Places We Go: Medical Students During COVID

Curriculum needs updating to unlock potential in case of unprecedented challenges like the pandemic.

Introduction

The role of medical students in clinical settings has changed significantly over the past two decades.  An erosion of once-robust participation in clinical care has occurred, in part, due to institutional concerns regarding liability, risk, billing and safety. [¹]

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While these are important and legitimate concerns, there remains an inherent obligation to adequately train the next generation of physicians, an obligation that feels lacking or goes somewhat unfulfilled in modern training programs.

Never has the balance of education with clinical care been tested so rigorously as during the COVID-19 pandemic.  At the start of the pandemic, the American Association of Medical Colleges (AAMC) recommended “medical students not be involved in any direct patient care activities.” [²]  Much was unknown about the virus and personal protective equipment (PPE) shortages were nationwide so this recommendation was made out of safety and practicality.

However, it created uncertainty regarding training competency and moral obligation unique to the modern medical student.  A sample of 741 medical students across the nation surveyed in the Spring of 2020 showed 38% believed they had a moral, ethical or professional duty to serve the population during the pandemic.

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Several other themes emerged. About  35% felt a sense of guilt being on the sidelines of a public health crisis and 61% had concerns about developing the necessary skills for residency.  Despite the uncertainty, 72% of medical students were able to find meaningful learning experiences during the pandemic. [^3]

This article will highlight three successful medical student-led initiatives that arose to fill healthcare voids during the pandemic.  The larger objective of highlighting these projects is to ask medical schools, professional and community organizations and hospital systems: how can the process that leads to such initiatives be interwoven earlier into the medical school curriculum to help students unlock their full potential during unprecedented challenges?

Personal Protective Equipment Re-Distribution, Med Supply Drive

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Med Supply Drive (MSD), a volunteer-run, 501(c)(3) non-profit organization, was founded by second year medical students at Georgetown University School of Medicine in mid-March 2020 to address the PPE shortage.

Med Supply Drive volunteers and airport staff loading gloves, hand sanitizer, and masks to be delivered to underserved medical facilities in Texas by a private pilot who donated his time and flight costs.

MSD used social media to engage medical and undergraduate students across the country and develop a vast national network of highly motivated volunteers.  Volunteers, via direct community outreach, were able to gather unused PPE from shuttered labs and doctor’s offices to re-distribute to emergency rooms, intensive care units and nursing homes in immediate need. In under a year, MSD donated over one million pieces of PPE nationwide and raised more than $15,000 through social media.

As the global supply chain to hospitals stabilized, MSD remained resourceful by obtaining PPE for long-term care facilities, homeless shelters, soup kitchens and public housing developments.  This outreach served minority and marginalized communities, often in low-income, low-access areas.

Med Supply Drive volunteers drop off gloves and gowns to a community healthcare facility in Yonkers.

As a further step to nurture prospective medical providers, the existing MSD team developed an eight-week virtual leadership course for high school students which outlined health inequities unmasked by the pandemic so students could recognize problems much earlier to then find earlier solutions.  The entire project was made possible with the simple recognition that smart, skilled and caring students all across the country were ready, willing and able to help.

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Flexible Student Clinical Experiences, Central Maine Medical Center

In mid-March 2020, Maine’s first case of COVID-19 was discovered at Central Maine Medical Center (CMMC). That same day, medical students were abruptly dismissed from all duties in the hospital and clinics.  The decision was a temporary measure to protect medical students from COVID-19 while preserving a diminishing supply of PPE.  During this interim period, students transitioned to entirely virtual rotations which included reading assignments, online videos and occasional didactics from attendings.  From the start, it was clear that virtual learning was not an adequate substitute for in-person experiences and students quickly developed concerns about the direction and quality of their medical education.

After two months of deliberation, medical students finally returned to their clinical rotations at CMMC.  Upon returning, traditional educational constructs were no longer the norm.  In addition to seeing non-COVID 19 patients nearly independently, students also now triaged and screened patients for COVID-19.

This allowed physicians to focus on the sickest patients in the COVID-19 units. In pediatrics, students acted as a liaison between admitted children and their families as COVID-19 protocol prohibited guests from staying in the hospital.  Although these new tasks felt daunting at first, they taught student skills necessary to adapt rapidly to changing hospital protocols and emergency scenarios while empowering students to take on new responsibilities to help ease the burden on physicians. This wide array of experiences at CMMC showcases how utilizing medical students outside the traditional scope can rapidly respond to changing needs.

