The long term effects of COVID-19 on medical education

Ten years from now, the internist stands in the emergency department. Doctors run past him as he stares at the number of gurneys pushed against the wall with struggling patients who all need assistance. There are not enough gowns for him, and his colleagues, the sheer volume of blood needed surpasses what the hospital provides, and he has never faced a hospital emergency room in a time of such uncertainty and crisis. He thinks, “This is deja vu – just like when COVID-19 took the world’s hospitals by storm. And I’m seeing it again, with no difference in our readiness.”

While COVID-19 has recruited entire populations to aid in flattening the curve, those in the hospital to fight the virus directly include only essential personnel. Anyone excluding physicians, nurses, and support staff, have been sent home as part of infection control. These include our future doctors, the medical students who are supposed to be engaged in learning through direct patient care, and using the time in the hospitals to prepare a physician workforce to meet the needs of our country. Per the Association of American Medical Colleges’ interim guidance, medical students should avoid involving themselves in any direct patient care activities.

The definition of essential personnel during the COVID-19 crisis has excluded medical students, and perhaps rightfully so as patient care should be the utmost priority. But the profound consequences of this crisis on medical education and its future repercussions in the training of physicians must be considered.

We have the unique opportunity to train students on how to be great physicians in resource-challenging times. From makeshift personal protective equipment (PPE) to complex disaster triage, doctors are learning to think and practice in novel ways. Although we are certain there will be more pandemics or disaster scenarios in the future, we are not training our medical students today to be better prepared. Instead, medical students are being told to stay home, thereby creating a missed opportunity in their training.

For pre-clerkship students across the nation, medical schools have transitioned to online platforms. From learning to take a patient’s sexual history online to exploring the complexities of the immune system, distance-learning is challenging medical students to adapt their learning styles. For students training on the hospital wards, education has come to an abrupt, indefinite pause, with clinical rotations now replaced by online cases. This pause translates to less time learning essential clinical skills as well as less exposure to a potential pursuant specialty. A medical student may miss out on the opportunity to deliver a newborn on their obstetrics rotation or participate in a code in the emergency department. In a curriculum as compact and fast-paced as that of medical school, this break in education might result in negative long-term consequences for our society.

Medical education is not designed to be fully online, nor does it permit the time to have large gaps away from clinical rotations. Although many medical students find some aspects of medical education to be feasible in an online environment, other parts of the curriculum like team-based learning applications, patient interviewing skills, and physical exam skills cannot be properly learned through online methods. Here, we see the aspect of learning directly from patients and as part of a health care team with the nuances of seniority and hands-on procedures being stripped away completely.

Another ramification of this pause in medical education is the impact on residency applications. For many pre-clerkship students, the opportunity to engage in extracurriculars and build leadership experience has greatly decreased for the next few months. Internships and fellowships that were to take place in hospitals are considered rightfully socially irresponsible. For clerkship students, the ability to do sub-internship rotations at potential residency institutions proves to be an insurmountable hurdle when many states have ordered shelters-in-place. These seemingly small inconveniences are currently compounding for medical students. Although shelter-in-place orders are the type of interventions that we need now, we must consider the missed hours of work for medical students and how those experiences might be made up. These formative months of clinical work and leadership experiences prove vital in preparing the best doctors of tomorrow who will be fully equipped to deal with future crises.

Medical students have demonstrated that they are capable of providing alternative assistance during the COVID-19 pandemic through patient outreaching efforts, supporting frontline providers through childcare and obtaining groceries, organizing blood drives and PPE donations, and helping identify housing options for the homeless community in a time where social distancing is vital. However, they should do even more to prepare for their roles in the next pandemic. In a decade, they will need to know how to make medical decisions and manage complex patients in a high stake setting.

Medical schools are indeed training the future “essential personnel” and must help prepare our students to address the next pandemic.  In addition to engaging in direct clinical care that is central to the medical student curriculum, this cohort of students can learn from the mistakes that we may make in this current pandemic and how to avoid similar situations down the line. There is some inherent risk associated with a physician’s work, but it is vital for students to learn that early and in a supervised setting.  Students were not pulled during the HIV epidemic, and students and doctors alike still provide care to patients with tuberculosis – a highly infectious disease. It is imperative that we protect ourselves, but also fulfill the obligation to serve our patients. Preventing medical students from practicing and learning medicine during this crisis will be detrimental during the next global health crisis.

Samya Faiq is a medical student and can be reached on Twitter @samyafaiq. Harveen Kaur Sekhon is a medical student and can be reached on Twitter @harveenkaur_. Sharad Jain is an internal medicine physician.

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