Medical students ‘feel very behind’
Pandemic disrupts their in-person training with patients
COVID-19 is disrupting just about every student’s 2020 education, but medical students have it particularly hard right now.
“It’s a nightmare scenario for the class of 2021,” said Jake Berg, a fourth-year student at theKentucky College of Osteopathic Medicine in Pikeville. In March, studentswere abruptly pulled out of hospitals and medical offices, where they normallywork with professionals to learn about treating patients. Over the space of less than twoweeks, he said, medical students in “pretty much the entire country” transitioned fromseeing patients in person to learning online.
“Everyone goes along with the idea thatwe’re all in the same boat together,” he said. “But, really, it’s like we’re all on the Titanic, and it’s sinking.”
MeganMessinger, in her fourth year at theWestern University ofHealth Sciences in Pomona, California, calculates she has lost about 400 hours of patient time. Sheworries “the class of 2021 is going to be the dumb class of interns,” said Messinger, who hopes to do a combined residency in pediatrics and psychiatry. “I feel very behind.”
The problem is most acute for medical students in their third and fourth years of study. Year three is when most medical students do their “core clinical clerkships.” These are oneor two-month stints in hospitals and clinics, through which they get the flavor of specialties such as internal medicine, pediatrics, surgery and obstetrics/ gynecology.
Fourth-year students tend to spend time in more specialized options, often traveling to get experience in specialties in short supply at their own medical school’s affiliated hospitals, and also to informally “audition” at places they might like to apply to for residency. Because of the coronavirus pandemic, however, “away rotations” have been suspended, and residency interviews for next year’s graduating class will be done virtually.
Schools and hospitals are trying to restore the core clerkships but, in many areas, this is awork in progress.
“I have no idea howI will learn about the culture of the hospitals I’m applying to,” said Garrett Johnson, a fourth-year student atHarvardMedical School. On one hand, this year’s class of doctors-to-be will save a lot of money— typically, travel and housing costs for away rotations and in-person residency interviews are paid by the students. On the other hand, he said, “you don’t get to meet any of the people or get a feel for the place.”
Karissa LeClair, a fourthyear student at the Geisel School ofMedicine atDartmouth, agreed. “Iwas looking forward to getting to knowplaces I had not been to previously,” she said.
LeClair, whowants to become an ear, nose and throat specialist, said clerkships she applied to inNew York City; Ann Arbor, Michigan; and Bostonwere all canceled.
Since shewas not planning to be inNewHampshire for most of this year, LeClair nowhas no place to live nearDartmouth. “I’m piecing together sublets and staying with friends,” she said. Unless something changes, she will spend her final year of medical school only in facilities formally affiliated withDartmouth.
Messinger is facing similar problems in Southern California. “I’m at Cedars right nowand loving it,” she said, referring to Los Angeles’s Cedars Sinai medical center. “But you can only do one rotation there. I don’t have anything scheduled after this. My only audition rotation, at Tulane, was canceled.”
Administrators are sympathetic. “They have had (a) major disruption,” said Dr. Alison Whelan, chief medical education officer for the Association of AmericanMedical Colleges, which oversees M.D.degree programs. “Medical school is stressful, and with COVID, it’s even more stressful.”
“I feel for the students, they’re really in a tough position,” said Dr. Robert Cain, president and CEO of the American Association of Colleges ofOsteopathic Medicine, which oversees osteopathy programs. About 1 in 4U.S. medical students pursue a doctorate in osteopathy, which is similar to an M.D. degree but includes training in hands-on manipulative techniques and more emphasis on whole-body health.
One hurdle is that all these students, in order to becomewell-rounded doctors, need to see a broad mix of patients with a diverse group of medical issues. But even at hospitals and clinics that have resumed general care, patients with ailments other than those associated with COVID-19 are not showing up, because they are afraid of catching the coronavirus. Elsewhere elective procedures have been canceled or postponed.
“That has become a challenge,” Whelan said. In areas with highCOVID-19 rates, hospitals and other facilities often do not have enough personal protective equipment for even essential health personnel, so students are kept out.
TheAAMCin August updated its guidance on student participation in clinical rotations. It continued to leave decisions about allowing students into patient care areas up to individual teaching hospitals and medical schools. But it also noted that while students are not technically essential in day-to-day care activities, “medical students are the essential, emerging physicianworkforce” whose learning is necessary to prevent future medical shortages.
“The progression of students over time for relatively on-time graduation is essential to the physicianworkforce,” Whelan said. Enabling students to finish their education in the COVID-19 era “is an ongoing, complex, jigsaw puzzle.”
In addition to losing in-person patient contact, medical students face obstacles in taking required national board examinations— there are several types and are not always conveniently offered near their training sites.
While the travel may be a burden, the exams are needed “to protect the public” fromdoctors who have not demonstrated competence, said Cain.
Whelan and Cain said details are beingworked out and changes are possible as theCOVID-19 situation evolves.
In the end, Cain said, this crop of students may emerge as better doctors than those who didn’t face such challenges.
“Hopefully, we’ll look back and see them as the class of resilience,” he said. “That theywere able to work through some very hard times.”