Online clinical training that can't be 'hands-on'
"It's a nightmare for medical students in the class of 2021." Jack Berg, a senior osteopathic medical student at the University of Kentucky, said.
After the March outbreak of C.pneumonia in the U.S., all students in clinical training were suddenly "kicked out" of hospitals. Berg revealed that in less than two weeks, almost all U.S. medical students' clinical training switched to online learning. "It was like we were on the Titanic that was sinking."
What worries Jack Berg so much is the critical importance of medical students' third and fourth years of clinical training in the United States. The third year is when US medical students complete their "core clinical practice," and the fourth year is when they train in key specialties based on their preferred specialties and career plans.
Megan Messinger, a senior medical student at Western University of Health Sciences who shares Jack Burger's concerns, said she has spent most of her time studying at home. She has missed about 400 hours of hands-on clinical training because of the outbreak, and "I feel like I've fallen behind on my homework."
Robert Kane, president of the American Association of Colleges and Universities Section of Osteopathic Medicine, said medical students are in a truly difficult position, with about a quarter of U.S. medical students pursuing doctoral degrees in osteopathic medicine, and that hands-on skills training, as well as training in the whole-body health of the patient, is as good as it gets.
However, at this stage in the U.S., even in hospitals and clinics that have resumed routine medical care, patients other than those associated with the new coronary pneumonia are largely absent from hospitals for fear of infection. In other words, even if hospitals allow medical students to return to the hospital for training, there are no patients "to see.
This has become a challenge for medical students participating in clinical training, according to Alison Hyland, chief medical education officer for the Association of American Medical Colleges. In addition, in areas with high rates of new coronary pneumonia, hospitals and other health care facilities don't have enough personal protective equipment for their regular health care workers, and medical students are forced to do their online learning at home.
Distance clinical training that is not hands-on is certainly the equivalent of "no training" for medical students, but the problem needs to be solved.
Association of American Medical Colleges Changes Clinical Training Guidelines
The Association of American Medical Colleges updated its clinical training guidelines for medical students on Aug. 14, before the start of the school year.
The AAMC argued that medical students can still travel to hospitals for clinical training during an outbreak, but that it is not necessary for medical students to be involved in daily patient care.
The AAMC recommends that medical schools do at least two things:
First, ensure that medical students have personal protective equipment. It is the responsibility of the hospitals affiliated with each medical school to have a PPE supply program that covers the needs of medical students and to ensure that the supply of PPE is available before medical students begin their clinical training. If PPE is required for the relevant position in a medical student's rotation and the department is unable to provide it, the medical student may not participate in any clinical training that involves direct patient contact or in any other course that involves patient contact.
Second, the amount of patients and supervising clinical instructors should be sufficient for medical students to complete their clinical training. Medical schools are required to provide effective safety measures to minimize the risk of neocoronavirus infection to medical students during their clinical training, and medical students are required to participate in clinical training that is recognized by the Council on Medical School Education as a "clinical skill that must be attained through clinical training".
Allison Hyland said the ability of students to graduate on time is critical to the growth of the physician workforce, but keeping students on track during an outbreak is also an ongoing and complex task.
Major U.S. medical schools, however, say junior medical students can still complete most of their clinical rotations as usual. By the time they get to the residency stage, they still have a lot of training and learning to do," said Art Papier, a professor of dermatology at the University of Rochester School of Medicine. I think the lack of clinical training due to the outbreak can all be made up."
A previous AAMC survey of 155 U.S. medical schools showed that more than 80 percent plan to "send back" juniors and seniors for clinical training by the end of August, while freshmen and sophomores will spend most of their time learning online.
Medical schools are also trying to figure out how to arrange for students to return to hospitals.
Six metrics determine whether students can participate in clinical training
Oregon Health & Science University Medical School resumed clinical training in late June, but because of the unstable situation with the outbreak, it was still uncertain whether it would be able to complete the entire academic year successfully. So OHSU developed six criteria to decide whether medical students should be kept at the hospital.
The six criteria were:
1. Patient volume. A hospital that does not have enough patient volume for treatment will not be able to meet the needs of medical student training. OHSU will consider discontinuing the clinical training of medical students if patient volume drops below 50 percent of what it was before the outbreak.
2. Ability to meet learning objectives, i.e., whether the clinical environment at this stage meets the student's educational objectives for clinical training.
3. the amount of clinical instructors responsible for supervision. For example, if all cardiac surgeons were quarantined due to neocoronavirus infection, students in clinical training in cardiac surgery would not be able to complete their training, in which case clinical training would also be discontinued.
4. Personal Protective Equipment (PPE) The OHSU monitors PPE inventory through a dashboard. If the stock of PPE is below a certain level and the supply is not keeping up, then the clinical training will also be discontinued.
5. Hospital conditions.60 percent of OHSU medical students do their clinical rotations at off-campus medical facilities. "These students are like guests at these medical facilities, and if the host says, 'Can't keep the guests, then these guests must go.'" OHSU Senior Associate Director of Education George Mejicano said.
6. Signs that a hospital is overwhelmed include the positive detection rate of hospital patients and the volume of existing patients with new cases of crown pneumonia. If those indicators are high, the governor of the state in which they are located may issue orders, including limiting the number of medical students participating in clinical training.
Unlike OHSU, the Icahn School of Medicine at Mount Sinai allows junior and senior medical students to participate in clinical rotations together. Michelle St. Willis, senior associate director of medical education administration at the medical school, said seniors with a year's experience can mentor junior "novices" and the two can learn from each other.
Florida State University College of Medicine, on the other hand, has chosen to use technology to provide "realistic" remote clinical training for medical students. For example, the university's medical school requires faculty members to wear a camera on their bodies, which can follow the faculty member's dissection angle during the dissection and transmit the dissection footage to students watching and learning from a remote location, to achieve the effect of students learning on the spot.
Daniel Alban, a medical student who will return to the hospital for clinical training, said all medical students are "guinea pigs" for the new school year's education and training methods, and the outcome of the experiment is unknown.
References:
1.KHN: MedStudents'FeelVeryBehind'BecauseofCOVID- InducedDisruptionsinTraining
2.AAMC: GuidanceonMedicalStudents'ParticipationinDirectIn- PersonPatientContactActivities
3.AMA:Medstudents:These6factorsdictateresumingclinicaltraining
4.AAMC: BacktomedicalschoolduringCOVID-19