Third-year medical students return to clinical activities June 1

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.