From online education to frontline medicine

When the COVID-19 pandemic came to the United States, it required drastic changes in medical education curricula across the nation, with the majority of learning opportunities transitioning to the virtual setting. As our nation enters the ninth month of this public health crisis, it is necessary to reevaluate the current system and curate the innovative strategies that have been implemented. It is essential that the next generation of physician-scientists complete training that prepares them for eventual clinical practice. If medical education is not optimized, an abrupt transition from online classes to the frontlines of health care may result in a generation of physicians who are unprepared to transition into clinical roles. However, with the information available to us now, and by critically assessing the new educational strategies implemented, it is possible to create infrastructures and improve medical education optimized for practicing health care in this new COVID-19 world.

Maintaining evaluations of skills virtually

An integral component of medical education is feedback on patient interactions and physical examinations. However, many medical students currently cannot practice or receive feedback from standardized or real patients on physical exam maneuvers. Schools have, and must continue to, increase communication and transparency to reassure students they will make up this important part of their education. As preclinical students are now restricted from receiving in-person feedback from patients, they may instead benefit from more frequent evaluations on virtual patient interaction workshops and guidance on practicing key physical exam maneuvers with family and roommates. These important clinical education components will likely also need to be incorporated into curricula later in training when the pandemic is under control, and more consistent in-person physical exams and evaluations are possible.

The pandemic has also highlighted the growing importance of telemedicine, a practice now more formally included in medical curricula, and many schools have shifted standardized patient interactions to zoom calls. This has created a unique opportunity for medical students to be trained in telehealth protocols and nuances, which will likely remain a large component of future health care practice.

Another invaluable experience that has been affected is the anatomy lab, with some schools implementing virtual reality and 3D programs to enhance student learning. Overall, there is a need to assess the many changes that have been made in response to the pandemic and more widespread use of strategies that have improved medical education.

Building professional identity in clinical experiences

Clinical experiences with faculty and many research projects that help build professional identity and readiness for rotations have also been halted in many cases for safety concerns. This has resulted in many students feeling disconnected from the medical field, finding it increasingly difficult to explore career-related interests. Co-curricular tracks aimed at engaging students in global medicine, urban medicine, innovations in medicine, and patient-centered medicine, among many others, have also suspended most activities and restructured some to the virtual space. Some medical schools have started providing virtual networking opportunities, including rotations, shadowing, mentoring, and research. While building a professional identity is typically an extracurricular endeavor, medical schools now have a larger responsibility in supporting students as they also grapple with their roles in providing care, health disparities, and the limitations of medical interventions. Robust professional identity is an essential component of medical education linked to reducing burnout; thus we urge more widespread use of these strategies now and beyond the pandemic.

Addressing medical student mental health  

This pandemic has affected medical students’ mental health two-fold: as individuals living through an unprecedented time and, as future physicians navigating a drastically impacted health care environment, from an education and clinical standpoint.  Several studies have shown the COVID-19 pandemic has increased psychological distress among medical students, especially women. Those experiencing financial difficulties have experienced an increase in moderate-severe anxiety and depression symptoms. Medical schools have increased access to counseling services, implemented regular check-ins on students, and more interactive feedback on scheduling and workload to address this issue. Medical student wellness was often a topic of discussion before the pandemic, and the past months have highlighted the stressors already existing in medical school and emphasized the importance of medical student wellness. We urge medical schools to continue their efforts to better student mental health beyond the current times.

Future directions

Medical education across the nation changed abruptly and drastically in the Spring of 2020 with the transition from in-person lectures, clinical skills workshops, standardized patient interactions, hospital visits, student organization events, and various other hands-on opportunities to the virtual space. To be sure, some may say that the pandemic is temporary and we should prepare for a return to normalcy. Yet, it is clear that the pandemic will have lasting effects on health care, some of which we already see as the framework of medical education is changing. The transition to online education has been a collective learning experience and adjustment period for administrators, professors, and students alike.

Medical schools have had to adapt to the uncertainty and limitations of the pandemic. It is now time to consider more long term adjustments to curricula. To adequately train and meet current and future medical students’ needs, it is necessary to define an implementation strategy by identifying the best practices learned this year.  The pandemic has highlighted the need for flexibility and infrastructure to address the current situation and any other unexpected events that may occur in the future. The quickly reactive but highly implicative changes medical schools have been forced to make in the last nine months must now be evaluated for adequacy and sustainability for the indefinite future to optimize medical training for physicians’ next generation.

Diana Ioana Rapolti, Deepika Khanna, and Vivian Jin are medical students. Shikha Jain is a hematology-oncology physician who blogs at her self-titled site, Dr. Shikha Jain.  She can be reached on Twitter @ShikhaJainMD.

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