
When Daniel Alban heads back to Florida State University (FSU) College of Medicine next week, the second-year student says heāll be excited but also somewhat nervous. Since COVID-19 ended his in-person classes months ago, so many aspects of medical education have changed ā from strict safety protocols to dramatically different modes of learning.
āThe upcoming semester feels like a test run for all of us, maybe even a bit of a mess,ā Alban says. āBut weāre up to the challenge. Students are resilient.ā
For months after COVID-19 hit, schools stopped many aspects of student involvement in patient care to free up faculty to focus on battling COVID-19 and conserve personal protective equipment (PPE).
Now, a new year is beginning. Though the virus is far from contained, experts note that medical education still needs to keep rolling forward.
Across the country, leaders in medical education are churning out creative ways to balance training future physicians with ensuring the safety of students, patients, staff, and communities.
Some schools have already launched the 2020-2021 academic year, and others will do so by September. An AAMC survey of 155 member medical schools showed that more than 80% of respondents plan to return third- and fourth-year students to required clinical clerkships by the end of August. The survey indicates that first- and second-year students, who generally receive less hands-on clinical training, will largely be studying online ā at least initially.
Gearing up for this school year has meant reconfiguring rooms for social distancing, boosting student supports, adjusting calendars to make up for lost time, and much more.
āThe upcoming semester feels like a test run for all of us, maybe even a bit of a mess. But weāre up to the challenge.ā
Daniel Alban
FSU College of Medicine
āSchool leaders are dealing with a puzzle, putting together the pieces to make sure students receive all the experiences they need,ā says Katherine McOwen, AAMC senior director of educational affairs. āThey know that without sound educational and safety decisions, students could suffer greatly.ā
Some decisions still lie ahead. Not all schools have figured out whether students will treat COVID-19-positive patients, for example. Others are watching local COVID-19 cases and PPE supplies to adjust educational plans accordingly.
Still, leaders say theyāve made great strides in understanding how to train medical students during a pandemic.
āItās amazing how much teaching we can do via Zoom. We also know much better how to teach students safely in hospitals and clinics,ā says Donna Elliott, MD, EdD, vice dean of medical education at the Keck School of Medicine at the University of Southern California. āThere are still many challenges, but August looks completely different from March.ā
Fitting the same educational pegs into new holes
As educators prepare for this school year, theyāve had to decide which students will return in-person ā as well as how and when.
Leaders say they intend to achieve the same fundamental educational goals, though they may use altered timelines and formats. For example, some clinical rotations will have an online component, such as watching morning rounds via Zoom or working with patients via telemedicine.
One top priority for leaders is ensuring that students finish clerkships that were upended when learning went virtual in March.
At Morehouse School of Medicine (MSM), last year's third-year students started their fourth year later than usual so they could first take could take a catch-up clinical skills boot camp. To avoid overcrowding clerkships, the new third-year students temporarily studied remotely, explains Ngozi Anachebe, MD, PharmD, associate dean for admissions and student affairs.
A similar bottleneck is being handled differently by Icahn School of Medicine at Mount Sinai (ISMMS). āWeāre allowing third- and fourth-year students in the same clerkships,ā says Michelle SaintĆ© Willis, senior associate dean for medical education administration. āThird-years are going to be training alongside more experienced students, so weāve been working hard to ensure a supportive environment for those newbies.ā

Another key concern is having enough non-COVID-19 cases to ensure a range of learning opportunities. āSo far weāve been able to manage,ā says Alma Littles, MD, FSU senior associate dean for medical education and academic affairs. āIt could become an issue as some of our affiliated hospitals decrease elective surgeries. If necessary, we may be able to move students from one facility to another.ā
Anachebe is not particularly concerned about numbers. āThe number of patients students can see likely will vary,ā she says. āBut Morehouse School of Medicine moved to competency-based education. That means students demonstrate they have certain skills rather than certain numbers.ā
As leaders grapple with educational issues, theyāre turning to resources from groups like the AAMC, including curricula for teaching remotely, guidelines for involving students in patient care, and webinars on returning to campus.
Theyāre also turning to students for their thoughts. At Albert Einstein College of Medicine, students are serving on working groups that are exploring how to accelerate courses, notes Josh Nosanchuk, MD, senior associate dean for medical education. āWe want to make sure we balance Einsteinās mission and our accreditation requirements with the evolving vision of our students,ā he says.
Zooming in on creativity
The toolbox for teaching medicine remotely contains elements created quickly last year as well as fresh innovations.
Popular options include step-by-step videos that teach skills like inserting an IV and virtual cases that provide numerous pieces of patient information so that students can hone their diagnostic abilities.
One thorny issue has been how to handle anatomy lessons traditionally taught using cadavers. Last year, schools often relied on sophisticated 3D software to replace dissection. Now that in-person training is an option in some places, educators have more options.
