Assessing COVID-19's Impact on Clinical Education of Osteopathic Medical Students

Hello. My name is Dr Elizabeth McMurtry, and I am

the assistant dean for clinical education and faculty development at

Pacific Northwest University.

We're going to be covering assessing covid 19 impact on

the clinical education experiences of osteopathic medical students.

We're going to start with some context for the impact

Covid has made on undergraduate medical education.

Review the project.

We, as investigators undertook to address some of the gaps

and describe implications for the future of medical education in

a post covid world.

Covid 19 has affected the education of the nearly 90,000

medical students across the United States as healthcare organizations, medical

schools and their staffs responded and adapted to the demands

of a pandemic of unprecedented proportions.

Interruptions to clinical rotations, changes in guidelines for hands on

patient care, interaction and increased pressures on precept Ear's will

lead to gaps in medical school education that will have

long term implications for developing medical leaders.

We will discuss possible implications of those changes as well

as opportunities to fill gaps and improve the quality of

medical, educational and leadership experience for students, faculty and patients

alike. But first, let's take a look at our past

pitching in during pandemics and wars can provide medical students

opportunities to accelerate their real world knowledge, building their grit

and professional identities.

Looking back at history, we find examples of this.

With many hospital staff assisting war efforts, overseas students shouldered

the burden of care for overwhelming numbers of patients.

During the 18 19 influenza pandemic, Dr Isaacs Star published

a dramatic narrative of his experiences as a third year

medical student.

During the six week surge of influenza cases in Philadelphia,

he performed duties as a head nurse, working eight hour

shifts, while fourth year students acted as interns, functioning above

their training level to manage the death and disease all

around them.

During World War Two, the U.

S government encouraged medical students medical schools to create three

year accelerated programs to address physician shortages, including increased class

size and relaxed admissions requirements to expedite medical education.

And then there was the polio epidemic in Copenhagen.

In 1952 medical students, nicknamed student saviors, were an integral

part of an experimental approach to managing respiratory failure associated

with polio.

The students saviors worked in six hour shifts for many

weeks to ventilate patients by hand, decreasing mortality rates for

respiratory failure from 87 to 31% and saving 100 and

20 people.

More recent outbreaks, such as SARS and Ebola, have hit

front line personnel.

Hard. High case fatality rates among health care providers leads

to new assessment of risks.

And with these memories, fresh academic medicine and health care

systems responded differently to the Covid 19 pandemic.

So what was different this time around?

The national clinical pause from March 17th through May 4th

of 2020 was a pause on student participation in clinical

activities. It was intended to provide medical schools and partner

clinical sites some time to develop and implement programs to

educate students and prepare them to safely return to clinical

settings in transitioning classes and rotations to online formats.

Medical schools hope to promote social distancing, limit the risk

of students contracting the virus, limit the exposure to health

care workers, minimize the teaching burden on frontline providers and

preserve precious PPE.

So what was different this time is that medical schools

prioritized patient care provider safety and pandemic control over student

learning. Our goal with this project was to conduct a

quality improvement project to assess and address changes to clinical

medical education delivery brought on by pandemic conditions.

We included a question in Precept ER and student post

rotation evaluations about the impact of Covid.

19. On clinical experiences conducted a focus group with Precept

Ear's collected, detailed information regarding challenges with reintegrating students back

into clinical spaces.

And then we delivered an intervention a clinical precept er

education session via zoom with pre and post event measures

of precept er, awareness and comfort in adapting students clinical

roles. Post rotation evaluations were sent to 349 faculty and

474 student rotations, with a response rate of 67% and

47% respectively.

Nearly half of faculty and students indicated that experiences were

not significantly altered, or that PPE utilization was really the

only change, diving deeper into the major changes.

While only 6% of faculty and students were concerned about

long term impacts of limited student participation, 26% of rotations

band students from important settings like the emergency department, development

of clinical reasoning was compromised as 9% of faculty and

5% of students reported that students were not permitted to

care for patients with fever or upper respiratory symptoms.

When in office visits were conducted, physical exams were often

abbreviated or not performed.

Students appreciated remote rotations, especially in disciplines like radiology and

ethics. And finally, telehealth utilization increased significantly, augmenting student learning

opportunities and offering increased health care access to rural and

underserved populations.

The faculty development session students as helpers during pandemics, provided

tools for addressing the identified gaps in education before the

session. 25% of Precept Ear's rated themselves as comfortable or

better with these activities, and after the session, this rating

improved to 85%.

The pandemic raises implications for both skills and values development

in the next generation of physicians.

So what happens when precept Ear's face significant and sustained

challenges? Well, the lack of supportive participation results in lost

learning opportunities, clinical services and workflows changed things like reduction

in work hours and elective procedures and the shifting use

of sick and well patient areas altered workflows.

The overall result was that students gained less experience with

core skills, had fewer patient interactions and expressed uncertainty about

the effectiveness of supplemental online materials.

So how did the clinical pause affect professional identity formation

and values.

A strong professional identity forms through engagement with community of

practice. The context of socializing allows a newcomer to experience

clinical competence, invites personal reflection and enables identity formation through

participation. Suspension of clinical placements and the result in decreased

exposure to a social learning system may have long term

negative consequences.

But it wasn't all bad.

Some positives have come out of the changes in clinical

rotations. We will continue to use tools to maximize student

experiences and help them expand into new roles by inviting

them to participate in delivering care.

During pandemics, students can act as navigators, helping patients overcome

barriers to health care, access by performing callbacks or completing

med reconciliations or assisting patients in completing screening questionnaires.

Students can help improve patient satisfaction by delivering patient education,

which also creates an opportunity for students to demonstrate and

practice their skills.

They can find, deliver and explain materials about certain patient

conditions. They can write summaries of conditions and discharge plans

for patient instructions.

They can use their evidence based medical skills and develop

patient education materials by creating patient handouts that list reliable

patient education websites.

Finally, some opportunities rose out of the use of telehealth

students got early exposure to this important care delivery method,

even as seasoned physicians gained familiarity with it, both of

which will bode well for our future.

Increasing student engagement through innovation, participation in health care delivery

and expanding roles leads to the best outcomes the highest

satisfaction from all parties involved, including students, precept, ear's and

patients, and fulfills the need to welcome these newest members

into our communities of practice.

So here's what we will take with us going forward.

Covid 19 has led to temporary and possibly permanent changes

in medical education delivery, and educators across the continuum must

remain mindful that knowledge and experience gaps may extend for

several more years.

We know that changes can present both challenges and new

opportunities, so explicit education and innovative thinking will increase positive

and decrease negative impacts.

And lastly, medical schools, precept, ear's and students must think

through the long term implications of the changes wrought by

covid. If we are going to positively leverage those changes

to level up medical education, thank you

Assessing COVID-19's Impact on Clinical Education of Osteopathic Medical Students

Audio TranscriptAuto-generated