Zooming Through Medical School

In Commentary, Opinion by Fiona RaymondLeave a Comment

We all know that medical school is a journey – but, honestly, during the pandemic it has felt more like a slog. In March of 2020, when the Covid-19 pandemic arrived, I was seven months into my medical training. After barely scratching the surface of medical school, I was nervous about what was to come.

I have now entered my third year of undergraduate medical education, with the majority of my pre-clerkship being online. Medical training is challenging no matter the circumstances, and the pandemic added layers of difficulty for both learners and instructors. Nonetheless, I’ve learned several important lessons. 

The Teaching & Learning Environment

The first lesson I can take away is the value of adaptability. Traditionally, medical education demands its learners be assertive, independent, and at times, intense. As medical education changed, so too did the demands on learners. Online medical education is prone to technical difficulties and unforeseen disruptions, and learners had to be flexible and accommodating in situations out of their control.

Online instruction also challenged the camaraderie amongst classmates. When presented with challenging topics, one of the most comforting moments is leaning over to your neighbour and confirming they are just as confused as you are. Learning online removes this companionship and intimacy. Without your neighbour’s assurance, part of you worries that maybe you are just not clever enough. An online environment cannot replicate the in-person interaction of the lecture hall, and no number of online chats can replace those comforting and commiserating debriefs. 

Administrators and instructors had to adjust to an online format as well as deal with increased and altered clinical duties. One of these adjustments was the delivery of our clinical skills curriculum; we moved from weekly in-person standardized patient interactions to weekly online standardized patient interactions, with minimal in-person sessions throughout. A surprise benefit of this is that many students learned how to interact with patients virtually. Throughout the pandemic, outpatient care was delivered via telehealth and virtual care.​1​ Online clinical skills education will prove to be valuable in future practice as virtual care will remain a mainstay of outpatient medical care even as the pandemic eases.​1​

Patient Interactions

A unique component required for medical education is patient interactions – which have been difficult to navigate during a pandemic. William Osler famously said, “[One] who studies medicine without books sails an uncharted sea, but [one] who studies medicine without patients does not go to sea at all.” Medical schools and medical learners across Canada had to adapt. 

When learning physical exam maneuvers, it is necessary to see the technique first-hand. Small elements, such as nonverbal cues or orienting yourself relative to the patient, cannot be appreciated virtually. In-person instruction and feedback are critical for learning how to recognize cardinal features of various presentations. Practice makes perfect might not be true, but practice undeniably brings confidence, and it will take some time to gain that confidence.

For learners interested in Emergency Medicine, it becomes difficult to gain experience and appreciate what that career looks like. You cannot replicate the physical environment, much less the mental load of juggling and prioritizing multiple patients at once without being in the middle of it. Ultimately this lack of patient interaction will be an added stress to those who will use their clinical experience to decide on this career path.

Balancing Uncertainty 

In a time where physician burnout is so high, this pandemic has served as a reminder of the importance of finding balance. As a busy medical student, it is imperative to prioritize activities that make you feel like yourself: for example, going to the gym, the movies, or socializing with friends. These activities are imperative for student wellness throughout medical education and to balance the stress of medical school.​2​ However, as the pandemic and medical school continued, many if not all extracurriculars could not. We lost some of our most reliable coping mechanisms, and our social support circles shrunk, seemingly overnight. 

It was a difficult adjustment period for a multitude of reasons. Many of us were away from home, there was uncertainty surrounding our education, and we feared a pandemic that was rapidly evolving. Eventually, new coping strategies emerged that fit into our lives. This meant prioritizing activities that were most important to us, such as being with loved ones when possible and virtual visits when not. It also meant stepping away from the news, or social media, and monitoring how that was affecting you. Recognizing that you are not okay is a strength, and many of us also had to give ourselves space in that regard. To foster resilience, we had to set realistic expectations. Exercising outside, ordering take-out food, and going to virtual classes in pajamas became standard for many of us. In hindsight, I can recognize our strength and ability to adapt to challenging circumstances. This strength will inform our coping strategies moving into practice.

Looking ahead

For a cohort of medical students who are now more familiar with the phrase “you’re on mute” than the sound of the hospital intercom system, clerkship is bringing a sense of uncertainty for many of us. Clerkship is a chance to solidify career goals, but for many, this year will be more of an exploration period and an opportunity to connect with mentors and faculty. Most importantly, it will be the chance we need to enrich our clinical experiences and immerse ourselves in patient interactions, which are imperative to our future success in medicine. 

Medicine is about lifelong learning, and there are many lessons we have benefited from throughout these “unprecedented times.” It is imperative to take with us that flexibility, and ability to prioritize our wellbeing. It also has given weight to patient interactions and experiences that we might have taken for granted before. As learners, we have adapted and risen to the challenges and will continue to do so.

References:

  1. 1.
    Wosik J, Fudim M, Cameron B, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957-962. doi:10.1093/jamia/ocaa067
  2. 2.
    Slavin S, Schindler D, Chibnall J. Medical student mental health 3.0: improving student wellness through curricular changes. Acad Med. 2014;89(4):573-577. doi:10.1097/ACM.0000000000000166

Featured image designed by Fiona Raymond. This post was copyedited by Casey Jones (@CaseyMAJones).

Reviewing with the Staff

It’s been over a year since Fiona (Raymond) and I were matched as mentor/mentee for the CAEP WiEM mentorship program. To say that we’ve shared an atypical experience together throughout the COVID pandemic would be accurate. I’ve struggled to support my mentee as I had originally planned – with numerous clinical observerships in the ER, meals at my house, introductions to trainees in EM, and more – as many of my activities had to be cancelled or significantly modified. Despite these challenges, however, I have witnessed my mentee (Fiona) persevere with maturity, positivity, and a renewed commitment to undergraduate medical education as her clinical clerkship is about to start. Her blog piece is a testament of her spirit. Keep it up Fiona! It’ll serve you well for the next 30yrs+ of your career.

J Damon Dagnone
Dr. J Damon Dagnone is an Associate Professor of Emergency Medicine at Queen’s University. His main research areas include competency-based medical education, simulation-based assessment, and the medical humanities. In 2018, Damon published his first book “Finding Our Way Home: A Family’s story of life, love, and loss” about losing his son to cancer during his last year of EM residency training.
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Fiona Raymond

Fiona Raymond

Fiona is a third-year medical student at Queen’s University. She is interested in emergency medicine, rural medicine, and medical imaging. When not at school or the hospital you can often find her out playing soccer or cooking up a big pot of pasta!
Fiona Raymond
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Fiona Raymond

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