Over the past 3 months, nearly 30,000 medical students across the United States have been displaced from their traditional health care roles. With relatively little warning or time for preparation, students, faculty, and administrators scrambled to create platforms, structures, and processes to support learning and find ways to keep students engaged in patient care. Here is a look inside the impact of COVID-19 on medical education through the eyes of four class leaders at the Penn State College of Medicine, University Park.
Tom’s perspective: new ways of teaching, learning and contributing
Medicine is a team sport. Medical school, however, can feel quite the opposite. Across the nation, learners who enter medical education with energy and compassion are too often diverted from those qualities by cognitive overload, systems not always patient centered or designed for learning, and the reality of competitive career paths. All of this can contribute to a high prevalence of burnout among medical students. Developing efficient, non-team-based approaches sometimes feels like the only way to survive.
This all changed one Tuesday in mid-March. I had ‘quarantined’ myself for weeks with thousands of practice problems, the board exam I was convinced would define my future was only days away. I had heard about coronavirus and was secretly terrified, but kept such emotions at bay since I had no time for anything but test preparation. An “unknown caller” screen on my phone was accompanied by an unfamiliar voice telling me that the exam was cancelled and all test centers were closed indefinitely. Coronavirus was now a reality.
My first thought was anger. I had trained for years and was now being forced to shelter in place, not allowed near the hospital. I felt useless and alone. After a few days of wallowing I found renewed presence and energy. Partnering with classmates, we recognized that although our in-person talents could not be safely utilized within the clinics, there were other critical roles we could play. We reached out to colleagues in Hershey I had previously only known as names on paper and began to develop a plan. Despite the generalized confusion and uncertainty, this engagement was nourishing and built our sense of community. We quickly identified that many of our classmates were willing and eager to help address the needs of the hospital and its patients. Working with faculty and system administrators, we identified and co-designed a range of needed interventions that took advantage of our training and the diversity of our backgrounds, from engineering to public health to editing. I quickly learned to think not like the ‘lone-wolf’ focused on academic achievements but the ‘team-oriented’ physician I aspire to be.
Over time, my pandemic despondence was replaced by a new sense of purpose. I collaborated with peers and faculty to co-design a new remote educational program of discussions, cases, and problem sets. Since the onset of the pandemic we have been working with our student and faculty colleagues in Hershey, to truly embody the “One College” spirit of the Penn State College of Medicine that had too often previously been more of an idea than a reality. Students have been problem solving alongside our faculty, to navigate the challenges and obstacles on a daily basis, truly embodying the meaning of co-production each day in ways that would make any experiential learning module envious. We are now united, one community of medicine practicing together.
Lindsay’s perspective: value-added roles for students – how can we help?
I woke up early in the morning darkness and reported to the hospital to receive my assigned patients for the day. I performed a history and physical examination with each patient, answering their questions with a mostly-perfunctory “we’ll talk about this with the team when we come back this afternoon.” I presented my findings to my superiors, nodded vigorously and thanked each of them for their feedback. I followed the long line of white coats into room after room and nodded along from the back of the crowd. I spent the afternoon writing patient notes and receiving feedback - more nods, more thank-you’s. I think back over my interactions throughout the day to verify that I was kind and sounded prepared.
While studying with a classmate for our high-stakes board exam (only 5 days away), our laptops rang out: Medical students will be immediately removed from clinical care until April 27. I didn’t know what to think. I worried that I would be taken even further away from my goal of helping patients and I spend the next days scrambling to understand the impact of the pandemic.
I woke up to read the latest literature on COVID-19 symptoms and prevention techniques. I pored over our newly-developed patient contact tracing script with a medical student colleague at the Hershey campus. Together, we determined how to elicit the patient’s perspective, brainstormed potential barriers they may encounter, and discussed how best to gain their trust over the phone which is important to do so as this allowed us to contact their friends and family. We role-played patient calls and worked together over Zoom to establish a workflow. That evening, I made my first contact call. Our diligent scripting and role-playing allowed me to quickly identify what the patient did and did not know about COVID-19 and social distancing and to address any misunderstandings. The days went by quickly, information was coming rapidly. We were all trying to learn as much and fast as we could with the goal of helping the best we could.
