The pandemic brought some positive changes to medical education
By Alexandra Kenefake, MBS
The COVID-19 pandemic forced most medical schools to change their curriculum drastically in a very short period of time. Administrators cut in-person clinical training to the bare minimum, and shifted much of typically in-person learning to online learning. At first, most medical students worried that these changes would hamper our ability to learn necessary skills. Specifically, we were worried that the reduced clinical hours would decrease our knowledge. However with my increased study time at home, I have found myself more capable of mastering the management of my patient’s diagnoses, which I prefer to having many patients and no time to achieve mastery. Ultimately, many US medical students are pleased that the changes have led to savings in money and time, and feel relieved that we can now take sick time when necessary.
COVID disrupted the status quo of medical education. In 2020, away rotations, in-person interviews, and the STEP 2 Clinical Skills exam were cancelled. The average away rotation costs medical students $958; this additional cost can rise for more competitive specialties, like neurosurgery, to more than $2,500. (1) Away rotations are optional, but residency interviews are not. Traditionally, students have spent very large sums to fly to different cities for interviews. The AMA estimates that the average in person interview season costs $4,000, but ranges in cost from $1,000- 11,580. (2) This year, students completed their interviews over zoom for free. During the COVID-19 pandemic, the USMLE also decided to permanently cancel the STEP 2 CK exam, an exam that was only administered in a select handful of cities, and cost $1600.(3) However, this disruption is not without consequences. For many people, away rotations were vital to get a foot-in-the-door in competitive institutions, and many people saw their exams cancelled, even ones they needed to apply to residency programs. The cancellation of the STEP 2 CK exam upended the plans of thousands of international medical graduates who need to take the exam in order to apply to the residency match program. Personally, my STEP 1 exam was cancelled 6 times before I was able to take it last summer. Although there was some disruption, it is my hope that this disruption will help us to reduce costs for future medical students by realizing change is practical and possible.
Not only is the move to online interviews saving money for medical students, reports have even shown improvement in online learning. Since the pandemic started CSE, NBME exams, and performance evaluations have all improved. (4) Past studies have also endorsed that online education results in similar or better outcomes on exams (5). According to numerous studies, success in medicine, pre-medicine, and college admissions testing is linked to family income more strongly than anything else (6,7,8). The high cost of testing and test-prep courses throughout pre-medicine and medicine makes colleges less accessible and less equitable, ensuring that families with the most money get the most opportunities. By reducing facilities costs dramatically through online learning, there is now an opportunity to reduce tuition for future medical students.
Additionally, students were previously discouraged from taking sick days during medical training; they are now encouraged to be cautious and not come in if they are unwell. Attendings and other faculty expected students to show up ready to perform at top levels, no matter the personal toll it was taking prior to the pandemic. Students rarely scheduled doctors appointments during working hours, even though we see patients during the day. Family events are approved for time off depending on how important they seem to the administration, and if you ask for time off you are not seen as a team player. During this pandemic, I have seen this attitude dramatically shift. Instead of being told to “miss as little as possible” by the administration, I was encouraged to take time off if I needed it. I was also given a specific absence policy by my medical school that allowed me to take time off for appointments, family events, or mental health no questions asked. Our Preceptors and Course directors also mandate that we don’t go in if we are sick, and encourage us to take as much time as we need.
Numerous studies report that the average medical student should expect their mental health to be adversely affected by medical school. (8) The high cost of medical school and the emotional toll of denying sick days and time off for mental health and doctors appointments prior to the pandemic certainly had a negative impact on mental health.This problem was intensified during the COVID-19 pandemic, as students had even more to worry about. In my school, and many medical schools throughout the country, mental health resources were not only offered but actively promoted. One could argue that this was needed for medical students all along, and I hope it stays.
It’s hard to find a silver lining to the COVID-19 pandemic, but it did force major disruptions in medical education. With that disruption, there are several opportunities for us to grow and change. I hope that this spirit of innovation forced upon us by COVID-19 will help us to create a more equitable, accessible, and kind future for everyone in medicine.
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