HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.

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THE MAN IN A BLUE SARONG

I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.

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PATIENT “OWNERSHIP”

I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

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outweigh the educational benefits of student participation. This prompted University of Washington senior leaders to remove medical students from clinical rotations on March 16, 2020. To learn more about how COVID-19 is affecting our students and trainees, Drs. Gallagher and Schleyer conducted a brief anonymous survey and received responses from 316 third year and fourth-year medical students, interns, and residents in Internal Medicine and Emergency Medicine, and fellows in Pulmonary and Critical Care at that institution. These doctors learned that students and trainees felt anxious and vulnerable to COVID-19, and these fears were amplified for trainees serving on the pandemic’s front lines. Many students reported moral distress associated with watching patients be isolated from loved ones and be described feeling distant from patients while wearing PPE. Especially for fourth year students, apprehension about “being rusty” and maintaining skills that would be required when they began their internships shortly, loomed large.


The United States’ experiences among its medical students are similar with those in other countries. A British Medical Journal article(5) noted significant impact of the COVID-19 pandemic on final year medical students in the United Kingdom following a national survey. The overall conclusion of this study was that the impact on medical student education had been significant and particularly affected the transition from student to doctor. In this study, a total of 440 students participated per medical school from 32 out of 33 UK medical schools. The medical schools were represented throughout England, Scotland, and Ireland.


Almost all respondents to this study (93.9%) felt that the changes that had been made were necessary measures during this pandemic. There were 77.3% respondents that had electives canceled. Although these were disappointing to many of the students, they recognized that worldwide travel restrictions were necessary. The medical system in the UK is a bit different than that in the United States. Those students in the final year of medical education go on to assistantships, these are a transition from student to doctor. They noted that 25.5% of students had no change in their assistantship as they completed their medical education; 16.8% reported that their assistantship had been formally canceled, and 43% reported that assistantships were postponed. Further, 59.3% of students felt less prepared for their assistantships, while 22.7% felt much less confident. This is an exhaustive study,(5) and it is worth reading by medical students. The authors noted that the impact of COVID-19 on final year medical student education had been significant in the United Kingdom. Most students felt less prepared for beginning work as a doctor, and the disruptions to assistantships had a significant impact on preparedness. The authors opined those changes in force by this pandemic provided a key opportunity to evaluate alternative models of medical education and assessment, including novel online summative assessments.


Local Impact of COVID-19 upon the Training of Medical Students at UKCOM

The author of this article contacted Charles Griffith, III, MD, MSPH, Vice Dean for Education at UKCOM. He advised this author that all medical students had now been vaccinated, and there was sufficient PPE for all. The guidelines for M3-M4 UKCOM students are no different than for physicians. They will take care of COVID-positive patients with appropriate PPE, including N-95 masks with no restrictions. Thus, incoming students to the 2021-2022 M3 and M4 years will be function similarly prior to the pandemic with full attending and senior resident supervision. They will be allowed to function the same as physicians with-regard-to interaction with COVID-19 patients.


As the author has reported in a prior article in KentuckyDoc, he assists three M3 mentees and one M4 mentee at the UKCOM. Of course, this is by no means a proper statistical sample. They shared they have not been allowed to have face- to-face interactions with patients known to be positive for COVID-19. Thus, in general, they have missed most of the face-to-face interaction with COVID-19 patients. While they have been able to receive education through online video training, observing attending physicians at a distance and didactic lectures, this of course, is not the same in the third and fourth years as face-to-face clinical education and patient responsibility. However, this author believes that student safety was justifiably paramount and like most US and global medical students at UKCOM. Going forward, medical educators will have to individually judge Class of 2021 students entering residencies regarding their COVID-19 pandemic knowledge and skills and provide further training where needed.


References


  1. Lucia VC, Kelekar A, Afoniso NM. COVID-19 vaccine hesitancy among medical students. Journal of Public Health (2020); pp. 1-5. doi:10.1093/ pubmed/fdaa230. Online ahead of print. PMID:33367857
  2. Jain J, Saurabh S, Kumar P, et al. COVID-19 vaccine hesitancy among medical students in India. Epidemiology and Infection (2021); May 20: 149e 132. doi:10.1017/ S0950268821001205. Published online.
  3. Rose S. Medical student education in the time of COVID-19. JAMA (2020); 323: 2131-2132. Published online: March 31, 2020. doi:10.1001/ jama.2020.5227
  4. Gallagher TH, Schleyer AM. Perspective: “We signed up for this!” Student and trainee responses to the COVID-19 pandemic. New England Journal of Medicine (2020); 382 e96(1)-e96(3), June 18, 2020.
  5. Choi B, Jegatheeswaran L, Minocha A, et al. Research article: The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: A national survey. BMC Medical Education (open access), (2020); 20:206. https://doi.org/10.1186/s1209-020-02117-1        

Introduction

The COVID-19 pandemic has thrown our world a serious curve. The necessary focus of international physicians has been to care for patients and communities, because of the emergence of severe, acute respiratory syndrome coronavirus(2). This disease has disrupted medical education and will require intense and prompt attention from medical educators. This article is designed to share light on the global situations for our medical students, and lastly to explore the needs of University of Kentucky College of Medicine students from the Class of 2021. COVID-19, for the years 2020-2021 has had a profound impact upon medical students worldwide. It had the potential to affect students adversely throughout their educational process.


Global Impact of COVID-19 upon the Training of Medical Students during 2020-2021

The first COVID-19 tough pandemic issue to face medical instructors throughout the world was getting their students vaccinated. It is interesting that vaccine hesitancy has been a significant pressure point for moving students through their medical education in a safe manner. For instance, a recent research article from the Oakland University School of Medicine in Rochester, Minnesota notes that nearly all participants in their study of medical student attitudes about vaccination, revealed positive attitudes towards vaccines. However, when push came to shove, 23% of students at this institution were unwilling to take COVID-19 vaccines immediately upon FDA approval.(1) This was the first study the author could find about vaccine hesitancy among U.S. medical students.  

BY ROBERT P. GRANACHER JR., MD, MBA

Medical student education in the time of COVID-19 has been explored at the Perelman School of Medicine at the University of Philadelphia.(3) Dr. Rose notes that in response to COVID-19, medical education faculty have quickly transitioned the entire pre-clerkship curriculum to online formats that included content in the basic sciences, health system sciences, and even in behavioral sciences. Small group formats convene in online virtual team settings, and clinical skills sessions may occur online, or in some cases, may be deferred. Examinations have also transitioned to online settings. Dr. Rose concluded, “It is crucial that the academic educational community learns from the experience and prioritizes a forward-thinking and scholarly approach as practical solutions are implemented.” She also opined, “The COVID-19 epidemic may represent and enduring transformation in medicine with the advancement of telehealth, adaptive research protocols, and clinical trials with flexible approaches to achieve solutions.”(3)


Gallagher and Schleyer(4) explored student and trainee responses to the COVID-19 pandemic. These professors of medicine are associated with the University of Washington School of Medicine. Drs. Gallagher and Schleyer noted that the high probability that medical students in the hospital would be exposed to COVID-19 and the need to conserve personal protective equipment (PPE) seemed to

ROBERT P. GRANACHER, JR., MD, MBA

Robert P. Granacher, Jr., MD, MBA practices clinical and forensic neuropsychiaty in Lexington and Mt. Vernon, KY. He is a noted scientific author and past president of the Kentucky Psychiatric Medical Association. He is currently president-elect of the Lexington Medical Society and Clinical Professor of Psychiatry at the University of Kentucky College of Medicine.