Lauren E. Powell, BA1, Will P. Bataller, BS, MS1, and Payton M. Miller, BS1
1 Virginia Commonwealth University School of Medicine,
Richmond, VA 23298, USA
ABSTRACT
As we plan the future of our medical education following the broad impacts of the coronavirus pandemic, we ask for guidance both in words of advice and modeling examples set forth by our residents and attending physicians. We seek to learn how to better express support to patients who have suffered. We also ask for direction in our medical education to follow, in our careers, and in applying lessons learned to the future of public health. Ultimately, our hopes are that during this unprecedented time our residents and attending physicians will model the phrase, “do as I say, do as I do,” through demonstration of empathy, knowledge, generosity, humility, wisdom, and dedication to the future of medicine to come.
The foundation of education during the first two years of medical school lies in knowledge from the past. Whether “past” is defined as research published within the past week, or knowledge shared from prior years, decades, or even centuries before, is widely variable; each piece is key to the development of medical student trainees. Frameworks that underlie medicine paint stories of the past, from Louis Pasteur’s 1861 germ theory publication, which set the tone for the study of infectious disease, to John Snow’s breakthrough research of the 1854 cholera outbreak, which provided the premise for our public health course. Medical milestones such as these hold featured slides in our preclinical curriculum, and there is no doubt that the multitude of clinical impacts, knowledge, and reflections from the novel COVID-19 will stand as lessons for medical students to come [1]. As three medical students entering our fourth year in the wake of this pandemic, our reflections are interlaced with hope, as well as concerns, over the future months and years of our education. We write this piece to call attention to the knowledge, skills, and insights we hope to gain from interactions with residents and attending physicians in the clinical experiences ahead.
A key tenet of medical education is to mold providers who possess maximal “doctor-oriented” traits, such as being evidenced-based, safe and competent, compassionate, reflective, self-directed learners, while resisting internalization of external pressures that may cause self-neglect, emotional detachment, or a debilitating work ethic [2]. The call to this duty is challenging, and our predecessors understand that mastery of said traits requires maximal effort and conscientiousness on the part of the student. As fourth year students embarking on this journey, we have created a list of goals that we hope to fulfill as we advance our education in these unprecedented, unforeseen and unpredictable circumstances:
Practicing empathy while acting as a source of reliable information for patients. While current research is heavily focused on understanding and combating COVID-19, an abundance of ever-changing information is available to patients at the click of a mouse. The ability to distinguish between fact, fiction, and everything in between is a valued asset at this time [3]. Conveying factual information while also being mindful of the physical and emotional distress a COVID-19 diagnosis may cause a patient is a difficult task for new providers. We are asking for your guidance and expertise in building fortified, trusting, and compassionate relationships with this new patient population.
Embracing COVID-19 learning opportunities and pandemic-specific teaching points. Anecdotally, each generation of physicians is shaped by the medical peculiarities that they experienced in real time. COVID-19 will be one of those distinguishing events for us rising senior medical students. We see before us opportunities to have difficult conversations with patients, to consider our local disaster preparedness, and to learn to safely innovate and allocate when resources are limited. From the physicians who came before us, it is our wish that you will reflect on these topics and share the pertinent wisdoms acquired from similar events during your own training.
Maintaining and developing fund of knowledge when clinical experiences are limited. Clinical apprenticeship has long been a cornerstone of senior medical student education. Thus far, this pandemic has tested students’ capacity to build upon practical knowledge in the setting of reduced clinical involvement, decreased availability of learning tools, and, in some cases, barriers to internet access. [1] Along with our peers, we pride ourselves on being lifelong learners. As such, we commit to taking responsibility for our personal educational growth during this uncertain time. However, we are requesting proper guidance to available resources, along with tried and true methods of retraining and reassessing one’s knowledge while developing new skills.
Advice in navigating the next steps of our careers. The effects of temporary suspension on medical school curriculum have been felt in virtually every aspect of students’ lives. Those of us who had hoped to complete away rotations, perform at a higher level on the second phase of our boards, and gain exposure to specialties not offered in third year curriculum find ourselves at somewhat of a loss. We ask attending physicians to assist us in minimizing the impact of these lost clinical and educational experiences. For our peers who were reliant on away rotations and improved board scores to be competitive for their desired residency program, we ask that those before us who have had circuitous paths to their specialty of choice share your stories and offer appropriate wisdoms and encouragements.
Defining and exploring the call of duty for physicians during pandemics. The role of a physician is fluid depending on the environment: at times of calm they may solely focus on the care of familiar conditions, while at times of crisis they may be working on the frontline for highly contagious and sometimes lethal pandemics. Some authors have explored or proposed utilizing incoming medical students as frontline agents to address shortages in public health workers during the pandemic [4]. As students, we are still in the process of learning what constitutes an acceptable role. The desires that inspired us to pursue physicianhood beckon us to the frontline, to fulfill our duty to serve patients. Our eagerness is hampered by thoughts that surely inflict providers senior to us, such as family obligations, awareness of our own mortality, and personal vulnerabilities [5]. Some of us with medical conditions such as diabetes and chronic lung disease may be more susceptible to infection or poorer outcomes, and others are considered less “at-risk”. At what point do we allow unease or discomfort to limit our willingness to work on the frontline, and if we can define that point, how do we retain our ability to assist patients in need of evaluation and treatment? We turn to the leaders in our fields to lead us by example in navigating these questions and uncertainties.
Conclusion
As we begin to plan our careers ahead, we ask for guidance both in words of advice and modeling examples set forth by our residents and attendings. Many senior physicians are already looking for ways to assist and offer guidance to medical students during this time and have found ways to provide these resources remotely and through modification of future curricula. We hope to build upon this communication through reaching out to students in a face-to-face setting when in-person lectures and clinical experiences resume.
The healthcare field and vast range of people touched by this pandemic will begin healing and recovering in the months and years ahead. We seek to learn how to better express support to patients who have suffered and to learn how to teach and provide patients with guidance. We also ask for your direction in our medical education to follow, in our careers, and in applying lessons learned to the future of public health. Ultimately, our hopes are that during this unprecedented time our residents and attending physicians will model the phrase, “do as I say, do as I do,” through demonstration of empathy, knowledge, generosity, humility, wisdom, and dedication to the future of medicine to come.
REFERENCE
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