COVID-19 Vaccine Administration to Underserved Populations, Jackson Free Clinic

Since 2002, medical students from the University of Mississippi Medical Center have run and staffed the Jackson Free Clinic (JFC), a free clinic for the uninsured, which runs every Saturday. At each stage of the pandemic, unique challenges arose in taking care of this underserved population.

Due to the safety concerns of in-person meetings, barriers to communication, information and technology were particularly magnified. Having been a vital part of the community for 20 years, JFC understood those barriers, particularly in regards to vaccinations. In early 2021, medical students created a program centered around bringing vaccine events directly to their patients.

Jackson Free Clinic hosts a Hispanic community health fair providing health screenings, community resources and COVID-19 vaccinations in Morton, MS.

The model for outreach to the Hispanic community was noteworthy for its many layers and success.  By partnering with family medicine faculty physicians, supervisors and trusted local community groups, such as Mississippi Immigrant Right Alliance and El Pueblo, vaccination clinics were held at community centers, small events, churches and grocery stores every week across the region.

Volunteer community members and native-Spanish speaking medical students were enlisted to provide translation services and trustworthy vaccine information. Through this program, medical students voluntarily served 400+ hours, held events in 10 towns and administered 1,800+ doses to over 1,000 individuals. These measures provided a model in Mississippi for future preventive health and mobile clinic outreach to rural medically underserved, ethnic populations.

Conclusion

These three initiatives serve as examples of the incredible ability our medical students have across the country to impact patient care in all four years of medical school.  From a sustained, creative PPE drive to modifying clinical roles to matching acute needs with an innovative, integrative community approach that provided vaccines, medical students have risen to the challenges of this pandemic at every turn.

It is worth noting how MSD started locally and created a template for a national program of medical student leadership – an infrastructure that remains untapped.  It is also important to recognize how an existing free clinic like JFC did the opposite.  They took their local infrastructure and knowledge to develop a template for vaccine outreach.  Both groups had a common denominator of a desire to contribute and used enhanced communication techniques aided by social media to accomplish their goals.

Leaders and educators in medical education should pay close attention to these achievements and recognize that re-imagining and strengthening the roles medical students should play in our 21st century healthcare system is long overdue.

While many medical schools offer unique grading, early clinical shadowing, free clinics and classes on social determinants of health, the pandemic has exposed a need to have an even earlier integration philosophy.

On day one, medical students should be given a list of ways to become a part of the social and medical fabric at their given institution and communities. [^4,5]  For example, a community service project or visit with local social workers or a nursing home could be a part of orientation.  The pandemic has shown that as medical professionals, we need to grow and strengthen our community ties in order to achieve better health outcomes.  We often ask residents in interviews why they like a given program or specialty, but we don’t ask potential medical students consistently why a given medical school appeals to them.

Perhaps, the question needs to be asked in interviews: ‘how do you see yourself fitting in and contributing to our community?’  By understanding what motivates a student, it is then possible to pair them up with appropriate mentors and ultimately, provide academic latitude to pursue impactful ways to contribute – well before the start of residency. The spirit of inclusivity and ingenuity has not been developed enough by medical schools. As evidenced by these three examples, when medical students are given this chance to shine the results are astounding.

References:

• Rose S. Medical Student Education in the Time of COVID-19. JAMA. 2020; 323 (21): 2131–2132.  doi:10.1001/jama.2020.5227.
• Miller DG, Pierson L, Doernberg S. The Role of Medical Students During the COVID-19 Pandemic. Ann Intern Med. 21 Jul 2020​​.  org/10.7326/M20-1281.
• Harries, AJ, Lee, C, Jones, L. Effects of the COVID-19 pandemic on medical students: a multicenter quantitative study. BMC Med Educ.  2021; 21 (14).  org/10.1186/s12909-020-02462-1
• Lin SY, Schillinger E, Irby DM. Value-added medical education: engaging future doctors to transform health care delivery today.  J Gen Intern Med.  2015; 30(2): 150-1.  doi: 10.1007/s11606-014-3018-3
• Gonzalo, JD, Dekhtyar, M, Hawkins, RE, Wolpaw, DR. How Can Medical Students Add Value? Identifying Roles, Barriers, and Strategies to Advance the Value of Undergraduate Medical Education to Patient Care and the Health System.  Academic Medicine.  2017; 92(9): 1294-1301.  doi: 10.1097/ACM.0000000000001662

Acknowledgements: Hannah Day, Georgetown University School of Medicine; Deepa Shankar, Rush University Medical College; Molly McGinnis, Georgetown University and Ritika Shrivastav, University of Virginia.