By Meredith Peck, D.O.
On March 17, 2020, the Association of American Medical Colleges (AAMC) issued the following statement: “The AAMC strongly supports medical schools pausing all student clinical rotations, effective immediately, until at least March 31.” This statement signified an overwhelming life change for medical students across the country.
COVID-19 has impacted all humans alive at this point in history. However, medical students occupy a unique position in the context of this pandemic. We are staring into a future that none of our mentors has seen before. There is not a generation of physicians alive that has experienced anything like this. We are prepared for a career in medicine, but are we prepared for a pandemic? Are we prepared for our patients to die because there is no treatment available to cure them? Are we prepared to expose ourselves to a deadly virus because personal protective equipment (PPE) is unavailable? Are we prepared for the societal, economic, and cultural fallout that will inevitably accompany a global pandemic? We do not have answers to these questions, but we do have our stories to tell.
We are prepared for a career in medicine, but are we prepared for a pandemic?
The Physicians for Human Rights (PHR) Student Program is an international network of medical school PHR chapters and asylum evaluation clinics. The program is led by a student advisory board (SAB), whose members are dedicated to the promotion of human rights and who have committed themselves to advocacy work in medical school. Three students from the PHR SAB spoke to us about the way the pandemic has changed their world:
- Shefali Sood is a third-year medical student at New York University (NYU) School of Medicine, where she has conducted extensive research on the implications of climate change on human rights and helped establish a student-run asylum clinic.
- Jessica Beer is a fourth-year medical student at Georgetown School of Medicine, where she held a leadership role in the Georgetown asylum clinic. She recently matched into Anesthesiology at Georgetown and is interested in pain management for refugee torture survivors.
- Michelle Munyikwa is a 2021 MD/PhD candidate at the University of Pennsylvania Perelman School of Medicine, and wrote her dissertation on refugees and asylum seekers in the United States. She was elected as the SAB’s co-director for 2020-2021.
Medical Student, Interrupted
The COVID-19 pandemic has affected medical students in all four years of training. Two years of medical school are generally spent in the classroom, reading biochemistry textbooks and memorizing muscles and nerves in anatomy labs. The remaining two years are spent in hospitals and clinics, learning patient care and management, honing physical examination skills, exploring different specialties in month-long stints called rotations, personal self-development, and applying to residency, the specialized training that follows medical school.
Shefali Sood was on a pediatric neurology rotation in New York when cases in the United States began to increase in early March. “There was a feeling in the air that a disaster was coming, and we were not adequately prepared,” she recalls. Remembering a specific patient, a child diagnosed with tuberculosis who needed management of her epileptic drugs, Sood says: “N-95 masks were already in short supply… [we] were unable to enter the patient’s room… we waved at the patient through the glass window and did our best to assess her neurological exam and function from 10 feet away.”
Medical schools across the country began to respond to rising cases in hospitals where their students were rotating. “At first, the school made changes to the kinds of patients we could see,” MD/PhD candidate Michelle Munyikwa explains. “No respiratory complaints, no going into rooms that required PPE, and definitely no seeing patients who were confirmed positive.” However, as the situation worsened, and the AAMC ended rotations, institutions drastically altered their curriculums. Sood summarized the NYU response: “For MS3 [medical school year 3] and MS2 students, the school cancelled all in-person elective and clerkship rotations involving direct patient care. The MS1 students are completing their pre-clinical requirements online and remotely.”
But moving medical education to online learning is not the same as moving a philosophy or math class online. Digitized medical education means no anatomy labs, no histology labs, no osteopathic medicine labs. The hands-on component of medical education was terminated.
Rumors circulated of medical schools graduating MS4s early to enter the work force. Eventually, Sood recalls, “it became national news that NYU Grossman School of Medicine allowed MS4 students who completed required rotations to graduate early and help on the frontlines.” This came as a shock to many students and demonstrated the severity of the crisis in New York: hospitals were so overwhelmed that they would take fourth year medical students who had not yet completed even the first year of residency to help lessen the toll of COVID-19.
Like the rest of the country, medical students experienced major life changes associated with social distancing and state shutdowns. Jessica Beer, who is married with two elementary-school-aged kids, describes the closing of her kids’ school coinciding with the cancellation of her Washington, DC emergency medicine rotation: “I was in a unique position watching the pandemic unfold in the U.S. from the front line…. [and in] what felt like the blink of an eye, I switched from being a medical student to being a homeschool teacher.”
