How 2 osteopathic medical schools navigated the challenges of COVID-19

The COVID-19 pandemic posed great challenges for undergraduate and graduate medical education, as schools and programs adapted to social distancing guidelines. Thomas Cavalieri, DO, dean of Rowan University School of Osteopathic Medicine, shares how his school navigated these challenges while undergoing reaccreditation with the Commission on Osteopathic College Accreditation (COCA).

Nikolai Butki, DO, associate professor of osteopathic medical specialties at Michigan State University College of Osteopathic Medicine and the emergency medicine residency program director at McLaren Oakland Hospital, shares his experiences and observations teaching osteopathic medical students and residents during the peak of the pandemic.

How did medical education continue with social distancing guidelines applied?

Dr. Butki: As emergency medicine physicians, we are a social bunch who derive energy from each other and prefer to learn and train collaboratively in person. However, early in the pandemic after the first one or two residents and attendings tested positive for COVID, we realized that continuing to hold in-person training that could expose and potentially put out of commission most of our EM physician workforce at one time would be irresponsible.

In response, we quickly modified our education delivery to a virtual platform.  This generation of learners are quite tech-savvy. So both the learners and instructors picked up on the nuances of virtual education quickly to make virtual education both effective and efficient.

In emergency medicine, there is some training, particularly in training procedural skills, that just cannot be performed virtually.  To teach those, we would still meet in person, but we would train in small groups, mask up with our N-95s and goggles, apply social distancing protocols and sanitize our hands and equipment frequently.

Dr. Cavalieri: As with other schools, we had to find new ways to deliver the curriculum. For pre-clerkship students, we delivered the curriculum virtually. However, students did come back to campus for clinical skills learning, OMM and examinations. Following the guidelines from the CDC and Occupational Health, the number of students in any one area was limited and everyone was expected to wear masks and practice social distancing.

Third- and fourth-year students on clerkships were removed from their clerkship sites largely because there was not enough adequate PPE. Clerkship students participated in self-directed learning experiences and online learning, and many of them were able to participate in telehealth. This was a very challenging time because it is very difficult to teach clinical skills remotely or not in patient care areas.

What was the response to these changes?

Dr. Butki: Students and residents are highly skilled in self-directed learning from whatever source is available to them. Using virtual platforms, instructors can still demonstrate physical exam techniques, or pull up pictures or videos online of proper technique.

I know MSUCOM students are prepared with a strong foundational knowledge in physical exam techniques. So teaching or reinforcing these skills in clinical rotations virtually is not ideal, but can still be effective.

And students and residents still rotated in the emergency department. Our expectation is that students and residents are still able to perform physical exam techniques and procedures and apply medical knowledge to patient care in the ED, even if they obtained their education virtually. The expected outcome, students and residents functioning as physicians, was not lowered.

And there were some benefits to the virtual education. For residents, eliminating non-productive driving time led to an increase in domestic wellness. When attending virtual education from home, we could multitask domestic duties and education by throwing a load of laundry in before a conference or have breakfast with our kids right up until conference started.

Dr. Cavalieri: Our staff, students and faculty were under a great amount of stress. We worked collectively to offer a more supportive environment. We had two psychiatrists and one psychologist available to support our students through telehealth.

We also worked to have ample PPE for our students. We made every attempt to enhance communication among students and faculty. Student government leaders helped us be aware of students’ needs and concerns.

RowanSOM medical students were passionate about wanting to serve our community and address the impact of the pandemic. Students were integral in the success of the Rowan COVID Vaccination Center on our campus in Stratford. Through the volunteerism of our medical students, over 55,000 vaccinations were administered on our campus.

The vaccinations were administered to several vulnerable communities such as the frail elderly, those with special needs, homeless individuals and migrant farm workers.

During the six months of operation of our vaccination center, students learned the proper administration of vaccinations, many issues related to public health, interprofessional collaboration and team-based care. Their outstanding work was recognized by the New Jersey Department of Health.

How did the pandemic affect the COCA accreditation process?

Dr. Cavalieri: Our school underwent accreditations for both the additional location of our medical school and a comprehensive site visit. Because of the pandemic, both visits were virtual and went very well from a technical standpoint. We felt COCA was able to do an appropriate evaluation to see that we met the standards and elements of COCA. As a result, we received accreditation for our new campus and are thankful we received accreditation with “exceptional outcomes.”

Factors that contributed to our success included a strong network of high-quality sites throughout our state for clerkship, highly qualified basic science and clinical faculty, a brand-new curriculum offering two learning tracks and outstanding students who are passionate about wanting to be great osteopathic physicians.

What changes in medical education influenced by the pandemic do you anticipate continuing?

Dr. Cavalieri: I do believe as a result of the pandemic we will see more and more medical education being done remotely. The pandemic has also led us to do more telehealth, so teaching students how to manage patients through telehealth will be an important part of the curriculum of the future.

Dr. Butki: We identified some benefits to virtual education. We have already modified our education curriculum to categorize the educational activities that work well virtually, like Journal Club, and we can organize these all into a single day so once a month we can deliver education virtually, providing the best of both worlds educationally.

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