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Third-year medical students return to clinical activities June 1

Students paused rotations March 17 for safety and conservation of personal protective equipment

While little has returned to normal as the coronavirus (COVID-19) pandemic continues, third-year medical students returned to their clinical rotations June 1.

Third- and fourth-year students were pulled from their clinical activities March 17 to ensure their safety and to save personal protective equipment (PPE) that was in short supply as the pandemic spread. While the fourth-year students graduated on May 23, third-year students have spent the last 11 weeks replacing their clinical time with other learning activities, such as small group discussions with clinicians, online cases and self-directed learning.

Pamela Baker, PhD, associate dean for medical education, says that curriculum leaders had to make some decisions on how best to use the next month for third-year students. “We worked with our seven clerkship directors to identify the core experiences that students will need to complete. We’ve compressed the normal timeline to ensure that they start their fourth-year on time,” she says.

For example, students will take advantage of more evening and weekend time to obtain additional clinical experience. But there are a lot of unknowns heading into the students’ return.

“Patient mix and patient loads are some of the variables that are unknown,” Baker says. “A lot of hospitals are gearing up with patients, both in the inpatient and ambulatory setting so we don’t know what the clinical environment will look like. We’ll be monitoring it very carefully to make sure our students get as much clinical experience as possible.”

Students will be working in UC Medical Center, Cincinnati Children’s, Cincinnati Veterans Affairs Medical Center, Good Samaritan Hospital, Bethesda North Hospital and Christ Hospital.

“Our partners, such as UC Medical Center and Cincinnati Children’s, have been very receptive to the students returning and are partnering with the College of Medicine to ensure it goes well. They have been very supportive,” Baker says.

Phil Diller, MD, PhD, senior associate dean for educational affairs, says local health systems have been very keen on having the students return. He particularly pointed to many new community physicians who have agreed to work with students.

“Clerkship directors and coordinators have worked really hard to ensure that students have places to train. They were contacting their colleagues and friends and saying, ‘we really need your help.’ That kind of advocacy has allowed this to happen,” he says.

Diller cautioned that students will see a different environment when they return.

“One of the other new realities is physical distancing for rounds. Each of the hospitals is trying to accommodate and figure that out for our students. The other adaptation that people have made is the number of individuals from a team who can go in to see a patient to preserve PPE. Students will not be seeing COVID patients directly, they will not be involved in direct patient care with COVID.

“One of the things that is different is that they may not be physically present when some of things are happening as they normally would and may hear about them later rather than to be there in person. The camaraderie you develop with your team may be different and so how much you work closely as team may be different.”

For example, spending time in resident areas, which typically are small, might not be possible for students because of physical distancing, he says

“Part of the hidden curriculum that you just can’t have includes the impromptu, informal conversations where a brief teaching point is shared. Those will be a lot more limited now. There’s a lot of learning that goes on that way.”

Diller says they will be very attentive to student feedback and will be surveying students after the first week of their return to seeing patients. Educators will try to quickly assess what is working and what is not to address issues.

Students are very happy to return to their clinical rotations.

“I'm really excited. We've been seeing and hearing about all the great work health care workers have been doing during this pandemic. It will be exciting and a great learning experience to see this work first- hand,” says third-year student Mara Nickel. “Being without face-to-face patient interactions for months has really shown me that the most valuable part of our medical education is working with patients. We forget facts from books so easily, but it's hard to forget the names, faces and stories that went with the disease or medication, and those are the lessons we will carry forward in our career.”

Before the third-year students return to interacting directly with patients, they received additional training May 22 and 26 in using PPE appropriately and how to conserve PPE. Those sessions, conducted via WebEx, were led by Danielle Weber, MD, assistant professor, in the Department of Pediatrics. They also received supplies of PPE from the college.

UC Health's Deana Brown speaking with a UC medical student. Photo/Colleen Kelley/UC Creative + Brand.

UC Health's Deana Brown speaking with a UC medical student. Photo/Colleen Kelley/UC Creative + Brand.

Third-year students also face a different summer than what was expected before coronavirus struck. Last year, 72 third-year students completed a four-week away rotation at another institution, providing them an opportunity to work in an area where they are considering specializing. It also offers a sort of residency interview opportunity, Baker says. But this year, it is unlikely students will be doing away rotations due to the coronavirus pandemic. The College of Medicine will be offering away rotations only for students in special circumstances, for example, if they are interested in a program that is not offered at their own institution. . Some students are doing a virtual away rotation.

Students entering their fourth year in July also will be facing a unique situation with preparing for their residency match. Instead of visiting numerous programs for in-person residency interviews this year, due to the pandemic, all residency interviews will be conducted virtually. Last month the Coalition for Physician Accountability recommended that all resident interviews this year be conducted virtually.

“And that includes interviews with your own students. It’s to level the playing field as much as possible,” Baker says.

Aurora Bennett, MD, associate dean of student affairs, says that the college will be helping students prepare for their virtual residency interviews in numerous ways. These include teaching students how to conduct virtual interviews, how to light the room and set up the background. They also will do mock interviews with students so they gain experience doing interviews via their laptops. Residency interviews begin in late October and go through early January. Each student usually does 10 to 12 interviews, Bennett says.

While virtual interviews will eliminate the cost of travel and lodgings for students, the method may make it difficult for students to get a feel for an institution’s culture, facilities, faculty and residents. Programs also will be tasked with virtually displaying their best qualities.

“There are some concerns on both sides,” Bennett says. “The programs are worried that students will not be able to feel the culture, and for some residencies it is their people, their culture and their camaraderie that are strong selling points. So, they worry the students will not be able to tap into that. The students feel the same way. They’re wondering: ‘How much can I garner from a Zoom meeting versus having dinner and casual conversation with the residents and also to be able to show my personal characteristics in a computerized setting rather than in an in-person setting?’ Some are applying to places where they have never been so they are curious to see how much of a sense of that city can they get from whatever is available online. I think there is hesitation on both sides.”

Last year Eric Warm, MD, Richard W. Vilter Professor of Medicine and director, the Internal Medicine Residency Program, interviewed 386 students for 31 residency spots in internal medicine. He says the process of selecting the best residents is extremely important as half the residents he recruits annually into the program typically stay on faculty at the College of Medicine after their residency graduation.

The Class of 2020 faced different graduation requirements due to the pandemic. Among these were a reduced number of elective weeks, dropping from 32 to 24. The two-dozen-week total, though, is still more than the average number of required elective weeks for graduating medical students at colleges across the county. The national average is just less than 20 weeks, Baker says. The distribution of required courses also changed. Half the students’ credits needed to be in an acting internship or an intensive clinical experience while the other half needed to be general electives.

Most fourth-year students this year had already completed sufficient requirements to graduate when in-person learning activities paused March 17. Those students who still had to meet requirements managed to do so through alternative learning activities.

“These were short term changes and if we decide that some of the curricular changes we are making are actually working better, and we do expect that some are working better, then that would go before the full Education Program Committee for permanent approval,” Baker says.

Featured image at top: UC Health employees Alex Maus and Deana Brown speak with UC medical student Derrick Lin. Photo/Colleen Kelley/UC Creative + Brand.