It is odd to be an incoming medical student during this pandemic. Thousands of students in my position were preparing for this moment for years. And, while many of us received advice to relax and travel before dedicating ourselves to four-plus years of medical school education, unfortunately, COVID-19 forced us to stay at home.
Teaching anatomy during a pandemic?
The impact of virtual dissections on hard and soft skills
The idea of starting medical school online is a difficult one to swallow. Although many aspects of the first and second year of medical education can be completed online, there are portions of medical school education that are impossible to teach effectively virtually.
For example, many incoming medical students interested in surgery would love to experience anatomy dissections with a cadaver. Virtual dissections are seemingly a great solution to this issue with medical schools like the Kaiser Permanente Bernard J. Tyson School of Medicine already planning on utilizing these tools even before the pandemic. However, the tactual experience gained from feeling actual organs is essential for anatomy knowledge acquisition. No matter how advanced anatomical computer learning tools are, the images presented are still two dimensional; whereas using radiology and dissections together helps students begin to develop a 3D mental image of anatomy. This is important for developing a proficient visuospatial ability for minimally invasive surgery. Even if a student has no interest in surgery, developing a strong 3D anatomical mental image can help clinicians more appropriately interact with radiologists and surgeons.
The dissection of a cadaver also assists with the development of soft skills related to medical professionalism. One study reported that after first-year medical students completed their gross anatomy course, over 50% of them reported less anxiety surrounding death. Medical students also develop empathy through dissections. Dissections can oftentimes remind students of their loved ones that are ill and could remind them of their own mortality. Experiencing these emotions can be an avenue for a student to grow empathetically as a physician. Such an experience is visceral and almost impossible to experience through a computer screen. Removal of dissection will surely impede such a valuable learning opportunity for future physicians.
Medical School… from home?
Losing the hands-on exposure
Another avenue of medical school that will be lost in virtual school includes a loss of early clinical exposure. This is useful for practicing patient interactions. It also contextualizes the basic science we will learn during the early years of medical school. Several questions about the material a medical student is learning could be answered through experience. The removal of early clinical exposure removes this important method of learning medicine. Early clinical exposure also integrates the societal perspective of medicine. Being exposed to early patient interactions allows for students to encounter social diversity and develop social awareness. This allows students to be prepared for their clinical years. Without these early experiences, clinical years will be a larger adjustment for students and that could add more stress and fatigue.
Effects on medical students’ mental health
But the biggest loss by having virtual classes is the inability to interact with a cohort of like-minded students. Medical school is difficult for most students. In fact, there is a higher prevalence of depression among medical students compared to the general population. Additionally, students that lacked social support were more likely to have depression symptoms by the end of medical school. These facts alone underscore the importance of developing camaraderie between students. An isolated student has greater opportunity to blame themselves harshly for their struggles when they do not see other students struggle alongside them. This leads to further anxiety and poorer school performance.
Although online classes can try to develop online discussion opportunities it is unknown how well they substitute for in-person interaction. It might be easier to avoid the online opportunities compared to avoiding in-person discussion material. Students that are prone to social isolation may be further subjected to developing depressive symptoms. That is hard to replicate through Zoom lectures.
The good news is that most medical schools understand the importance of early clinical exposure for the development of excellent physicians. Although some schools like Harvard already decided to go fully virtual, other schools like Rutgers or Dartmouth are considering a hybrid approach. A hybrid approach is most likely the best option for medical school education during the pandemic that balances the safety and maximizes learning and camaraderie.
For most hybrid class approaches, lectures attendance will be reduced or eliminated and be replaced with an online or recorded version of the lectures. Students have already been increasing their use of online resources. Current trends recorded by AAMC have shown that a majority of medical students year to year have “almost never” attend in-person pre-clerkship lectures, while the number that attend in-person lectures “most of the time” have been decreasing. Medical students have also increased their use of online videos for their education 2016 to 2018. These trends would most likely still continue without a pandemic and it is likely that all students gain a lot from lecture recordings.
Most studies investigating the impact of online lectures in medical education in the first two years of medical school have found that most students are very satisfied with the resource. Most Hybrid lectures will still include the crucial in-person clinical components needed for effectively learning medicine.
Pandemic Changing the Landscape of Medical Education
The uncertainty of medical school’s education plans is producing a great amount of anxiety for the matriculating class.
Current medical students are having issues scheduling their STEP 1 and STEP 2 board exams, which are arguably the most important medical exams in the United States. The United States Medical Licensing Examination (USMLE) has recently canceled one part of the STEP 2 exam, the Clinical Skills section, for the next 12-18 months. This calls into question whether or not this portion of STEP 2 could be canceled indefinitely after the pandemic is over. This year we already heard about the decisions from USMLE to transition STEP 1 to a Pass/Fail exam, so this would not be out of the realm of possibility.
Virtual residency interviews also make it hard for current 4th-year medical students to know if a residency program is right for them. This could be advantageous for students since future residency interviews may offer an in-person and a virtual option. This would drastically cut costs and reduce barriers to interviewing.
Hope for the future
Even with the numerous issues that the COVID-19 pandemic has presented, this pandemic provided medical students the opportunity to empower themselves to fight against COVID-19. Students from all over the nation are babysitting for physicians, sewing cloth masks, contact tracing, and more to help stop the spread of this virus. This pandemic has shown me, and hopefully other incoming students, the influence we all have. Even if we are not physicians yet, we can still leverage our current skills to assist communities and hospitals with the tools they need. My hope for the class of 2024 and beyond is to leverage these grassroots efforts to not only help with the treatment of COVID-19 right now but to also tackle other persistent health issues once the pandemic is behind us.