When a coalition of medical organizations, led by the American Medical Student Association (AMSA), petitioned in 2001 to cap medical resident work hours, they were turned down by the Occupational Safety and Health Administration (OSHA).
Despite their rejection, students and young doctors were determined. They knew that exhausted residents had poorer health and made more medical errors. Together with the Committee of Interns and Residents, public interest groups, and other allies, AMSA co-authored legislature in 2003 that would lead to change. That year, the national organization that accredits residency programs limited resident labor to 80 hours a week — a major victory for physicians-in-training and their patients.
This is one instance in history showing the collective power of students and doctors’ voices. Recently, my fellow medical students have taken up a new charge. The small wins we’ve claimed are a taste of what uniting our voices can do.
Like thousands of DO, MD, and IMG students, I would have taken my first medical licensing exam — Step 1 — in March. Or April. Or May. The pandemic, however, shuttered Prometric testing centers where all Step exams are held.
For medical trainees, these standardized tests are necessary to advance to the next stage of our education. Since we need board exams to become physicians, our future careers are now in jeopardy.
Like most of the world, my peers and I are navigating financial precarity, anxieties about the future, and even loss of loved ones during the pandemic.
Along with the question mark hanging over licensing exams, these circumstances, I fear, will push more students toward burnout even before we step into our roles as physicians.
Board examinations already have been a major stressor among medical students. For several weeks, we spend hundreds of hours doing little else but prepare for these exams. Across the country, our educators and we have been driven to find a solution that would lift this burden off students and keep proctors, examinees, and their families safe and healthy.
One campaign to change the way we administer Step exams started with two medical students. They penned a widely circulating letter that received more than 2,500 signatures of support from students, physicians, and other allies.
The letter strongly endorsed remote proctoring of exams, as well as an acceleration of the timeline for making Step 1 pass/fail (which likely won’t happen). A similar change.org petition, demanding that medical schools be allowed to proctor board exams, received more than 1,600 signatures. And on Twitter, an anonymous letter that received more than 100 retweets made similar requests of remote proctoring in addition to more efficient, timely communications from the National Board of Medical Examiners (NBME) and Prometric Testing.
As a result of unified communications, the NBME responded in the first week of May. They’ve announced that they are accelerating their timeline to create “alternate delivery” of Step examinations. Taking these tests at our own schools might very well be in our future.
Before these discussions moved into the spotlight, public calls for change started with individual students. They shared their experiences in Reddit posts. They wrote open letters. They tweeted at physicians to join the conversation. Eventually, these conversations moved from ordinary silos to the national stage.
This collective experience of sharing our stories has given us a toolkit to access for when we want to advance progress in the future. We know that we can communicate our experiences, gather support, and collaborate on solutions effectively. And we’re ready to take on more.
My sister (a rising fourth-year medical student) and I disagree about how the pandemic will move the next generation of health care workers. I first thought people would be discouraged. When doctors and nurses spoke out about limited personal protective equipment (PPE), they were given muzzles instead.
In the end, my sister convinced me of her own perspective. She insisted that she’s encouraged. In addition to their heroism on the frontlines, health care workers are risking their livelihoods and reputations by advocating for the well-being of their colleagues. That truly is inspiring.
Right now, nearly 100,000 future physicians are in school. They are studying for medical licensing examinations, attending meetings via Zoom, and starting back on their rotations. They are gathering PPE, making N95 masks, and watching over the children of physicians fighting the pandemic on the frontlines.
Even with everything on our plates, thousands of our voices came together. And we were heard. Think of what else we can do.
Amador Delamerced is a medical student.
Image credit: Shutterstock.com