Addressing COVID-19’s impact on the clinical education of students

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

AMA Chief Experience Officer Todd Unger speaks with AMA Vice President of UME Innovations Kimberly Lomis, MD, Co-Secretary of LCME and director of UME Barbara Barzansky, PhD, Associate dean of medical education at University of Michigan Medical School Rajesh Mangrulkar, MD, on updates regarding COVID-19 including the impact of COVID-19 pandemic on the clinical education of medical students and how schools are responding.

Learn more at the AMA COVID-19 resource center.

Unger: Hello. This is the American Medical Association's COVID-19 update. Today, we're discussing COVID-19's impact on the clinical education of medical students and how schools are responding. I'm joined today by Dr. Rajesh Mangrulkar, associate dean for medical student education at the University of Michigan Medical School in Northville, Michigan, Dr. Kimberly Lomis, AMA's vice president of undergraduate medical and education innovations in Nashville and Dr. Barbara Barzansky, the AMA's director of undergraduate medical education and the co-secretary of the liaison committee on medical education, or LCME in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago.

Back in the middle of March, the AAMC issued guidance to medical schools on suspending in-person patient contact for students related to COVID-19. It's now been more than six weeks. The question is, how do we get students back on track? Dr. Mangrulkar, let's begin with you.

Dr. Mangrulkar: Well, thank you, Todd. I really do think we could learn what happened back in March, in the middle of March. Let's learn from it. There was a lot of anxiety, discoordinated communication and a lot of different responses. I do think that what we need to do to get students back on track is to establish some principles for why they are essential as team members, and how do we actually adjust and make sure that our PPE is in good shape, that our testing protocols are right. But really, be very clear that the patient is a primary concern and that our students need to be actively involved in the care environment, helping our teams in the ways that they always are. And they can learn from that experience.

Unger: Dr. Lomis?

Dr. Lomis: Yeah, I agree with Dr. Mangrulkar. I think the students have been extraordinarily patient. I think that they initially understand the disruption, but they're anxious to serve. They want to be helping with patients. They want to be moving forward with their education, and so as time rolls on, the anxiety gets increased for them for sure because part of the history of this is that we measure education in time, traditionally.

You think about you go to college for four years, and there's a certain amount of things that have to happen in a given semester. And so if we can uncouple a little bit our thinking about time in order to use the time that remains as effectively as possible to really prepare them for the responsibilities that they'll take in the future.

Unger: Dr. Barzansky?

Dr. Barzansky: To follow up on that, the ability to decide when you're going to teach particular areas is really based on knowing what should be in the curriculum, your educational program objectives and where it could be covered. And so the issue of what you can teach when, didactic can be handled much more easily in the COVID area than actual hands on clinical, allows you to deconstruct how you used to structure the curriculum into ways now that better fit the new environment.

Unger: Dr. Mangrulkar, can you share some solutions that either you've implemented or you've heard that are working especially well for students?

Dr. Mangrulkar: I'd love to, Todd, and I want to build on what Barbara said. I think it's really nice that we can really adjust and look for creative and innovative ways to bring our students the learning while they're able to serve. Some of it can be from learning we're doing while the students are on this pause. Many schools have set up courses that are online. Many have piloted new experiences like virtual standardized patients. Some have now started to pilot, like we have at Michigan, how do you involve the student in virtual care with another faculty member and a patient? Because many of our ambulatory operations have moved into a virtual care environment.

I think the essential ingredient is that students can still add value to the team and learn while they're doing that, and I wonder if we can just learn from what we've experienced over the last two months to build the way forward.

Dr. Lomis: I think this is an opportunity for medical educators to step back and really focus on the competencies that we want these young, developing physicians to attain. We have traditions and expectations about how that is done that have actually been in place for quite some time. And so it does give us an opportunity to step back and think about the changing roles in the care system. Certainly in the immediate experience, but also just in general. The way medicine is delivered has changed, so the roles that students can fulfill in order to gain the competencies that they need to move forward may be different as well.

And so there's a great opportunity here to learn not only as Raj says, for the immediate future, but long-term. What would we do differently in medical education to get everyone where they need to be?

