Spring 2024 (Volume 34, Number 1)

Finding Rheum to Grow During the Pandemic

By Gemma Cramarossa, BHSc, MD, FRCPC

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The COVID-19 pandemic shaped many aspects of my rheumatology training experience. From reduced in-person clinical exposure to virtual academic half-days to the added stress of redeployment, there were many challenges along the way. Despite these obstacles, the faculty in the rheumatology division and my fellow trainees enriched my learning experience and helped me confidently enter rheumatology practice after graduation.

The earlier days of the pandemic were the most chaotic. Every academic hospital in Toronto had different guidelines about virtual versus in-person care. As such, at any given time, trainees based at different hospitals had vastly differing clinic experiences. Many of us worried about having adequate practice with joint injections and the musculoskeletal physical exam, a crucial part of our specialty. In comparison to residents in many other internal medicine subspecialties, this was a unique concern for rheumatology trainees.

When we matched to rheumatology, most of us thought our internal medicine days were behind us, but we were mistaken. With the pandemic came delayed Royal College exams and redeployment to work on the wards caring for admitted COVID-19 patients. We had studied for so long with uncertainty about when and how our Royal College Exams would be administered, and it was a relief to finally write the exam and focus on our rheumatology training. However, the real possibility of redeployment loomed over us as well. Working on the COVID ward itself was a good experience, but with redeployment came lost exposure to rheumatology. What if my only opportunity to aspirate an elbow happened while I was redeployed? What if I missed a rare opportunity to see a new presentation of Adult-Onset Still’s Disease? Still, we stepped up to do our part and put our rheumatology skills to use as the team’s tocilizumab experts and managers of all steroid tapers.

At the core of the Canadian rheumatology community is a sense of camaraderie. Since our specialty is smaller, cohorts get to know each other well through not only training, but also by attending local, national and international conferences. While many of these opportunities were still offered virtually, the level of engagement was much lower. Socializing within programs and departments was discouraged to prevent the spread of illness. The possibility of becoming ill carried with it potential negative consequences to not only our own health, but that of our colleagues, families, and our vulnerable immunocompromised patients. As trainees, we looked forward to the warmer months when we could organize socially distanced activities like picnics in the park after academic half-days. The first in-person rheumatology department event with-out masks was our annual Research Day in June 2022, my last month of training. It was comical when staff rheumatologists didn’t recognize us without our masks on!

Overall, training during the pandemic taught me how to be more flexible, innovative and resilient. I feel so grateful to have trained with the amazing cohort of rheumatologists who experienced the highs and lows with me.

Gemma Cramarossa, BHSc, MD, FRCPC
Rheumatologist,
Vaughan Rheumatology Centre/Mackenzie Health
Vaughan, Ontario