āYou canāt just move a traditional lecture online. Students would die of boredom if they sat home watching lectures all day.ā
Kevin Krane, MD
Tulane University School of Medicine vice dean for academic affairs
At FSU, leaders are planning to provide at least some anatomy education in person ā though in smaller groups. āWe think dissection is about more than being able to feel the physical structures,ā says Littles. āItās about the sacredness of interacting with the human body. Our students usually thank the cadaver as their first patient.ā
Keck is opting for a high-tech hybrid. There, faculty members will perform in-lab dissections while wearing body cameras, and students watching remotely will be able to experience different angles and degrees of zoom. āThe student will see exactly what the faculty member is seeing,ā Elliott says.
All the changes have required extensive faculty development, say those involved. At Tulane University School of Medicine, for example, educators have been taught to break Zoom sessions into smaller group rooms and encourage interactive conversations. āWeāve learned that you canāt just move a traditional lecture online,ā says Kevin Krane, MD, vice dean for academic affairs. āStudents would die of boredom if they sat home watching lectures all day.ā
Keeping students safe
Though much can be done remotely, educators say, some students must see patients in person, especially those getting closer to graduation.
At some schools, even first- and second-year students will gather, although generally in small groups, to practice the patient interactions, hands-on skills, and teamwork that are central to medicine.
So, leaders have been working hard to develop intricate plans to keep everyone safe.
Among the many challenges is figuring out how much COVID-19 testing is ideal ā and feasible. At MSM, learners will complete app-based health questions and have temperature checks before entering buildings, and all must test negative before returning to school. āI wish we could test frequently, but for now, weāll have random testing to make sure there isnāt a lot of infection,ā says Anachebe.
āThis pandemic is the kind of thing my generation only read about. Students need to learn this aspect of being a physician.ā
Alma Littles, MD
FSU senior associate dean for medical education and academic affairs
Adequate PPE is another issue schools must tackle. At FSU, for example, Littles learned from some of her local hospitals that they might have too little PPE to accommodate students. Her main campus quickly shipped out the needed equipment.
āSince we have access to PPE, weāre actually more worried about a surge [in COVID-19 cases] that would require faculty to shift obligations away from education and toward patient care,ā says Littles. āIf that happens, we may need to pull some students.ā But sheās determined to keep learners in clinics if possible. āThis pandemic is the kind of thing my generation only read about,ā she says. āStudents need to learn this aspect of being a physician. We want them to stay safe, but we want them to learn what this is like.ā
Safety also involves appropriate social distancing. Keck did careful calculations to figure out how many students could safely fit in certain spaces, for example, and ISMMS distributed iPads to reduce the numbers of students in computer lounges.
Meanwhile, experts say students themselves must step up. That means following school guidance and local rules, such as self-quarantining upon return from a hot spot.
āWe remind students to practice appropriate safety measures ā and not just at work but also outside school,ā says Krane. āWe emphasize that this is a professional obligation. Itās part of developing their professional identity as physicians.ā
A little extra help from faculty and friends
The school year entails much more than just didactics and clinical rotations. It also involves anticipating and addressing stacks of other student concerns.
Leaders are monitoring needs closely, particularly among students from communities hit hard by the pandemic. In a recent AAMC survey, more than 60% of schools say they are reaching out individually to students identified as at-risk for academic setbacks.
At ISMMS, leaders have been hosting weekly town halls so learners can get updates and ask questions. āAll of our senior team is on, and students can address any domain, from financial aid to curriculum,ā says SaintĆ©.
Housing is among the many concerns. ISMMS has been working to reduce occupancy in its 600-person residence hall to help prevent disease spread, SaintĆ© explains. Still, leaders there recognize that some students ā even first- and second-year students, who are studying 100% remotely ā may need a place to live.
āA person canāt necessarily study medicine in their two-bedroom apartment with their parents and siblings,ā says SaintĆ©. āWe set up a special process for anyone who felt their current environment was not conducive to learning.ā Once on-site, residential students have many rules to follow to help them stay safe.
Schools are also preparing to help students who do contract COVID-19 or need to quarantine if exposed. Keck will provide a quarantine space if students need it. Tulane has built time into the calendar so that students who have to quarantine can make up in-person learning later. In addition, schools are providing accommodations for students who are immunocompromised or live with family members who are.
āStarting medical school now has been very challenging for many reasons. Still, I believe all this is just another reminder of the reasons we want to become physicians.ā
Michael Hong
FSU College of Medicine
One concern emerges for many students: the risk of feeling isolated.
Given that reality, some schools have opted to provide occasional in-person social interactions. At Tulaneās orientation, students rotated through small gatherings in large rooms. āThey wore masks and lanyards with big photos of themselves and stayed socially distanced, but they were able to interact,ā explains Krane.
Other schools are trying their best to provide connection remotely. Alban, who is working as a teaching assistant, recently hosted a Zoom session for first-year students that covered key wellness domains. Heās also working hard to connect with first-years, who may find it easier to talk with a fellow student than faculty, he says.
First-year student Michael Hong appreciates the assistance. āMedical school is hard enough, but you shouldnāt have to do it alone,ā he says. āHaving a support system has been essential.ā
āStarting medical school now has been very challenging for many reasons,ā he adds. āStill, I believe all this is just another reminder of the reasons we want to become physicians. It also will help us advocate better for our future patients when theyāre going through challenging times.ā