Dr. Barzansky: And to follow up with what Dr. Lomis said, there are certain things that used to be taught in the clinical setting that can move out of it—telemedicine or other kinds of things. But there are going to be certain things that a school needs to decide have to be done with real patients. There are certain hands on skills that still need to be taught, and the complexity is finding the time to do that.

Unger: Yes, it's been complicated already once with the disruption at the current time. As you look ahead into the fall and thinking about the potential for another time when we have a similar disruption, how do we begin to deal with the potential issues of another surge and what impact it might have on these same students? Dr. Mangrulkar?

Dr. Mangrulkar: Well, I do think that what we should use this opportunity to do is to step back and determine what is essential for our students to be able to learn in the clinical setting, as Dr. Barzansky said, and what can be done virtually or an alternative format. So we should use this time to really define what that is, and then be very clear about our communication plan to our entire health system, to our senior leadership, to our faculty and honestly to our students as well.

I don't know that we were all rowing in the same direction back in the middle of March. It was a very chaotic time. But I think if we define those principles, use our committees to define what's essential and then communicate it effectively up and down, we'll be in much better shape for what could be a potential second surge.

Dr. Lomis: I agree with Raj. I think he's made the point of learning from the previous experience and being a little bit better prepared the next time. I think back in March, we had to pull students fairly abruptly, and it was difficult to communicate at that time the rationale for why they were being removed. And so it could be perceived simply that they shouldn't be there for whatever reason. And in reality it was much more nuanced. The insufficiency of PPE of course, has been a huge issue, and Raj already mentioned the potential for better testing protocols to ensure everyone's safety.

So taking advantage of the time we have now and the lessons that we've learned in order to be much more clear up front of if students need to be removed from direct patient contact, what are the criteria for that? And that may vary in different geographic regions in different systems. So starting to articulate those principles that he alluded to earlier will help us be prepared next time.

Unger: Is it really the issue of PPE or talk about how much is it related to that? If we were to be able to overcome that particular issue, how would that impact student involvement?

Dr. Barzansky: The other piece of that is the kinds of patients that are in the clinical setting now. The pattern changes across hospitals. Some are devoting a lot of their space to COVID patients, and we want to make sure students don't lose the general information and the general skills that they need coming out of medical school. And so finding new sites as well as finding new methods is going to be very important.

Unger: Dr. Lomis, does the AMA offer any resources right now to help schools and students navigate these challenges?

Dr. Lomis: Sure, Todd. On the AMA's COVID resource page, we have a medical education resource page within that, where we've been placing a lot of things that educators are sharing across the country, which is fantastic. There's so much collaboration happening to find solutions. We have an online community discussion in which the webinar discussing this particular topic from last week is there as a recording that people can view, and there's an ongoing discussion following that with moderators from the panel contributing to answer questions from actually all over the world.

So we definitely are trying to make sure that we keep things available to people, and we've been so happy to see the sharing of information across sites.

Unger: Dr. Mangrulkar, Dr. Barzansky, what's the one piece of advice that you would give students right now as they think about the time they're in and their future?

Dr. Mangrulkar: I guess I'll start and say that I think that students probably need to do two things. Number one, be prepared for an uncertain world. So much of medical education has been rooted in certainty, but things are fluid and decisions are changing. We try to make the best decisions with them, with the evidence at hand, but that may change also. So be prepared for decisions to change.

And then just be mindful of your own health and how we can work together to keep our students safe. It's not just the responsibility of the institution. We have a big responsibility, but students can really contribute to that by staying in touch with us and staying closely communicative with us, so we can help manage their health better.

Dr. Barzansky: And another piece of this is students should feel comfortable that medical schools are going to be sure they meet the educational program objectives, that they're going to graduate with the knowledge and skills that they were expected to have. It'll be different, but students should not worry that they're going to be big pieces taken out of their education even though that education looks different.

Unger: Well, thank you very much Dr. Mangrulkar, Dr. Lomis and Dr. Barzansky for being here today and sharing your perspectives. We'll continue to create more resources to help students during this difficult time and get their education on track.

That's it for today's COVID-19 update.

If you'd like to find more resources for students like the webinar Dr. Lomis talked about or our guides for student education, go to the AMA COVID-19 resource center at ama-assn.org/COVID-19. We'll be back on Tuesday with another COVID-19 update.

Thank you for joining us.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.