The COVID-19 pandemic has veiled medical education and the future of medicine itself in uncertainty. As K-12 schools, as well as colleges and universities, struggle with how to safely educate students, medical schools face the added strain of training doctors to fight disease while simultaneously contending with a pandemic. How will they pull it off? And more importantly, how will they do it without compromising the quality of student doctor education? Medical schools appear to be embracing virtual learning, as well as socially distanced in-person training, with added precautions. But will fewer hands-on learning opportunities affect the quality of medicine? Remote medical learning Harvard Medical School is taking a hybrid approach. For its entering medical, dental, and graduate students, all courses will be remote. Harvard hopes for a return to in-person learning for new students in January. Returning medical and graduate students will still receive hands-on learning opportunities, the school says, adding it “will continue to closely follow institutional guidelines and public health developments.” Harvard medical students will not provide care for patients with confirmed or suspected COVID-19. The David Geffen School of Medicine at UCLA recently announced it would be changing its plans for the fall. The school says about 8% of fall courses will be in person or hybrid, with most courses taking place online. After Thanksgiving, “nearly all classes” will be remote. The school says in-person classes will mostly be “those that would be effectively impossible to offer remotely.” Students can borrow laptops, wifi hotspots, and other devices if they need them. Oregon Health & Science University (OHSU) in Portland is taking a similar approach, the American Medical Association (AMA) reports. School officials say med students will learn online through mid-September, after which officials will decide to resume in-person learning based on conditions in the area. OHSU is encouraging its students to move now, even though experiential learning may not resume until the fall. The AMA highlights several logistical challenges that medical schools must confront: Access to student services Transportation (especially important, since mass-transit has been eliminated or reduced in many cities) Community-building with physical capacity limits What about clinical rotations? Clinical training rotations bring about a new set of concerns for third-year medical students during the pandemic. Rotations were largely suspended at the behest of the Association of American Medical Colleges (AAMC) in April. The AMA has since issued guidance on how to keep these students safe, suggesting “reasonable accommodations” for learners who can’t participate, training students on effective PPE use, COVID-19 testing protocols, and covering students’ care costs if they contract COVID-19 from a patient. Despite the uncertainty, it appears the pandemic may be driving up interest in becoming a physician. The Boston Herald reported that MCAT registrations went up 463% on May 7, the opening day of registration. Testing centers, considered non-essential businesses, shut down during the pandemic and this may be a partial contributor. Match Day in 2020 was also a record-setter. According to the AMA, a record-breaking 40,084 applicants applied for 37,256 positions. More doctors-in-training would certainly be a relief to a healthcare system that is already straining under the physician shortage. The most recent AAMC projections say we’ll be short by anywhere between 54,1000-139,000 doctors by 2033. In the next decade, 2 in 5 doctors will be over 65. The organization notes that these estimates were made prior to the pandemic. “We recognize that COVID-19 is likely to have short- and long-term consequences for the nation’s physician workforce, including changes in the specialties physicians choose, the educational pipeline, licensure and reimbursement regulations, how medicine is practiced, and workforce exit patterns,” AAMC wrote in its 15-year outlook. Will the pandemic exacerbate or alleviate the problem? And how will this new age strategy for medical education impact the quality of tomorrow’s physicians? We have a record-number of matched residents, for example. But will they be as prepared, given the fact that their training was disrupted by the pandemic? History will inform us, but right now, some experts are speculating. Lawrence G. Smith, M.D., is the dean of the Donald and Barbara Zucker school of Medicine at Hofstra Northwell. Earlier in the pandemic, she wrote a Stat opinion about how she feels the pandemic will actually make doctors better. COVID-19 forced many recently graduated physicians immediately to the front lines, where they saw how the disease killed and disrupted. The result, she writes, will be increased empathy among doctors. An April report from the AMA highlights increased COVID-related stress on residents, even in specialties that normally fall far from infectious disease. This could not only develop more patient empathy, but also produce more well-rounded physicians. It’s also possible that the pandemic will create more supervision for residents. The Accreditation Council for Graduate Medical Education has said “any resident or fellow who provides care to patients will do so under the appropriate supervision for the clinical circumstance and the level of education of the resident [or] fellow. Faculty members are expected to have been trained in the treatment and infection control protocols and procedures adopted by their local health care settings.” Will this mean more interaction with attendings? The pandemic’s impact on physician training is something we won’t fully understand for years. However, no new doctor will escape its influence. TL;DR Med schools will be relying on virtual learning in the fall semester. Some may scale up the amount of in-person learning if conditions improve. The AMA is suggesting added precautions and oversights to keep students safe, including guidance on PPE and easy access to testing. It’s possibly that the pandemic may have increased public interest in the medical profession. Unfortunately, we won’t know for years if the pandemic improves or worsens the physician shortage. Source
