Learning curves

How COVID-19 has changed medical education for these trainees

Two DO students and a fellow reflect on the twists and turns of 2020 and their medical training during a global pandemic.

Matthew C. Meranda, OMS IV, was sailing smoothly through his medical education when the COVID-19 pandemic suddenly sent a rogue wave crashing his way.

Seemingly overnight, in mid-March the DO candidate was forced out of a patient-centered clinical education and on to an online platform that offered few, if any, opportunities for human contact.

The transition was challenging, but Meranda, a member of the AOA Bureau of Emerging Leaders and immediate past student representative on the AOA Board of Trustees, made the best of his situation by finding ways to connect the components of his online education—such as test questions, prepared patient presentations and online lectures—to real patients.

In-person rotations started up again for Meranda, who attends Michigan State University College of Osteopathic Medicine, at the end of June. The transition back to in-person training was welcome, but also rough in its own way, he says.

“There was a very steep learning curve to get back to being in the hospital, dealing with medical charting,” he says. “But after a week or so, it was kind of like riding a bike. In COVID times, you’re wearing a mask all the time, and there’s an emphasis on social distancing.”

Below, Meranda and two other osteopathic trainees share details about how the pandemic has impacted their medical education and their advice for training during uncertain times.

Diving in to online learning

Kathleen Lundeberg, OMS III, is another student who has adjusted to the new realities. When the pandemic hit, she was still in her second year at the College of Osteopathic Medicine at the Pacific Northwest University of Health Sciences, which moved to an online format.

Lundeberg was impressed with steps her school took to adapt, such as allowing students to watch videos from last year’s classes.

“Our professors were selfless and made themselves available via Zoom to answer any questions,” says Lundeberg, who is a second lieutenant in the U.S. Air Force Reserve and the American Medical Women’s Association military student representative.

Lundeberg’s school requires students to do a mock-OSCE before students move on to clinical rotations. The pandemic ended such patient-intensive encounters.

So, once again, the school adapted, switching to Zoom meetings where students make virtual presentations on patient cases.

“This was a great way to not only prepare us for clinical rotations, but also engage our clinical thinking,” Lundeberg says.

Clinical rotations during COVID-19

During her third year, which began recently, Lundeberg has so far been able to attend in-person clinical rotations.

“Depending on where students are rotating, if the hospital or clinic is accepting students, we are allowed to complete the rotation in person,” she says. “I do feel very fortunate to be in an area that has accepted students again. Some of my peers at other clinical sites are still doing online rotations, and it is not the same experience.”

Meranda says that, to his knowledge, in-person rotations are allowed again at the majority of clinical sites across the country, but their status feels very tentative.

“There’s a sense that rotations could revert back to being online again,” he says.

In addition, the pandemic has limited some students’ ability to do certain elective rotations. Meranda notes that an elective rotation he scheduled in Atlanta was cancelled because of the pandemic.

The experience of an in-person clinical rotation during COVID-19 likely varies greatly depending on the attending, the facility and the severity of the outbreak in an area, Meranda says.

Residency programs also impacted

Many residency programs were also required to transition to an online learning format.

Alexis Cates, DO, a fellow in medical toxicology at Albert Einstein Medical Center in Philadelphia, helped create a virtual curriculum for residents rotating in her subspecialty this spring. After three months of teaching via virtual platforms, programs at her institution resumed in-person rotations for residents at the end of July, she says.
 
“We do not currently have plans to go back to a virtual curriculum, but we are prepared for it if things change,” says Dr. Cates, who is also the immediate past postdoctoral trainee representative on the AOA Board of Trustees.  

In some ways, relying on technology opened new opportunities for postdoctoral trainee programs, she says. “Many invited guest lecturers from all over the globe to join their didactics,” Dr. Cates says.

Still, Dr. Cates says the pandemic has made it more challenging for residents to access some important avenues of learning.  

For example, the pandemic and stay-at-home orders initially kept many people out of the emergency room. That meant fewer patients for trainees to see, and fewer procedures to observe. While volumes are going back up now, they are still lower than they were before the pandemic, Dr. Cates says.  

“For postdoctoral trainees, a lot of teaching happens at the bedside,” she says.  

Advice

While these circumstances are challenging for trainees, they can still tap rich learning opportunities if they are flexible and committed to furthering their careers, Dr. Cates says.  

She says it is up to the students and residents themselves to make the best of the situation. “Put time into your education and training, whether it is bedside or virtual,” she says.  

She notes that residents have just a small period in their careers to learn in a residency environment.

“We should take advantage of having physician faculty willing to teach while we can,” Dr. Cates says. 

Lundeberg also believes flexibility is crucial when working with an all-online curriculum. Creativity is particularly important when learning things that do not lend themselves to online formats, like osteopathic manipulative treatment (OMT), she says.

“That has been the skill I have feared losing the most,” says Lundeberg, who recommends watching videos on different OMT techniques to keep them in your memory.

She also says students should not be afraid to ask for help. “That is the one thing that I have been so grateful for: the people in my corner,” she says.

Even small gestures—such as a friend who lent Lundeberg his login information for SketchyMedical, or another who offers regular support via FaceTime—can be a big help.

Meranda urges students engaged in online learning to create a home office or other space dedicated to studying.

“Clear away clutter,” he says. “Set up books and electronics as you would at the library, and limit distractions like TV or roommates and family members as best as you can.”

Meranda also urges students and residents to reach out to their health care peers. He recently sat in on a study session hosted via Zoom.

“Many of us were studying for different exams, but it was still helpful to be able to ask questions we weren’t sure about, or to vent when we needed to,” he says. “People could come and go as they pleased, but it helped to have that sense of camaraderie.”

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