Diving Headfirst: Perspectives on Entering the Clinic in the Time of COVID-19

Sheikh Moinul Hannah Swartz

Early May marked a period of great uncertainty for many rising third-year medical students at UMass. The COVID-19 pandemic ensured that a rapidly evolving set of rules were being delineated on an almost-daily basis, leaving many students to refresh their Outlook inboxes at the same frequency as their Reddit feeds. With STEP 1 exam cancellations, quarantine modifications, and clerkship start date changes happening at what could only be described as warp speed, life as it was once known had been completely upended.

So, when the email announcing that clerkship experiences were set to start on June 1st, weeks before many other programs around the country were planning on doing the same, students expressed apprehension, uncertainty, and confusion. Every reassurance was made that extensive measures had been taken to maximize safety, but many students could still not fathom the prospect of being in a hospital during the throes of a global pandemic. However, many expressed excitement at the prospect of continuing education, fervently exhausted by the severe cabin fever that quarantine had brought to daily life.

The revamped COVID-19 clerkship experience was, in many ways, as strange as one could imagine. For starters, medical students were not allowed to participate in the care of any COVID-19-positive patients, which was to be expected. What were once weekly roundtable case seminars had become Zoom sessions, final examinations had become anxiety-inducers at home, and OSCEs

had transformed living rooms into virtual clinics. Students were urged to socially distance as much as reasonably possible by Zooming into conferences, eating lunch separately from residents, and avoiding congregation in already-packed lounges. Most patient encounters were carried out with face shields, surgical masks, and gloves, making students resemble makeshift astronauts as they visited their bewildered patients.

Despite all of this, the freshly revised clerkships still carried many characteristics that kept them familiar. The amount of immersion that they provide is still second-to-none; no online module can simulate the experience of building a bond with a 7-year-old receiving chemotherapy for metastatic renal cancer, nor can any textbook adequately replicate real interviews with acutely psychotic patients. Even learning how to coordinate care between treatment teams at UMass and elsewhere is a vital skill best learned in-person. The very real experience of being educated by a seasoned cardiologist on the risks and benefits of anticoagulation makes for a much more vivid lesson than those found in online flashcard decks. These conversations are essential components in the training of young doctors, and even during a pandemic their value makes them worth hazarding the risk.

For third-year medical students, this has become the new normal, and a life without masks, social distancing, and weekly nasal swabs has become unimaginable. Despite being mildly inconvenient, the numerous safety measures taken at UMass have ensured that clerkships remain safe overall. Moreover, clerkships have brought back a semblance of normalcy to a life that was once filled with uncertainty; they have given medical students the opportunity to continue their training in a feasible, immersive, and rewarding manner.

hannah swartz:

Our third-year medical school class started

clinical rotations in June, just one month delayed from the planned start. With coronavirus cases declining, and in an attempt to not have unnecessary delays in our training, our school made arrangements for us to reenter the clinical setting. I started on the adult general medicine unit

at our main hospital. Students were not allowed to see COVID-19 patients, but the residents and attendings we work with on our teams were. Every day we would discuss a patient who is admitted for two months, sick with COVID-19 and met with an incredibly unfortunate set of complications. I pass his room daily, unable to see him behind the sets of doors which isolate him from other patients. His wife only calls by phone, not allowed to visit due to strict protocols in place for COVID-19-positive patients. A few weeks into my rotation, he finally tests negative for COVID-19; the doors open, and the warning signs outside his room come down. We visit him as a team the next morning. Lying in bed, he is just a fraction of what he used to weigh. He is sad, he is lonely, and he is sick.

As medical students, we follow at most a handful of patients, learning the intricacies of their cases and spending more time with the patients because we do not have the same time constraints and responsibilities that the residents and attending physicians have. Because we are able to spend so much time with patients normally, being restricted from seeing certain patients – let alone ones without visitors – made me so much more appreciative of every moment I could spend in person with patients.

Starting clinical rotations during a pandemic goes outside the confines of what any of us as students imagined during our clinical years. The years of studying we put in to prepare are over, the nervous excitement we feel remains, but there is a hyperawareness of the ways in which the pandemic has changed the hospital environment. However, as students, we still have the ability to visit with patients longer and more frequently. We are able to give time and companionship, a listening ear in person rather than on the phone, a hand on the shoulder — even if gloved — and a warm smile behind a mask, one just big enough so that the patients can see the crinkle in our eyes. The learning opportunities are endless, and although some are different than what we expected, we are pushing ahead just the same, absorbing all the information we can as we rotate through different specialties, all hit by the pandemic in different ways. +

Sheikh Moinul and Hannah Swartz are third-year medical students at UMass Medical School