HealthMay 27, 2020

An entirely different, very frightening march madness: how Is COVID-19 affecting medical students?

By: Michelle A. Finkel, MD

An Entirely Different, Very Frightening March Madness: How Is COVID-19 Affecting Medical Students?

Typically, the National Resident Match Program® (NRMP) Match Day is a time of great pomp and circumstance for medical students. Across the country, medical schools hold big celebrations with colleagues, friends and family. However, this year's March 20 Match Day was conducted remotely at most medical schools via virtual meeting software, and no ceremonial envelopes were handed out.

Welcome to the frightening era of COVID-19.

The virus has affected medical students in a variety of ways, both curricular and emotional. Junior medical students are being excluded from the clinical environment just as some of their senior counterparts are being recruited to support an overwhelmed system. Here are a number of the recent developments.

Fast-tracking medical students

Matched fourth-year medical students are scheduled to start their residencies in July, so, in theory, they have basic clinical competencies. In Britain and Italy, some medical students have been "fast-tracked" to work in the hospital setting because of dire need, the New York Times reports.

No similar plan had been enacted in the United States until recently when, according to Time, New York University (NYU) Grossman School of Medicine announced it was allowing its fourth-year medical students to graduate early if they agreed to commence work as first-year residents immediately. Eligible medical students will need to meet all graduation requirements and voluntarily consent to work in NYU internal medicine or emergency departments starting in April. Just after NYU's announcement, medical schools in Boston began following suit, according to the New York Times. These unprecedented policies reflect an "all hands on deck" approach to caring for the high prevalence of COVID-19 patients in the New York City area.

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Suspending clinical rotations

In another bold move, on March 17, the Association of American Medical Colleges® (AAMC) called on member medical schools to place, at minimum, a two-week suspension on medical students' participation in any activities that involve patient contact, including clinical rotations. On March 30, the organization extended that date to April 14. The AAMC cited a need to educate students on COVID-19 and the conservation of personal protective equipment across the country as reasons for the proposal.

According to the American Medical Association, the AAMC has also asked medical schools to help their students seek alternatives to away rotations, clerkships scheduled in a location other than a student's home school. Under normal circumstances, these clinical experiences would help students explore other hospital systems before creating their rank lists for the Match. Consequently, some medical students worry that the inability to do away rotations might adversely affect their future residency choices by reducing their visibility as viable candidates to competitive programs.

Recommending housing changes and discouraging travel

Some schools have encouraged medical students to move out of their institution's housing complexes to live with their families for an indefinite period of time.

Administrators have also asked students who are planning domestic or international excursions to register with health services and are requiring students to alert health services prior to their return to campus after travel.

Suspending standardized testing

The National Board of Medical Examiners® (NBME) is currently seeking alternative delivery methods for the NBME Subject Exams, or the "shelf exams." These tests are typically administered with each clerkship rotation in group settings to assess medical students' comprehension of specialty subject matter and contribute to students' grades at many schools.

Additionally, as of this writing, the NBME has suspended one of its large qualifying tests: On March 16, the NBME put the United States Medical Licensing Exam ® (USMLE) Step 2 Clinical Skills (CS) on hold. A passing grade on CS is required for medical students to become residents. The test uses standardized patients to assess medical students and thus is not conducive to the current COVID-19 crisis.

Initiating virtual classes for first- and second-year lectures

Large lecture halls of drowsy medical students are a thing of the past for now. Medical schools around the country have moved to distance learning using videotaped lectures, virtual meeting software and remote problem-based teaching. Small-group curricula have been deferred, and tests are being conducted through examination software.

Managing anxiety

While many medical students are eager to be of service in this time of need, there are a good number who are understandably terrified about managing a dangerous, contagious illness without adequate training. Concerns about medical student depression and suicidality were prominent even prior to COVID-19: In 2016, JAMA published a paper showing that 27.2% of medical students surveyed were depressed, and 11.1% had had thoughts of suicide in the last 12 months. Now, compounding those issues of anxiety and depression are concerns about healthcare provider safety, especially in the setting of expected shortages of personal protective equipment.

While well-intended to maximize student safety and patient well-being, current changes to medical school curricula, programming, examinations, clerkships and graduation requirements are occurring at a dizzying speed. COVID-19 has upended medical student life from first- through fourth-year and will continue to do so for the foreseeable future. Whether medical students remain a vulnerable group in need of protection or develop into a resource to be tapped during a surge for this once-in-a-generation public health challenge remains to be seen.

Michelle A. Finkel, MD

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