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I’m a fourth-year medical student. I don’t want to graduate early.

Erin Aldag
April 14, 2020

Medical students who are a few weeks from graduation want to help out during these tough times. But deploying to the front lines during the COVID-19 pandemic could have serious implications for our mental health and long-term careers, one student argues.

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Fourth-year University of Colorado medical student Erin Aldag delivers donated meals to doctors and nurses in the UCHealth University of Colorado Hospital before the night shift one day last week
Fourth-year University of Colorado medical student Erin Aldag delivers donated meals to UCHealth doctors and nurses before the night shift one day last week.
Courtesy: Fourth-year student Megan Perez

Editor’s note: The opinions expressed by the author do not necessarily reflect the views of the AAMC or its members.

In New York, Massachusetts, Oregon, and elsewhere, fourth-year medical students are graduating early to help fight the pandemic. We need more physical bodies to help with the overwhelming number of patients with COVID-19, and those of us who are soon to be first-year interns have the knowledge to step in to help care for lower acuity patients in order to take some of the burden off more senior providers. None of us are arguing that we cannot help out. But the unspoken truth is that fourth-year medical students are worried, not just about the next few months, but about what this means for the rest of our careers.

When I asked our deans about the possibility of graduating early, I was told that if we got to that place, it would be voluntary. No one would be required to graduate early, apply for a provisional medical license, and start working. But realistically, how many medical students will say no? Will they be judged harshly (silently or cyber-ly) by their peers? Will they be seen as selfish in this time of great need? These are highly motivated young adults who have chosen to enter medicine to help heal and protect the health of their communities. Medical students will step up to the challenge. But who is watching out for the wellness of new doctors? Are we stepping up to help others at the expense of our own wellness, future productivity, and future patients?

None of us are arguing that we cannot help out. But the unspoken truth is that fourth-year medical students are worried, not just about the next few months, but about what this means for the rest of our careers.

A study in the Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal explored the long-term effects of working during the SARS outbreak in Toronto. Health care workers were found to have significantly higher levels of burnout, psychological distress, and post-traumatic stress. It isn’t hard to understand why. They were working long hours, with scared patients, in an environment filled with challenges. Every day they faced the threat of contracting the infection. They worked harder, longer hours and found that friends and others in the community avoided them because of the work they were doing.

This pandemic is undoubtedly going to affect the mental health of health care workers. I am worried that members of my profession, who are already struggling to fight burnout and high rates of suicide and depression, are now facing a new danger to their mental health. Still, health care workers are pulling through, showing up, and saving lives — because that is what is needed, and because that is what we are trained to do.

As fourth-year medical students, we have spent years training to get to this point — the point where we can finally call ourselves “Doctor” even knowing that we still have three to five years of supervised training during residency ahead of us. These last few months of medical school typically serve as a rest period: an opportunity to be able to stop, take a breather, and look back on that crazy steep hill we’ve just climbed. When you climb a mountain and feel tired and overworked, you stop, look back, and see what you have already accomplished. Better yet, you look back with your hiking partners — your fellow medical school graduates — and say, “Look how far we have come!” This serves an important purpose — it keeps you going and provides motivation: I can keep going because of how far I’ve come.

Right now, during this pandemic, we are not looking back to see how far we have come. Our Match Day ceremonies and commencements have been canceled. Weddings, vacations, final classes with our peers — they’ve all been canceled. We are not celebrating our accomplishments. Instead, our class is pitching in by passing out personal protective equipment, bringing meals to health care staff, packaging meals at food banks, calling seniors and patients isolated at home and in hospitals and long-term care facilities, waking up at 4 a.m. to virtually help intensive care unit providers organize data from their patients’ charts, and more. Some of us have stepped up to help organize the entire COVID-19 student response operation.

While we are busy helping our communities, there is talk about having fourth-year students graduate early and jump in, right now, to a system that may not even be ready for us. Our mentors are overworked. Nurses and other health care team members are overworked. The battle is still raging fiercely, and our coach is looking to us, asking if we are ready to be put into the fight.

I am worried about my class’s mental health. I am worried about 10 years from now, when students from the class of 2020 are tired, burned out, and have post-traumatic stress from these early days of their careers. This pandemic is a marathon, and it will have a lasting impact on our careers as future physicians.

I am worried about my class’s mental health. I am worried about 10 years from now, when students from the Class of 2020 are tired, burned out, and have post-traumatic stress from these early days of their careers.

So, when you ask fourth-year medical students if they want to “go help out” by graduating early, please understand that the answer may be “no.” It is not because that student is selfish or lazy or afraid. It is not because we don’t care about helping people. Remember that we are just at the beginning of our residency training — with so much more to learn. We know this pandemic isn’t going away anytime soon. Right now, we are tired and worn down, and we might need a rest before continuing the climb. Even if it’s just a few months. And when we do jump in, we will be motivated, energized, and less likely to experience burnout 10 years from now.

So yes, some medical students are graduating early and jumping into the fray. The rest of us are eagerly awaiting the start of our residency programs in June and July. When that day comes, we’ll be ready.

Erin Aldag is a member of the class of 2020 at the University of Colorado School of Medicine and will be starting her PGY-1 internship in pediatrics at the University of Utah Health on June 10. Erin is currently serving as the MD Student Involvement Co-Chair of the University of Colorado’s COVID-19 Student Response Task Force.  

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