Medical Education Adapts to Pandemic

When the COVID-19 pandemic came to Oklahoma, it caused immediate changes in how future doctors learn. Administrators and students felt anxiety at first, but they learned to adapt – and some of the changes may be here to stay. In late March, following national guidance, the OU College of Medicine removed undergraduate medical students from clinical settings to conserve PPE and limit exposure to the novel coronavirus.

Associate Dean for Student Affairs Mark Fergeson, M.D., said some students disagreed with the disruption. “Some were upset by changes, because they wanted to be on the front lines helping people. They were very concerned about patients,” he said. “But they also didn’t want to catch the virus or put others at risk.” Yashna Naidu, who was a third-year medical student when the crisis struck, said she felt uncertain when her rotations were disrupted and lectures went virtual. “It was quite a big change,” she said. “I usually wake up excited to go to the hospital and to experience a sense of community. Despite the major shift in our daily activities, everyone helped make it as normal as possible.” Administrators adjusted the traditional schedule so learning could continue online, then returned to an in-person model for clinical experiences as soon as it was safe to do so, Fergeson said. “For two months, our students focused on at-home work and lectures. But by late May, students returned to clinical education,” he said. “About one-third of students lost their two-week summer break, but everyone was back on schedule to prepare for the start of the academic year in July.”

“The education is now really very similar to how it’s always been,” he said. “The main difference is undergraduate medical students do not see patients who are COVID-positive or patients under investigation. Otherwise, we are back on track with PPE and social distancing measures in place, and some lectures being given online.” In fact, Fergeson said some aspects of the undergraduate medical experience may have improved, such as how the Human Structures course is taught. When other schools were shifting to an all-simulation model, the OU College of Medicine instead decreased group size from four students to two and implemented social distancing precautions. One student would read while the other examined a body. Each student gained more hands-on time. “Our primary goal from the beginning was to keep students and patients safe. Our secondary goal was to recognize it was not an option to let education quality drop,” Fergeson said. “It took hundreds of hours of planning by the COVID-19 Medical Education Response team, and I’m confident we did a good job getting students the experiences they needed.” The situation was similar for graduate medical residents and fellows.

Associate Dean for Graduate Medical Education Elisa Crouse, M.D., said the challenges were different because of the requirements to complete clinical experiences during a certain period of time. The timeline became especially tight because of isolations and changes in care brought on by the crisis. As with undergraduate medical students, the college found educational activities to help fulfill requirements, such as readings and research. No trainee was required to extend their training, though the college was prepared to do so. Crouse said one negative change was eliminating travel to medical conferences. But a handful of organizations moved their conferences online, and virtual tools were used for didactics and other activities.

This actually created new learning opportunities. Some national subspecialities rolled out free virtual didactics. Crouse said this may provide a new model for the future: standardized programs across the country. However, virtual meetings can never entirely replace face-toface meetings, especially when it comes to recruiting students into graduate medical education programs. “Virtual recruitment is a tough environment that is new to medicine. At OU, it’s especially difficult to overcome perceptions about the city and the school without being able to bring people in,” she said. “But it’s probably good for us to learn, and virtual recruitment helps cut down on costs of travel and meals.”

Away rotations also evolved for medical students. Naidu completed an away rotation in pediatrics at Northwestern University without ever leaving Oklahoma City. Despite not being there in person, she got a strong sense of the program, including its dedication to talking about societal issues such as implicit bias. The biggest losses, Crouse said, are related to the emotional side of medicine.

“Residency is a hard thing, and it helps when people have the opportunity to sit down together and share both good and bad experiences. In these times, residents just can’t get together and, without that, a portion of their support system is gone,” she said. “Humans are social, and connectedness is important. Physicians are taught to touch, but now some residents are hesitant about exams and rethinking even shaking hands with patients. It’s difficult.” Fergeson saw a similar problem for undergraduate medical students, who must learn to take patient histories and physicals. To limit social contact, OU had to go back to how training was done in the past — students practice on each other, rather than on simulated patients. Medical students also use a large, state-of-the-art simulation lab that allows them to practice a wide variety of procedures. Still, some appreciate the old ways.

Patrick Browne was one of several medical students who helped contact patients with upcoming appointments to let them know of changes due to COVID-19.