The pandemic hit during a time of educational transition, as final-year medical students are preparing for residency, third-year medical students begin exploring their options for residency applications and preclinical students become ready to work with patients. With students being restricted in their contact with patients during clinical clerkships through at least the end of March, all those transitions may appear to be in flux.
“The only thing we can honestly say right now, because the situation is so fluid, is that students have to have some trust in the dedication of their faculty and administration and organizations such as the accrediting bodies and licensing boards,” said Kimberly Lomis, MD, the AMA’s vice president for undergraduate medical education innovations. “We will make this work eventually. All of these organizations are working actively to think through the downstream implications for students and to build systems to accommodate accordingly.”
The AMA has developed a COVID-19 resource center as well as a physician’s guide to COVID-19 to give doctors a comprehensive place to find the latest resources and updates from the Centers for Disease Control and Prevention and the World Health Organization. The AMA’s COVID-19 FAQ will help physicians address patient concerns and offers advice on key issues such as how to optimize PPE supply.
In terms of affected milestones and how medical students may reach them, Dr. Lomis and other stakeholders offered some insight.
Learning the science and art of medicine is a graduated process, meaning that whether it’s assessment or experiences, medical students often have to complete one milestone before they can embark on another. With clerkships being suspended at schools, per the recommendation of the Association of American Medical Colleges, there are fears that medical students could stall.
The Liaison Committee on Medical Education (LCME) is giving schools significant leeway to get creative with helping students accomplish required tasks. The LCME has developed guidance for schools. Changes that are possible could involve altering the delivery mechanism, such as taking classes like anatomy online, or changing the structure of a school schedule—repurposing elective time to ensure that core requirements are completed, changing the length of clerkships and changing assessment formats.
For students who are on the cusp of graduation and just matched with a residency program, early graduation to enroll in residency immediately has become an option. The LCME on March 25 offered guidance on how that could work.
Each medical school should “review its educational program objectives (EPOs), the learning objectives of its required courses and clerkships, and required clinical experiences and skills,” the LCME said. “If students have met these requirements and been assessed on these required learning objectives, they may be eligible for early graduation. The school should confirm the eligibility of each student with its Student Advancement and Promotion Committee.”
“A local [alternative] response to allow them to finish is very viable,” Dr. Lomis said of how schools will approach fourth-year medical students. “Each school will work diligently to enable students they believe are qualified to indeed graduate on time.”
For second- and third-year medical students, Steps 1 and 2 of the United States Medical Licensing Exam (USMLE) are key events. The National Board of Medical Examiners (NBME) has put the USMLE Step 2 exam’s Clinical Skills portion on hold, while Prometric, the organization that operates the testing centers at which the exams are administered, has announced that its facilities are closed for 30 days. For affected students, the NBME has offered to waive fees for eligibility period extensions and testing region changes.
These closures are unlikely to affect second-year medical students preparing for the Step 1 exam. If closures extend, with most students taking the exam in late April and May, that development could have a significant impact on when students take the exam.
Many medical schools give students dedicated study time in the weeks before the exam takes place. During those weeks, when possible, it’s best to try to stick to your study schedule, according to Christopher Cimino, MD, chief medical officer, Kaplan Medical.
Dr. Cimino also said students are going to have to acknowledge their realities. “No study plan is going to survive distractions,” he said. “The coronavirus is a huge distraction. Everybody has family members and knows people over 60. You need to recognize that that’s a real thing.”
Medical students want in on the action, but with clinical rotations suspended, opportunities for direct patient care are limited. Even without direct patient contact, there are still areas in which students can add value for a health system. Some health systems, for instance, are using telehealth to answer patient questions.
Jeffanie Wu, a first-year medical student at Vanderbilt University School of Medicine and an AMA member, says she and her classmates have worked with their administration to find ways they can offer their services. Two volunteer projects have emerged in recent days: one to help offer child care services to hospital staff, and another to work on a hotline that helps patients screen for symptoms of COVID-19 before they consider going to the hospital.
Wu has signed up to work at the hotline once it is up and running.
“We’re trying to help out in any way we can,” she said. “We are trying to decrease the fear that’s out there right now. By talking to people about the symptoms of COVID-19 and telling them what the virus is. Providing that information can be a service.”
With patient contact being suspended, students are not doing traditional rotation activities right now. The same can be said of visiting or away rotations. Typically done early in the fourth year of training, these might be key for current third-year medical students who view them as potential residency program auditions.
Away rotations require students to adapt to a new health system, and those systems are now under significant strain.
“If we do get local clinical options open soon I suspect that [away rotations] would be slow to follow until systems feel like they are back to normal,” Dr. Lomis said. “The advantage to starting up local rotations is that you have the medical students who know your system and can contribute and add value in a number of ways while better protecting their own personal safety. I anticipate GME [graduate medical education] programs will develop distance alternatives to interact with applicants in meaningful ways.”
Editor’s note: This article was updated March 26 to incorporate guidance issued by the LCME.