Within the current COVID-19 pandemic, health care workers and educators have quickly needed to make adaptations and sacrifices. In order to make room for the conservation of necessary aspects of care, we need to take a conscientious look at our resources. As such, two missions have been embraced nationally by health care systems and university hospitals: conserve personal protective equipment (PPE), and reduce viral exposures to staff and students. Medical education was quickly one of the first targets identified to reduce both PPE and exposures, leading medical students nationwide to be pulled out of clinical environments. Resident education has rapidly followed, as residents are clinically or administratively redeployed. While this seems like a major hit to medical education objectives, adaptation and creativity can ensure that these goals are not ignored, and instead, new opportunities are generated.
Organizational guidance for learners during the pandemic
The American Medical Association (AMA) issued guidance on March 17 and March 30, 2020, recommending a hold on all clinical duties for medical students. Additional guidelines from the Association of American Medical Colleges (AAMC) and the Liaison Committee on Medical Education (LCME) corroborated these recommendations. These organizations encouraged medical schools to remove students from clinical environments when and where appropriate to conserve supplies, reduce stress on clinical educators who are also practicing themselves, and to protect students. Similar guidelines were set forth by the Accreditation Council for Graduate Medical Education (ACGME) for residents and fellows, with the ultimate goals of safety and supervision in mind. Notably, with the cancelation of elective cases, the ACGME loosened clinical case number requirements, and will instead rely on individual programs and directors to determine competency for graduation.
Guidance from these organizations suggests creating new alternatives to replace educational objectives. In some cases, these substitutions are natural, such as in the preclinical years, where educational materials were often already being delivered virtually in some capacity. In other situations, such as for residents and senior medical students, comparable and enriching substitutions for clinical experiences become more challenging.
Creatively maintaining educational goals
The population of medical students and residents is not an idle one. The vast majority of these learners expect to be challenged and thrive when being put to the test. Students are actively looking to be more involved and feel empowered in confronting administrators when educational alternatives are not meeting expectations. In order for all parties to be successful during this time, we must get creative with our solutions and create two-way lines of open communication. Straightforward methods of adapting to strained times within the health care system will not cut it. Fortunately, physicians and those in training are often deeply creative and capable of finding solutions never entertained before.
As an example, pulling most learners away from face-to-face clinical encounters was vital. However, this does completely eliminate clinical interaction. With current technologies, learners are able to join rounds virtually via video conference or join telemedicine clinics remotely. Moreover, learning telemedicine is an opportunity students are not likely to have experienced prior to the current pandemic.
Another consideration has been maintaining surgical education goals for residents as elective cases are on hold. It may make immediate sense to double-scrub residents in emergent cases to increase surgical experience, but this consumes additional PPE. It also opens the door for more residents to concurrently be placed in quarantine if exposure occurs. In these instances, creative solutions may include remote surgical simulation or virtually watching microscopic dissection. Additional skillsets may also be cultivated through communication workshops or interdisciplinary projects around topics of interest, such as end-of-life care or epidemiology. Although the immediate outlook may seem bleak, creative solutions can provide enriching and unique opportunities for learners at all stages.
Value-added roles for learners
Adapting educational experiences relies on the understanding that learners of all levels can be placed in value-added roles. With some creativity and support, these roles can combine learners’ desire to help with the needs of the health care system to bridge service and education.1 By opening the door for innovation, large-scale, safe opportunities can be created by eager learners and administrators within weeks or even days. Some examples of these value-added roles include assisting with PPE production and supply chains, staffing hotlines (sometimes in multiple languages), providing support to community members in need, creating wellness initiatives, and assisting in telehealth where appropriate. All of these activities can satiate learners’ desires to be involved in this historical time, and provide educational value.
Attitude is everything
While this situation is unprecedented, educators and learners alike must remember that everyone is facing similar challenges, and it is our attitude in this time that will ultimately predict the outcome. If learners believe educational adaptations will never suffice, their participation and growth will not be meaningful. Similarly, if educators are wary or hesitant to investigate new educational or technological alternatives, their learners will remain stagnant during a time of great potential opportunity. Instead, we can embrace this era and adopt the attitude that we are all learning new skills and information that might not previously have been explored.
Many of these outlets will strengthen our clinical careers or educational programs in the future in unexpected and beneficial ways. We must all remain hopeful and committed to the task at hand, and allow the COVID-19 pandemic to enhance professional development rather than render learners temporarily obsolete.
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