I moved on to become a leader within our newly-expanded team. I found myself On the other end of the phone with is a patient who does not speak English. She and her husband had both been diagnosed with COVID-19. The woman was scared that her husband may have to go to the hospital as he was increasingly short of breath. She wondered if the same would happen to her. They had two children under the age of 5 and were running out of diapers and food. They could not go to the grocery store and had a limited social support system. Leveraging relationships with social work and community organizations, I facilitated food delivery to her home, set her up with a patient navigator who speaks her preferred language, and connected her with a community church to provide her with baby food and diapers. I smiled as I e-mailed my team about our small win.
I was interviewed by NPR to share my insights. We spoke about contact tracing and the role that it can play in preventing COVID-19 morbidity and mortality, what the public should know, and how such information might allow us to begin to re-open the country. On one hand, I was taken aback that NPR wanted me to inform the public about medical issues. On the other hand, this is what my experiences at Penn State have trained me to do.
In two short months, I went from a medical student doing her best to help out in a care system that would have been generally fine without her, to an, active role leading a team, improving lives that would have suffered if I had not been there, and sharing my experience on NPR. Quite a ride.
Daniella and Ryan’s perspective: Improv. Alone … Together. We Are … One Team
On March 1st, I was engaged in my typical Sunday routine of grocery shopping. In line for the cashier, I waited impatiently for my turn amidst a group of equally impatient shoppers. I had homework to do and wanted to get a jump on the week ahead. While preparing dinner that evening, I listened to a favorite podcast with rapt attention while guest science journalist Donald McNeil Jr. announced that Americans should urgently prepare for a looming pandemic. He projected a grim picture of people confined to their homes, stockpiling food, medicine, and toilet paper. At the time, the possibility of a pandemic felt other worldly and remote to me. I asked a friend that evening whether she was nervous about coronavirus. “Not really,” she answered. “Me neither,” I replied. Three months later, my answer is dramatically different. I watched nervously as hospitals in my home town of New York City were over-run with patients. An eerie similarity to September 11 crossed my mind. I reflected on how quickly life as we know it can turn on a dime.
Traditionally, medical education is marked by an expected chronology. Clerkships, courses, exams and residency applications have definitive deadlines and timelines. It takes discipline and planning to stay on track. During the pandemic, while we still cling to our goals, definitive planning has become futile. Indeed, our future is one of uncertainty. As students, this is an uncomfortable reality.
COVID-19 has reinforced to us that the very practice of medicine is defined by uncertainty. As future physicians, we cannot always rely on “textbook answers” and we need to accept the frequent discomfort of not knowing. Every part of what we do is complex and open to question, from histories and physicals to diagnostic testing and treatment. There are no scratch-off “answers.” Coronavirus and the pandemic have continued to surprise us and test our tolerance for uncertainty, highlighting how improvisation is central to the practice of medicine and not the esoteric domain of stand-up comedians and actors. Change, particularly disruptive change, demands agility and improvisation to move forward. We believe that the skills of improvisation are an essential skill for learning and for the effective practice of medicine in uncertain todays - and tomorrows.
Over the past few years our campus has embraced the core mantra of improvisational theater: “Yes, and….” The idea behind this phrase is to take whatever information your colleague is giving you and to add something unique to it. “Yes” affirms your partner—their importance and the value of their ideas. “And” allows you to build on this information in a collaborative fashion to extend the process of creativity. In the context of medical education during the COVID-19 pandemic, saying “yes” allows us to see all of the rapid, sudden changes and uncontrollable variables as a gift. “And” allows us to provide suggestions for improvement, taking into account our differing emotional and physical responses to what is occurring. Working with our faculty and administration to embrace this challenge and learn from it, we as students must be able to respond, adapt, and add. “Yes, and” does more than just allow us to quickly adapt to curricular change. It prepares us for ubiquitous uncertainties that are part of clinical care.
To be clear, no one was thrilled that our learning was upended. Recognizing, however, what we could--and could not--control, allowed us to shift our focus to the task at hand and find ways to optimize our time. We stand confident as medical students and soon-to-be doctors that accepting changing circumstances and embracing the unknown will make us better physicians in the long run.
While COVID-19 is nothing anyone wanted or predicted, our students have demonstrated an extraordinary sense of grit and resilience in working hard to support the health and welfare of their communities. They have also worked diligently with their peers and faculty to maintain a sense of connection and further their learning under exceptional circumstances. Rest assured, the future of medicine is in capable hands.