15 minute read
Clerkship Corner How COVID Changed Our Medical Education
How COVID Changed Our Medical Education
By Nathan Lewis, MD and J. Scott Wieters, MD on behalf of the SAEM Clerkship Directors in Emergency Medicine
The SAEM Clerkship Directors in Emergency Medicine (CDEM) academy strives not only to provide the best educational tools and resources for students, but also to understand their experiences. Recently on EM Stud, the official student podcast for CDEM, Drs. Nathan Lewis and J. Scott Weiters, cohosts of the podcast, invited medical students from across the country to share how the COVID-19 pandemic impacted their medical education. A partial transcription of the episode, originally recorded in April 2021, follows. Listen to the full podcast at www.emstud.com, on Apple Podcasts, Google Podcasts, Spotify, or SoundCloud. EM Stud covers a range of topics including how to excel on clerkships, EM subspecialties, residency application and interviewing tips, and much more.
Dr. Wieters: Nate, this was a year that none of us have ever seen in medical education. We didn’t have this when we were medical students, but we’ve got some students today that have experienced and walked the walk in what it looks like to be educated during a pandemic. Dr. Lewis: Yeah, Scott…As you know, we’ve gone back and forth a lot about just all the changes related to the residency application process, interviews, going through the match statistics. But we really haven’t been able to get the student perspective yet. And so today, we have with us eight students to tell us about how COVID has impacted their medical education and their medical education experience over the past year. Dr. Wieters: We’ve got a really good representation, a lot of different years, a lot of different schools, and so, we’re very interested to learn how medical school looked during a pandemic. Nate, what’s on your mind? What are you interested in getting to know from these folks? Dr. Lewis: I’m curious to hear from our students just exactly how things are going. I mean, obviously it’s been a very long year, a lot of changes, but how are things going now? Are things roughly back to normal? Kayla Nussbaum: I would say at Dell for our nonclinical students, things are not back to normal. Most lessons are still over Zoom or online and asynchronous. But our clinical students are back in the hospital, back on rotations as scheduled. and things feel pretty normal in the hospital. Callie Adams: At Texas Tech, I think that our school did a pretty good job trying to keep things as normalized as they could from the beginning, but they are starting to get back to our new normal. I don’t think there will ever be anything that
CLERKSHIP CORNER
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goes back to quite like it was. For right now our OSCEs (Objective Structured Clinical Examination), and things like that, are still virtual but for our next rotation, which is the last one of third year, we will be back in person and finals week will be back in person. So we are moving towards that direction. The first and second years still have a pretty heavy virtual component, but that was already something that was built into our first and second year curriculum where you could have that flexibility to stream and do things online. It was really just the testing that changed quite a bit. Angela Nguyen: At UIW (University of Incarnate Word), I would say things are going well. I wouldn’t say things are back to normal. At the start of the quarantine we moved to an online platform. There was trial and error in trying to figure out how to make a flipped classroom curriculum work on that type of platform, but now, over a year later, we are more of a hybrid platform. All of our lecture classes, like large groups and small group discussions, are still online, but we do come in once or twice a week for our clinical skills and our anatomy labs. Dr. Wieters: I remember this well… We were skiing for spring break with our kids in Colorado and the day after we left to return home, the slopes shut down. We were driving back wondering what it would be like when we got home. Everything was shut down so we immediately bought tons of toilet paper and rice… we were those people. But when did you first start to feel the impact of COVID on your medical training? Colton Junod: Here at Indiana we started to really notice it in the middle of March. I was ending my second year, so that was our dedicated month to study for Step 1. All of my classmates were at school together and we got the notification that all of our testing centers had closed and our Steps were postponed. We were nine days before our exams. So that’s when we first felt like it affected our education. Just around that time IU also pulled all students from clinicals. So, all the third- and fourth-years were taken off of clerkships. And then, of course, the firstyears went online for school as well. So that was really the first time we noticed it, and then of course we continued to feel it over the summer and when
our third year start date was delayed. It was supposed to start at the beginning of May and it ended up starting at the end of June. So our clerkships ended up being shortened to three weeks and six weeks instead of the normal four and eight weeks. That was also one of the first things we felt really in our education. Angela Nguyen: I think I definitely felt it since the very beginning of quarantine as well. It was really hard not only to find the motivation, but also to focus — to sit down and study with everything else going on in the world. And I think a big part of that also is that all the things I used to do to help refresh and keep myself motivated between study sessions — hanging out with my friends, getting $7 coffees at coffee shops, and normal med school experiences like clinical experiences and actually being able to do clinical skills classes in person, using my hands, stuff like that—were all taken out of the equation. So it did take