In New York City, the epicenter of the U.S. COVID-19 cases, Sood was living in medical student housing and recalls “as my roommates began returning home, I was the only one in my apartment…it was very isolating.” Living across the street from Bellevue Hospital, Sood describes her new reality as “harrowing.” “You could hear ambulances pass every 20 minutes or so as cases began to build and could see triage tents and even morgues being constructed from your window.”
“Stay at home” orders came at a particularly devastating time for fourth year medical students like Beer. March 20, 2020 is Match Day, the day that every fourth-year medical student in the country learns of their acceptance into a residency program. Match Day is the culmination of three years of exhaustive work and knowledge acquisition followed by months of sub-internships, residency applications, and interviews. Traditionally, medical schools host a gathering and classmates open envelopes revealing their residency position together, in solidarity, after having weathered the joys and obstacles of medical school as a class. While Beer notes that her institution hosted a nice virtual match day, for many, the Match Day celebration was cancelled. A few weeks later, medical school graduations were cancelled as well. When asked what plans their institutions have for these celebrations, Sood replies “everything has been cancelled;” “Nothing! All digital,” says Munyikwa. Disappointment is an understatement in describing the loss felt by medical students who wanted to celebrate the culmination of the labors endured to earn their degree.
Poised to Serve
In the face of a global pandemic, U.S. medical students are torn. We chose to dedicate our lives to serving others, to ensuring our fellow humans co-exist safely and in good health. We want to be involved, but we are still students in many ways, very early in our training. We have all taken exams on infectious disease and been fitted for N95 masks, so we know enough to be scared. Sood is concerned about the continuation of her clinical years due to the lack of PPE and the direct supervision medical students require. Beer admits to feeling “torn about being on the sidelines” as she watches doctors and nurses she has worked with struggle and sacrifice in the face of COVID-19. Munyikwa, who is interested in a career in infectious disease, expressed feelings of “guilt for not being more involved or able to help.” Despite her fears about the lack of protection for health care workers, though, she says she would “go [to the front lines] if we were told to without reservation.”
Meanwhile, Beer has been volunteering with her hospital system’s telehealth efforts. Her team monitors patients diagnosed with COVID-19 after they are discharged from the hospital using an application where the patients can record their vital signs and symptoms to ensure no worsening or recurrence of disease. Sood has been continuing her education, taking online electives in ophthalmology and clinical anatomy in addition to research projects she can make progress on remotely. She has also been volunteering to notify patients by phone who tested positive for COVID-19, saying “I have chart-reviewed almost 500 patients to notify them of their COVID status.” Munyikwa has been keeping herself busy with “some combination of helping design curricula, flinging all my free time into my hobbies, fretting about residency, and cooking a lot.” She describes this as “the most unstructured time in my life in a long time.”
An Uncertain Future
When asked about their most pressing concerns for the future, students’ worries run the gamut. Sood says she is “very concerned about my future training and exposure to specialties and different fields….[The pandemic] is putting unnecessary stress on students who are missing out on this period of exploration.”
“My biggest concern on a daily basis is how tenuous our federal government’s response to this crisis has been and I worry that it is further eroding the fabric of our country.”
Beer, who is living out the pandemic in Washington, DC, states: “My biggest concern on a daily basis is how tenuous our federal government’s response to this crisis has been and I worry that it is further eroding the fabric of our country.”
As members of the PHR student advisory board, these students are acutely aware of the pandemic’s global impact. “My husband and I were both peace corps volunteers,” says Beer, “and so I worry for those in the developing world because I know this will be hitting them very hard.” Munyikwa, an immigrant herself, says “I am concerned about my loved ones who live abroad in countries with fewer resources.”
The future physicians of the United States know that treating patients is more complicated than ordering blood tests and prescribing drugs. Health is multifaceted, and medical students are taught that good health cannot be achieved without the cohesive functioning of all these factors. Although our lives have been uprooted by COVID-19, we know that many of our future patients have already endured more than we can imagine. Says Munyikwa: “While this is an unprecedented opportunity to share our political reality and support the most vulnerable among us, I fear that we will see instead more isolationism, xenophobia, and violence. I hope I’m wrong.” The world must come together during this time to build a stronger, more resilient global community. As future physicians, we have an enormous role to play in post-pandemic global transformation, and I believe we are up to the task.
Meredith Peck is a member of the 2020 graduating class of the Touro College of Osteopathic Medicine. She was elected the 2019-2020 PHR SAB co-Director after serving as the Touro PHR chapter vice president in 2017 and organizer of the 2018 National PHR Student Conference. She will be starting her residency in Anesthesiology at Maine Medical Center in June 2020.