Ethical Issues in Residency Education Related to the COVID-19 Pandemic: A Narrative Inquiry Study

Abstract

BackgroundAmidst the pandemic, residency programs were faced with new challenges to provide care and educate junior doctors (resident physicians). We sought to understand both the positive and negative experiences of first-year residents during COVID-19, as well as to describe potential ethical issues from their stories.MethodWe used narrative inquiry (NI) methodology and applied a semi-structured interview guide that included questions pertaining to ethical principles as well as both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio-recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. A composite story with threads was constructed. Discrepancies were resolved through discussion to attain consensus.ResultsEleven residents participated from Internal Medicine (n=2), Family Medicine (n=2), Ophthalmology (n=1), General Surgery (n=1), Pediatrics (n=1), Diagnostic Radiology (n=1), Public Health (n=1), Psychiatry (n=1), Emergency Medicine (n=1). Resident stories had three common themes in which ethical issues were described: 1)Intersecting healthcare and medical education systems, 2)Public health and the public good, 3)Health systems planning/healthcare delivery.DiscussionThe pandemic exacerbated the lack of autonomy experienced by resident physicians. The notion of public health and the public good at times eclipsed individual wellbeing for residents and patients alike.ConclusionEfforts to understand how resident physicians can be engaged in their own education as well as how they can navigate public health crises with respect to ethical principles could benefit both residency education and healthcare delivery.