quite a bit of time and adjustment just trying to get back into the groove of doing med school again. Juliana Castrillon: We felt the impact pretty early on. I’d say it was late February and we were just about to leave for spring break. We had in our sister hospital what I think was the second patient in New York City to be identified as COVID positive. At that point, we didn’t know that much about COVID and what the implications were. I think we were expecting it to all blow over pretty quickly. Although it felt like a scary unknown, we still didn’t think it would last this long. It's a year later and we're still feeling the impact of COVID in our hospital and in our medical school. When we left for spring break, we all thought we would be back in person in maybe a few weeks or a month, and I think a few days before we were meant to come back to campus we found out it would likely be for the entire semester that we would be virtual. I think the administration did a great job shifting us to fully virtual education. As several people have mentioned, we did have a lot of online lectures that could be viewed from home. But given that we were in our first year I think there are a lot of hands-on things that are difficult to do virtually; a lot of clinical skills that are really helpful to do in person and get feedback about in real time. I think that was the hardest part of the transition — not having the in-person components. To hear the rest of this episode, visit www.emstud.com, or listen on Apple Podcasts, Google Podcasts, Spotify, or SoundCloud. Dr. Lewis is an associate professor and attending physician in the department of emergency medicine at Virginia Commonwealth University (formerly Medical College of Virginia) in Richmond, VA. He is also the clerkship director, which is awesome, because he gets to spend a lot of time with some of the best and brightest medical students anywhere in the country. Their enthusiasm and intellectual curiosity is energizing and one of the main driving forces behind developing this blog/ podcast. @ERDrN8 Dr. Wieters is the director of undergraduate medical education for The Scott & White EM Residency Program. His favorite part of his job is working along side students as course director for the Texas A&M College of Medicine EM Clerkship. He has been awarded multiple teaching awards, yet is most proud of “meeting expectations” as a trophy husband to his wife, THE Dr. Wieters. He’s a proud parent of four children who are all “exceeding expectations”. His kids all agree he “needs improvement” in his role as a youth sports coach. @EMedCoach
Podcast Panelists
Class of 2021 - Lauren Bayliss, University of Texas Rio Grande Valley
School of Medicine - Kayla Nussbaum, University of Texas at Austin Dell
Medical School - Billy Shank, Texas A&M
College of Medicine Class of 2022 - Callie Adams, Texas Tech
University Health Sciences
Center School of Medicine - Dan Hubbard, Texas College of Osteopathic Medicine - Colton Junod, Indiana
University School of
University Vagelos College of Physicians and Surgeons - Angela Nguyen, University of Incarnate Word School of
Osteopathic Medicine
About CDEM
Clerkship Directors in Emergency Medicine (CDEM) represents the interests of undergraduate medical educators in emergency medicine. It serves as a unified voice for EM clerkship directors and medical student educators and provides a forum for them to communicate, share ideas, and generate solutions to common problems. For more information, visit the CDEM webpage. As an SAEM member, you may now join as many academies* and interest groups as you choose. Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.
Medical Right to Repair: A Primer for Emergency Physicians
By Helena Halasz MD; Shuhan He MD; and Jarone Lee MD on behalf of the SAEM Critical Care Interest Group
If you have ever ordered a McFlurry® at McDonald’s only to be told that the ice cream machines are down, you may be surprised to learn that the reason behind it is the same reason why hospitals during COVID-19 were often left without working equipment.
In the manufacturing industry, it is common practice for companies to sell their products with an exclusive right to perform all necessary repairs going forward. This, along with strict intellectual property-related restrictions, serves as a reliable source of ongoing revenue for manufacturers. However, limitations on consumers’ ability to use third-party repair companies has come under scrutiny in recent years, and the “Right to Repair” movement, which petitions for access to information and tools, has gained significant traction. The problem exists worldwide, across industries ranging from automotive to farming to electronics. In 2012, the state of Massachusetts passed the
“Right to Repair legislation could move health care in the United States in a more affordable, sustainable direction.” country’s first Motor Vehicle Owners’ Right to Repair Act; since then, several other states have followed suit. In March 2020, the European Commission announced plans to instate new right to repair rules that would cover mobile phones, tablets, and laptops.
But what happens when the restricted device in question isn’t a cellphone, but rather a decommissioned ventilator that could potentially save a patient's life? During the COVID-19 pandemic, this became a very relevant question. Hospitals across the world reported a lack of sufficient medical equipment, with shortages of ventilators, decontamination equipment, hemodialysis machines, and personal protective equipment. As cases surged worldwide, health care institutions were faced with unrelenting demand for repair and maintenance related to high use, secondary to increased patient volumes, acuity, and turnover. Due to limitations, these repairs could only be performed by authorized service staff. In many cases, hospitals’ own biomedical engineers, who had the technical knowledge required, lacked both the vital information and permission to attempt repair of essential equipment.
