By Deborah Conway, MD

Medical Student Education in the COVID-19 Pandemic:

The Show Must Go On, Safely

By Deborah Conway, MD

A tsunami warning system detects an event far away and sends alert signals to those who may be affected so they can respond, prepare and MOVE! In February and early March of 2020, the medical education world began to detect tremors of how the seismic event of the SARS-CoV-2 epidemic would impact our domain. The disease was in the news, of course, having reached U.S. shores. San Antonio received quarantined cruise ship passengers. National medical education meetings scheduled for March began to get cancelled preemptively: the first wake-up call to many faculty that this was a different type of crisis. The alarm bells were sounding, and we didn’t know how big the wave was or when it would hit. How far and how fast did we need to run to keep our students safe while minimizing interruptions to their tightly scheduled four-year curriculum? What critical milestones in the life of a developing physician would we have to “leave behind” as we rapidly moved everyone to safety?

In the early days of March 2020, we concluded one first-year medical student course under normal circumstances and sent the students on their scheduled one-week Spring Break. Our second-year students were elbowdeep in United States Medical Licensing Examination (USMLE) Step 1 preparation, with individual scheduled test dates looming. Our third-year students were rotating through core clerkships with our main hospital partners, as well as community practices. Our fourth-year students were eagerly awaiting residency Match Day and graduation activities. At this point, however, the full measure of the infectious threat, the critical shortage of personal protective equipment (PPE) and the urgent need to “flatten the curve” became apparent. The wave was on the horizon.

In the second and third weeks of March, the tsunami hit. During the week the students were on Spring Break, we converted our first-year curriculum, including many team-based, collaborative learning activities, entirely online. Third-party testing centers, where USMLE exams are administered, had closed their doors and cancelled test dates. We pulled clerkship students from clinical environments based on national organization recommendations as well as health system partners scrambling to care for patients in new ways while protecting their workforce. Perhaps most painfully of all, we held a virtual Match Day celebration and committed to a virtual graduation event. No one – staff, faculty, leadership, campus and clinical partners – wavered or flinched during these chaotic days and weeks. Our focus remained on the well-being, safety and ongoing education of our students.

By April 2020, conditions had stabilized locally to an extent that allowed us to return our clerkship students to their rotations by the end of that month, and our students were eager to resume their role in patient care and clinical development. Established, strong partnerships between our undergraduate medical education team, clinical departments and hospital affiliates were key to this rapid resumption of clinical activity by our students. To do this safely required additional

training in PPE, modification of rotations while still providing sufficient experiences, monitoring systems for symptoms and exposures among students and free-flowing lines of communication among the stakeholders. We further benefitted from a robust community response to COVID-19 that kept our first-wave case numbers manageable by our hospital systems.

The current academic year finds us at a new-found steady state, seamlessly delivering classroom content virtually to both first- and second-year students, who continue to learn and engage enthusiastically despite the challenges and isolating circumstances. It is certainly not our preferred way of teaching, because much of our curriculum, like medicine itself, is designed to foster collaborative learning and work. Nonetheless, we are discovering new ways to blend technology into learning in order to enhance student engagement, collaboration and well-being. Clinical students continue to rotate, albeit on shortened clerkships this year. Residency interviews were only held across screens, and we provided our students with campus “office space” and equipment to ensure technical glitches (or barking dogs) didn’t diminish their interview experience or the impression they were making. Again, it is the resilience and creativity of our staff, faculty, clinical partners and the students themselves that have cleared a path for us to continue to educate medical students despite the challenges and dangers.

The COVID-19 wave is, hopefully, receding, and we will never be the same. It has changed the medical education landscape in ways we can see right now – such as accelerating the decision to eliminate USMLE Step 2 CS (Clinical Skills) as part of the medical licensing pathway – and surely in ways that will only become apparent over time. Our current medical student colleagues will have an experience like no other generation of physicians. Because of their unique position during the pandemic, they will gain perspective and wisdom from this time that might differ from ours, but is no less relevant. Our job as medical educators is to teach and support them now, honor their experience of the past year and continue to model what it means to uphold our physician’s oath and commitment to patients.

Deborah Conway, MD is the Vice Dean for Undergraduate Medical Education at the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio. She is a board-certified OB-Gyn and Maternal-Fetal Medicine specialist who trained and has practiced in San Antonio for more than 20 years.