The Crisis Of Rotation Availability During A Pandemic: A Medical Student’s Ethical Conundrum

With COVID-19 still consistently creating setbacks in the health care community, we see yet another issue for medical students because of this pandemic. In prior years, the traditional medical student would be expected to be part of a team assisting medical professionals in the field, developing relationships with future mentors, and gaining the experience necessary to take on the difficulties presented in that given field. COVID-19 has been altering the health care community at each level, presenting unseen hardships for Doctors and medical students alike. The workflow of hospitals has since become severely diminished in its lack of personnel, availability of PPEs, and the limitation of hospital beds, all necessary in equipping the institution with the essentials of care needed to treat its patients in a time of crisis.

At the beginning of their academic careers in the health care system, the medical student strives to take all the necessary steps in furthering their medical profession during these unparalleled times. Top organizations, such as the AAMC, are currently recommending a pause in clinical rotations, illustrating the hardship faced by third and fourth-year medical students during their pivotal years of education.

A new dilemma for third and fourth-year students will be the acquiring and attending of audition rotations. During these trying times, committees are seeking to adapt by accommodating for the lack of opportunities by delaying applications and lessening the required amount of away rotations. A specific example of these guidelines can be seen by the Advising Student Committee of Emergency Medicine (ASC-EM), which has recommended a substantial reduction in EM rotational spots for applying students. These guidelines recommend that students without a home program limit themselves to no more than two away rotations, and those with a home program are recommended to visit only one away rotation. These current guidelines put constraints on the ability of the medical student to stand out against one’s peers in an already competitive field. These proposals have caused an ethical dilemma to medical students going into their fourth year by limiting the number of rotations they may choose to participate in.

The student is faced with a simple choice that is not straightforward: to follow the suggested guidelines in order to respect other students in the same predicament or to pursue all necessary possibilities to advance their chances of attending their ideal residency.

Here lies the issue: How can one choose between one or the other? On the one hand, a student who may not be a strong applicant on paper may deem it necessary to do as many audition rotations as possible in order to maximize their chances in an already competitive field. Students must illustrate their ability to the residency program director and what better way to do that than in the face of a pandemic.

On the other hand, the student can uphold the ethical principles of the guidelines by shaping an even playing field during a time of deprivation with the trade-off of limiting their exposure with medical professionals in their chosen field. During this time of difficulty in the medical community, the student wants to respect their colleagues and do what is best for all. What can be done in this situation?

This difficult situation is not just limited to the emergency medicine field; other fields are also facing a similar situation with altering their guidelines. Elective surgical specialties may not take students at this time or even applicants for the upcoming year. One example is the PCOM Orthopedic Surgical Residency, who has deferred all elective rotations and will not take part in the NRMP match until the end of the 2020-2021 academic year. This suspension of elective rotations will make fields even more competitive and feeds into itself by making elective audition rotations even more imperative to gaining the respective residency position.

Otolaryngology societies such as the Society of University Otolaryngology (SUO), Association of Academic Departments of Otolaryngology (AADO), and Otolaryngology Program Director Organization (OPDO) have stated they understand the difficulty COVID-19 has placed on students. Their recommendation states that students should try to limit sub-internship rotations at away facilities and instead to rotate at a home facility. In regards to letters of recommendation, they will acknowledge that some students are unable to obtain otolaryngology‐HNS faculty letters, and this will not bias their judgment towards candidates who decide to take fewer audition rotations.

Though medical students are currently faced with these ethical dilemmas, ultimately, we must work together to find an optimal solution so that we can maximize both our education and opportunities to get into the field of our choice. To obtain news about the current fluctuating residency program status visiting, we suggest the AAMC specialty information for up to date information.

Amit M. Khan, Javaid Afghani, Taner B. Celebi, and Zachary Scheid are medical students.

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