In August 2020, Oregon Senator Ron Wyden introduced the Critical Medical Infrastructure Right-to-Repair Act of 2020, which aimed to compel manufacturers to provide, on fair and reasonable terms, access to the tools and information that would make it possible for hospitals to take matters into their own hands. Even without legislation mandating them to, many medical device companies provided crucial information and resources to biomedical technicians during our fight against COVID-19. Additionally, despite supply chain constraints, several medical device companies ramped up production to try to meet the needs of front-line health care workers.
On July 9, 2021, President Biden signed an executive order that urges the Federal Trade Commission (FTC) to establish right to repair regulations. These policies would force manufacturers to give individuals and independent repair shops access to special tools, parts, and diagnostic software, as well as to grant the freedom to service their own products. This federal legislation would remove barriers to maintenance of live-saving devices in a timely fashion. Furthermore, reports predict that Right to Repair legislation could move health care in the United States in a more affordable, sustainable direction.
These unprecedented times during COVID-19 demonstrated how important collaborations between medical device companies, hospitals and clinicians really are. Our equipment is like our stethoscopes: we must take care of our tools to be able to take care of our patients. This not only means repairing them when they’re broken, but also ensuring that we can prevent unintended consequences of repair limitations. By working together, these issues can be resolved, but it is crucial to keep the momentum going.
ABOUT THE AUTHORS
Dr. Halasz is a recent graduate of Semmelweis University (Budapest, Hungary) and an aspiring emergency medicine physician, with a special interest in social emergency medicine and bedside ultrasonography. @halaszhelenamd
Dr. He is an emergency medicine physician and faculty member of Harvard Medical School and in the Lab of Computer Science at Massachusetts General Hospital. @shuhanhemd
Dr. Lee is an associate professor at Harvard Medical School, director of the Blake 12 ICU at Massachusetts General Hospital, and a member of the SAEM Critical Care Interest Group. As a medical officer in the National Disaster Medical System, he deploys in response to disasters and other major events. @JaroneLeeMD
Join the SAEM Critical Care Interest Group
If you are an SAEM member and are interested in adding the Critical Care Interest Group (CCIG) to your membership, simply log in to your SAEM profile and join today for free. SAEM members who are already part of the CCIG can find more information and resources by visiting the SAEM CCIG Community Site.
Don’t Hesitate, Innovate! A MacGyver Solution to a Common Problem
By Ali Dakka, MD and James Bishop, MD
Attempting to remove a ring that is stuck on your patient's swollen finger can be a frustrating experience. You try lubricating it. You try using soap and water. You try wiggling it around and pulling with force. However, nothing seems to work. Now, you must decide whether it is time to invoke the last resort: cutting the patient’s precious ring off with a ring cutter. Time is of the essence in the emergency department (ED), and you have other patients waiting to be seen, not to mention any codes that may come in. How do you solve this dilemma? You think like MacGyver!
Recently, my attending and I were in this situation. We had a patient who presented with significant finger swelling following a fall and distal radius fracture. After performing a hematoma block and reducing the fracture, we tried to remove her ring with lubricant and then with soap and water. Both attempts failed. We informed the patient that we might have to cut her ring off.
As we were losing hope looking around the room for something we could use, a MacGyver-like idea came to us. We found a supply of patient wristbands and wondered if they could be used to help us slide the ring off. Inspired by furniture sliders, which work by reducing friction between two items, we carefully slipped a wristband between the finger and the ring. Once in place, the wristband functioned as a smooth interface between the finger and the stuck ring. After some pulling and careful rotation of the ring, the ring came off!
As emergency medicine physicians, we are often challenged to solve our patients’ problems using only the basic tools at our disposal. Through innovation and improvisation, we were able to achieve a successful ring removal for our patient. Fortunately, patient wristbands are typically readily available, so this ring removal technique could easily be applied in the ED setting. Multiple wristbands may be used, but one was sufficient in our case. Watch the video associated with this article to see our technique in action. When in doubt, think like MacGyver! ABOUT THE AUTHORS
Dr. Dakka is a first-year emergency medicine resident at the Ascension Providence Emergency Medicine residency in Southfield, MI, and a clinical instructor for the Michigan State University College of Human Medicine. He graduated from the Wayne State University School of Medicine in 2021 and the University of Michigan-Ann Arbor in 2017 with a major in cellular and molecular biology.
Dr. Bishop is the associate program director for the Ascension Providence Emergency Medicine residency, Southfield, MI and an assistant professor of emergency medicine for Michigan State College of Human Medicine and College of Osteopathic Medicine. He has over 20 years of experience and is a partner with Independent Emergency Physicians. He is a graduate of Wayne State University School of Medicine and the University of Michigan-Ann Arbor.
