In 2010, experts in public health and health care, declared that health education is about improving the health of both individuals and of communities. The commission called for curricula designed for the education of health professionals to include causes of morbidity and mortality in their communities. The COVID-19 pandemic has added utmost urgency to examining health as it functions in and affects communities; academic health systems in the US have responded.
The COVID-19 pandemic is a source of disruption. It could also be a catalyst for the transformation of medical education, an issue and a need which has been smoldering for a decade. The physician workforce needed for the future must embrace the traditional competencies of professionalism, service, and accountability. It must also, however, incorporate competencies that suit today’s health challenges. These include population and public health issues; design and improvement of health care systems; incorporation of data and technology in patient care, research, and education. Health care disparities and discrimination must be eliminated. Across the country, medical schools have embarked on curricular redesign, but the pace of change is slow. It is constrained by trying to balance time among many important subject areas, both traditional and contemporary.
The onset of the COVID-19 pandemic required a colossal and immediate response from public health authorities to minimize the catastrophic spread of the disease. Medical educators at national and local levels outlined concerns and offered guiding principles to academic health systems. They stated that physician graduates must be prepared to address current and future threats to community health. Each school responded differently, but common themes emerged.
Learners serve as ambassadors for facts about COVID-19, produce evidence reviews, and prepare public service announcements in different languages for diverse communities. Electives are being offered about testing, case characterization, and contact tracing.
The pandemic provides an opportunity for learners to realize the dynamic nature of medical knowledge and the importance of mastering key concepts in basic sciences, as well as how to respond to future novel problems.
Students are immersed in learning experiences, demonstrating the commitment that physicians make to lifelong learning. Basic, clinical, and translational scientists, epidemiologists, public health officials, health systems leaders, and frontline clinicians demonstrate how physicians with diverse skill sets can come together to solve complex health care problems. Psychology, sociology, and humanities are important for analyzing ethical challenges, such as rationing care, challenges of caring for patients in the presence of homelessness, food insecurity, poor access to health care, and for policy challenges which restrict personal autonomy.
A problematic aspect of education during the pandemic is the substantial restriction of clinical learning experiences for medical students. The shortage of personal protective equipment, limited testing abilities, and uncertainty about spread caused reluctance among medical schools to expose learners to potential infection. There were fewer patients with other conditions. Faculty and residents are coping with patient surges and have limited time for teaching.
Guided by their established graduation competencies, schools prioritize clinical learning experiences for students close to graduation, preparing them for the intern workforce. Some schools graduated students early so they could start working.
Core clerkships advance clinical knowledge through faculty-guided, remote learning strategies. These involve case conferences, didactics, and participation in video conferences of patient encounters. The traditional time-bound block clerkships have been shortened without lessening performance standards.
Many schools had to suspend their usual practice of offering visiting rotations for senior students. The inconsistent availability of visiting rotations threatened the use of rotations in the resident selection process. In response, educators recommended that residency programs eliminate the use of visiting rotations to select candidates for this residency cycle.
Principled decision-making, change leadership, and crisis communication are essential to the educational response to the pandemic. In response to the shifting environment, health professions schools share learning resources. Many schools hold daily learner town halls, using frameworks such as the Centers for Disease Control and Prevention’s Crisis and Emergency Risk Communication approach for providing up-to-the-minute information, acknowledging uncertainty, and demonstrating empathy.
Public health departments allow health care institutions to define senior students as essential so that they can complete their rotations and graduate on time. State governments use regulatory statutes to enable early medical school graduates to work temporarily in the COVID-19 responses. The Association of American Medical Colleges issued national guidelines for students’ safety but support deans of medical schools to modify the guidelines in accordance with local circumstances.
Medical students have accelerated their acquisition of the types of competencies that physicians need to respond to the pandemic and other complex problems in health care. These changes in medical education were needed for some time. There should be more changes in the future.
