COVID-19, Medical Education, And The Role Of Medical Students Around The World

As the world becomes more interconnected, one of the upsides is the ability to share our journey as medical students with other medical students across the world. The International Medical School Conference on COVID-19 held by the International Medical Association of Keio University School of Medicine was attended by medical students from the United States, Japan, Brazil, China, Italy, Korea, and Thailand. Through presentations by representatives from each country and discussions about how we felt about our country’s response and the overall state of healthcare, we discovered both shared experiences during the pandemic as well as differences driven by the unique cultures, policies, and situations of each country. Here are some of the key take-aways:

Medical education across countries

In most countries, students begin medical school directly after high school, embarking on a six-year journey that begins completely didactic, leading into a combination of theoretical knowledge and time spent in the clinic, and finally is completely clinical. Following these six years, medical students in some countries, such as Brazil, can practice emergency medicine or internal medicine, although most choose to pursue a residency to further specialize. Medical students from the United States are unique in that we typically have four years of undergraduate education, four years of medical school, and then a variable number of residency years before we can practice independently. However, most medical schools in the United States maintain the general structure of pre-clinical years focusing on theoretical knowledge followed by clinical years.

The roles of medical students in the COVID-19 pandemic

For the most part, as classes were transitioned to online and clinic was postponed, medical students helped with the COVID-19 pandemic through volunteering, public health, and research initiatives. At the Johns Hopkins University School of Medicine, medical students founded the Instagram account @covidup2date, a social media initiative that provides daily updates on the pandemic from reputable sources to help combat online misinformation. Groups of medical students in South Korea took a similar approach, creating YouTube videos and Instagram feeds emphasizing the prevention of COVID-19 through hand sanitization, wearing face masks, and additional testing. In Thailand, medical students organized fundraisers and donations for PPE, provided education on how to make masks, and encouraged people not to hoard surgical masks so that healthcare personnel would have access. In Italy (as in the United States), medical students volunteered at call centers or helped deliver groceries to the elderly. Although medical students may not have had previously defined roles for a pandemic, medical students across the world stepped up to help in whatever way possible.

A minority of medical students at the represented countries helped with clinical care during this pandemic. Sixth-grade medical students at the University of São Paulo found themselves front and center in the care of COVID-19 patients, as their main hospital building was designated only for COVID-19 patients, and other patients were transferred to other buildings. In the United States, some medical students were given the option to graduate early to help take care of COVID-19 patients.

Views on the role that medical students should take in the COVID-19 pandemic varied among countries represented. A medical student from Italy reasoned that the situation was chaotic, and the huge wave of patients overwhelmed even fully trained health professionals, and medical students, unfortunately, do not have the competence to handle such a situation. On the other hand, a medical student from Brazil who took care of COVID-19 patients described it as an honor to be able to serve her country and a wonderful learning experience. In addition, it felt like a secure environment in looking after patients because all actions were supervised and endorsed by their faculty.

How culture, politics, and situation played into the response to COVID-19

The COVID-19 pandemic highlighted the many cultural, social, and political differences between countries. For example, South Korea’s value of public health over personal privacy during this time of crisis enabled highly effective contact tracing. Indeed, a record of all the places that a South Korean COVID-19 patient has been is publicly available. South Korea’s value for transparency and the amendments made to the Infectious Disease Control and Prevention Act after the 2015 MERS outbreak about notifying the public also meant that people received text messages about new patients in their areas. In contrast, the United States has a more individualistic culture, which has, at times, fostered rebellion against public health messaging—some people have ignored or protested restrictions.

The culture and policies of a country have also helped to shape the role of the medical student. In Japan, the Medical Practitioner’s Act Article 17 states that “No person except a medical practitioner shall engage in medical practice,” and Japanese medical students are not yet considered medical practitioners, so they have stayed at home during the pandemic. Meanwhile, Article 7 of the “National Curriculum Guidelines for the Course in Medicine” in Brazil states, “The physician training will include a mandatory practical training under the supervision of the professors at the School/Faculty”. The greater clinical autonomy that medical students in Brazil already had as compared to medical students in Japan may have accounted for the differences in the roles of medical students for caring for patients during the COVID-19 pandemic.

Conclusion

The role and experience of medical students during the COVID-19 pandemic has varied widely in the context of individual countries. However, despite differences, we found similarities in the structure of our training and our desire to help respond to the pandemic. Overall, students at the conference found that we had more experiences shared than diverging, and we were united by our desire to positively contribute and give back to our communities during this pandemic.

Clarissa C. Ren, Sara K. Hurley, Matthew A. Crane, Ayumi S. Tomishige, and Masato Fumoto are medical students from the United States, Brazil, or Japan.

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