The evolving COVID-19 outbreak has generated concern for students across a variety of disciplines. While some might believe the healthcare sector is protected in the setting of a pandemic, rising medical graduates are realizing they, too, are not immune from uncertainty. Third- and fourth-year medical students, in particular, are experiencing unprecedented changes to the traditional paradigm of medical education, which will surely impact their career trajectories, not to mention the national makeup of the physician population.
On March 17, 2020, medical students nationwide were suspended from clinical duties, thereby limiting hospitals to essential healthcare personnel only. Restricting the total number of individuals in health facilities also helps to preserve resources in the wake of looming PPE shortages. But, what does this mean for future doctors who are now unable to complete their core clinical rotations prior to medical school graduation? For more than 200 years, these fundamental in-hospital experiences have provided the foundation for medical students to help them fine-tune their clinical judgment and guide them into thinking like seasoned physicians. But now, in the age of COVID, clinical experiences may have to be forgone. Should medical education, therefore, be extended? Should graduation requirements be modified? Are medical students receiving a diluted education?
Although the initiation of a virtual curriculum may open the door for filling these educational voids, the traditional rigor and intensity of hospital rotations cannot be replaced. And how about those unforgettable, life-changing patient care moments that later end up shaping the course of a young student doctor’s career trajectory? Now, graduating medical students perhaps will never hear the high-pitched whine of a newborn baby or feel the delicate contour of their fontanelles – an experience that could have otherwise inspired one to pursue a career in Obstetrics/Gynecology. And what about the fourth-year student still deciding between Emergency Medicine and General Surgery, eager to complete an elective rotation prior to finalizing her post-graduation training plan? Getting these decisions right the first time has significant economic and life-planning implications for rising medical graduates. Imagine choosing the wrong specialty and then realizing after your second year of Neurology residency that you would have actually been happier as a Radiologist.
In the pre-COVID era, fourth-year students would often travel around the country to complete “away rotations,” helping to solidify not only their career choice but also their future training hospital. Orthopedic Surgery and Neurosurgery residency programs, for instance, have historically been very reliant on applicants who have completed these visiting rotations. Lack of access to electives also limits students’ ability to acquire necessary letters of recommendation, an essential ingredient for a complete residency application. Unfortunately, many hospitals have yet to reach a consensus regarding their willingness to accept outside medical students for such rotations. Perhaps virtual courses will help address this limitation, but will they be substantive enough?
Questions also linger about how and when young physicians will receive their state medical licenses, which hinge on a series of exams that demonstrate mastery of clinical and scientific knowledge. Because highly regulated testing conditions are required, student access to examination centers is being impacted due to travel and social distancing guidelines. As it stands, the licensing exam schedule is unclear, and it is unknown if these tests will take place or will even be required by residency programs prior to entry. So, how and when will these newly-minted physicians be licensed? Procedures for rescheduling exams have been vaguely communicated while the National Board of Medical Examiners (NBME) and Prometric testing sites collectively decide how to proceed. It has taken months for decisions to be published.
On May 8, 2020, the NBME identified alternative testing methods for the United States Medical Licensing Exam (USMLE) Step Exam. One proposal was to conduct the Clinical Knowledge exams at individual medical schools rather than official Prometric testing sites, and a phased approach was published on June 4, 2020. Polls have been sent out to gather public opinions, but no concrete plans have been communicated. As of May 26, 2020, the NBME published its decision to suspend the in-person clinical skills examination for at least the next 12-18 months. It should be noted, though, that a virtual testing model is being investigated, which may later establish a new normal for this exam. Medical students waited anxiously for months for these preliminary decisions to be made.
The COVID-19 virus outbreak has created unprecedented challenges for medical trainees. Inability to complete core rotations, decreased access to elective experiences, greater difficulty obtaining letters of recommendation, and unclear guidelines regarding examination requirements has generated anxiety and confusion amongst medical students nationwide. Trainees are frustrated about the lack of communication from the NBME, Prometric testing sites, and state licensing agencies. Until new expectations are clarified, rising medical graduates across the country remain in purgatory, wondering how and when they might receive their medical licenses to officially practice and prescribe for patients in need.
While this pandemic has emphasized the importance of transparency, it has also been a lesson in adaptability for medical students. We are at a unique inflection point in history, and our ability to adjust to these new conditions will undoubtedly make us more resilient physicians who will be ready to take on the new challenges of the post-COVID era.
Asha Dasika is a medical student.
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