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The Trainee Experience: The Boarding Boiling Point and Emergency Room Care

July 11, 2023

In a recently released issue of Pediatrics, Drs. Jasmyne Jackson and Robyn Wing share a trainee perspective on experiences in first year Pediatric Emergency Medicine (PEM) Fellowship during the “tripledemic,” the aptly named confluence of respiratory syncytial virus (RSV), COVID-19, and influenza (flu) (10.1542/peds.2022-060783). During the COVID-19 pandemic, measures to prevent COVID-19 transmission, including hand washing, masking, and distancing, were serendipitously effective at also decreasing transmission and outbreaks of RSV and flu.1 While societal benefits accrued, pediatric residents who trained during the pandemic are reporting (in several essays submitted to the Section on Pediatric Trainees [SOPT] Feature section) that they now are acutely aware of missed and valuable clinical experiences usually acquired during busy bronchiolitis and flu seasons. Stepping into the tripledemic as unseasoned senior residents and new fellows has been fraught and difficult from every point of view for many.

While this Feature focuses on both the challenges of safely managing care in an overcrowded pediatric emergency department (ED), the authors recognize there is no one simple fix or solution. Dr. Jackson shares her first intubation experience in fellowship of a 17-month-old ED “boarder” who developed respiratory failure in the ED while waiting for a hospital bed. She was successful in the procedure, likely due to the diligence with which she pursued every avenue, such as simulations, to become skilled in the absence of clinical experiences during residency.  Yet despite appropriate feelings of pride and relief, she felt frustrated with the clinical scenario and the overfilled ED that led to the situation.

What I found most meaningful about this Feature is the resilience she developed. She leaned into her personal relationships and found comfort and strength in her wife’s explanation of “duality,” best explained as, “it can be both [joy and heartbreak, frustration and fulfillment] at the same time and that is OK.” This guiding mantra has applicability to training and to life – who hasn’t had to reconcile hardship and happiness, either in the workplace or at home? I think readers can feel both reassured and energized that colleagues in training like Dr. Jackson are finding a path forward through and around the COVID-19 pandemic and are becoming the excellent physicians that children and families need now and in the future.


  1. Olsen SJ, Winn AK, Budd AP, Prill MM, Steel J, Midgley CM et al. Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic - United States, 2020-2021. MMWR Morb Mortal Wkly Rep. 2021 Jul 23;70(29):1013-1019. doi: 10.15585/mmwr.mm7029a1. PMID: 34292924; PMCID: PMC8297694.
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