, and the design has been submitted to the FDA for emergency approval.

Jordan Pomeroy, MD, PhD

Fellow, Cardiology, Department of Medicine

Who am I?
I am a fifth-year cardiology fellow starting my seventh year as a member of the Duke house staff. Under normal circumstances, my daily work activities are primarily clinical with a monthly shift in specific duties to complete cardiology training requirements. I work as our Cardiac ICU team leader, perform diagnostic catheterizations, round on consults for electrophysiology and transplant along with significant imaging time performing and interpreting echocardiograms, nuclear stress and cardiac MRI studies. Additionally, I have one half day of community cardiology clinic built into my clinical rotations where I focus my attention as an outpatient provider. Each of the roles has deep nuance to the daily routine, but the main goal is a balance of service and education such that I learn how to provide excellent subspecialty care to my patients. The hours are long, especially on call in the ICU, and the pace is extraordinarily fast. I function as a learner, a teacher (to nurses, PAs, medical students, residents), and a provider throughout my time on service.  
 
For many of us in fellowship, we also spend a great deal of time building an academic cardiology career whether the focus is clinical research, basic science research or education. My particular focus over the past 15 years of medical training has been to build a basic science research career in a true physician-scientist model. Currently, as a member of the Bursac Lab (Duke Biomedical Engineering), I am developing functional engineered cardiac tissue models of cardiac disease. I must stay abreast of the most recent research through literature reviews while also building new data into abstracts, manuscripts and grants. My goal is to start an independent lab in the next several years although post-COVID funding is likely to be a challenge.

The reality of the pandemic
Much has changed in the COVID-19 era! From end-March through mid-May. I was asked to work from home, a radical change given that the majority of my training requires direct patient care interactions. While this was a relief from the perspective of dramatically reduced exposure to SARS-CoV-2, especially for my family, I watched as my colleagues on "essential" inpatient rotations marched into battle every day. I have a deep sense of purpose when I am providing direct patient care. I learn best with practical training experience or in-person didactics. I am most rewarded by training the next generation of providers/researchers. All of this professional support mechanism disintegrated with the hospital and lab shutdowns. It was mentally challenging to say the least. I have since returned to inpatient duties, and I am now in the thick of it working in our Cardiac ICU. I feel capable and I have seen my teams' confidence grow in their capabilities.

The last few months were also slated to be the pinnacle of my scholarly activity while in fellowship. I planned to submit a feature manuscript along with my first career grant (NIH K08 mechanism) in June 2020.  This did not happen.  I spent a lot of time thinking. Will there even be science jobs available come 2021? What will be the impact on scientific grant funding in the next 5-10 years? Will there be intermittent lab shutdowns that repetitively stymie progress? Starting a lab is like starting a small business. You are an entrepreneur and you are at the whim of your business environment. 

Aaron Vose, MD

Fellow, Pulmonary and Critical Care, Department of Medicine

Who am I?
I am a second-year pulmonary and critical care medicine fellow at Duke. During the second and third years I split my time between clinical practice and research endeavors. Prior to COVID-19, I had clinical responsibilities in our inpatient and ICU services as well as our weekly outpatient clinics. Research and academic interests among fellows in our division are comprised of basic science/lab research, clinical research, biomedical engineering, and master’s degree programs through Duke. Additionally, I have regularly scheduled multidisciplinary and pulmonary specific educational conferences.  My personal daily work activities were a mixture of clinical care at Duke and the Durham VAMC in the ICU and inpatient pulmonary units. During my non-clinical time I work in a research lab studying the impact of glucose intolerance on the pulmonary response to lung injury. 

The reality of the pandemic
A lot has changed in our division during the COVID-19 pandemic which has really demonstrated our division's ability to be flexible and continue to provide excellent care and fellowship experience under strenuous circumstances. Clinically, we take care of a large number of COVID-19 patients in our intensive care units. We have learned a lot about how to take care of patients and how to protect ourselves and our nurses. We have added multiple COVID-19 specific conferences- journal club and intradepartmental meetings - to ensure that our care is cutting edge. We have worked hard as a division to transition to telehealth/televideo visits to make sure that our patients who are high risk for COVID-19 complications are able to avoid coming into the clinics. From the research side, this has been more difficult. With labs closed and clinical arena closed to many research projects, many of us are working through data and planning for the future. Degree programs have moved online.