Academic Medicine Open Forum

I wonder if you could shed any insight on what the residency programs should do when approached by residents stating that they are 'uncomfortable' with their assignments?  As I am sure you are aware at other institutions residents are being asked to deliver care that may be outside their specialty and I can also foresee instances where residents may not want to work at the hospital given we will be caring for COVID-19 patients here.

I really think this is 2 separate questions- can a resident refuse to care for patients when he feels uncomfortable/ out of scope-  even in a crisis. My initial reaction is yes, he can but I'd like thoughts. The second question is whether a resident can refuse to take care of COVID-19 patients and I guess my answer to that is no- but maybe I'm wrong Insights from anyone who has been through this are much welcome.

Thanks for the question Eva.

Residents like all health care professionals should speak up when they are not comfortable with their assignment.  This should give us a chance to understand why, have we provided them with enough education, experience, and resources to comfortably complete their role.  We also need to understand if they need more support during the initiation of a new role. Or if there discomfort is emotional and they may not be ready to play that role.  If you have addressed all of the education, experience, supervision, resources and support issues and the resident is still not comfortable then you should consider reassigning them.

Can a resident refuse to take care of a COVID-19 patient?  At the current time residents in many of our institutions have been restricted from caring for COVID-19 until/when the situation requires a greater workforce and the residents have received adequate training.  But in the end any healthcare worker can refuse to care for a patient.  We saw this during the initial part of the AIDS epidemic.  I think that many question these actions but in the end the answer is yes.

Janis Orlowski, MD

Chief Health Care officer, AAMC

I wonder if you could shed any insight on what the residency programs should do when approached by residents stating that they are 'uncomfortable' with their assignments?  As I am sure you are aware at other institutions residents are being asked to deliver care that may be outside their specialty and I can also foresee instances where residents may not want to work at the hospital given we will be caring for COVID-19 patients here.

I really think this is 2 separate questions- can a resident refuse to care for patients when he feels uncomfortable/ out of scope-  even in a crisis. My initial reaction is yes, he can but I'd like thoughts. The second question is whether a resident can refuse to take care of COVID-19 patients and I guess my answer to that is no- but maybe I'm wrong Insights from anyone who has been through this are much welcome.

Thanks for the question Eva.

Residents like all health care professionals should speak up when they are not comfortable with their assignment.  This should give us a chance to understand why, have we provided them with enough education, experience, and resources to comfortably complete their role.  We also need to understand if they need more support during the initiation of a new role. Or if there discomfort is emotional and they may not be ready to play that role.  If you have addressed all of the education, experience, supervision, resources and support issues and the resident is still not comfortable then you should consider reassigning them.

Can a resident refuse to take care of a COVID-19 patient?  At the current time residents in many of our institutions have been restricted from caring for COVID-19 until/when the situation requires a greater workforce and the residents have received adequate training.  But in the end any healthcare worker can refuse to care for a patient.  We saw this during the initial part of the AIDS epidemic.  I think that many question these actions but in the end the answer is yes.

Janis Orlowski, MD

Chief Health Care officer, AAMC

I wonder if you could shed any insight on what the residency programs should do when approached by residents stating that they are 'uncomfortable' with their assignments?  As I am sure you are aware at other institutions residents are being asked to deliver care that may be outside their specialty and I can also foresee instances where residents may not want to work at the hospital given we will be caring for COVID-19 patients here.

I really think this is 2 separate questions- can a resident refuse to care for patients when he feels uncomfortable/ out of scope-  even in a crisis. My initial reaction is yes, he can but I'd like thoughts. The second question is whether a resident can refuse to take care of COVID-19 patients and I guess my answer to that is no- but maybe I'm wrong Insights from anyone who has been through this are much welcome.

I wonder if you could shed any insight on what the residency programs should do when approached by residents stating that they are 'uncomfortable' with their assignments?  As I am sure you are aware at other institutions residents are being asked to deliver care that may be outside their specialty and I can also foresee instances where residents may not want to work at the hospital given we will be caring for COVID-19 patients here.

I really think this is 2 separate questions- can a resident refuse to care for patients when he feels uncomfortable/ out of scope-  even in a crisis. My initial reaction is yes, he can but I'd like thoughts. The second question is whether a resident can refuse to take care of COVID-19 patients and I guess my answer to that is no- but maybe I'm wrong Insights from anyone who has been through this are much welcome.