Anyone who has ever played sports knows the feeling of being “benched.” I’ll recall my own experience participating in middle school football. I worked exceptionally hard during practice to prove myself to the coaches. A burning, incessant desire stirred within me to be chosen as a linebacker. When game day arrived, our coaches called out our lineup. I was not included, only to be relegated to the special teams instead. Feeling as if all my hard work went to waste, I was almost in tears. Resentment and frustration brewed inside of me. I paced back and forth on the sideline like a madman. A whistle was blown for the opening kickoff, and I ran out to the 50-yard line. The ball was kicked, I sprinted downfield, and the returner appeared. Without any hesitation, I delivered a huge tackle that stopped him in his tracks, screaming wildly as I made contact. My coaches noticed; I started the rest of the season as a linebacker.
Now, in 2020, I am a fourth-year medical student. I am about to apply for a residency in emergency medicine. COVID-19 has swept across the world and caused massive disruptions to medical education. In March, hospitals turned away learners to preserve PPE and mitigate viral transmission. Medical students throughout the country were sent home and effectively became “benched.” As a current medical student, I am concerned about the short- and long-term implications of this.
In the short-term, COVID may lead to numerous consequences for medical students. Two, in particular, are worth mentioning. Firstly, when clinical rotations were paused, a student’s ability to choose a specialty became jeopardized. A sizeable percentage of our cohort missed out on the opportunity to rotate in their prospective field of interest, which is crucial for confirming their career path. For example, aspiring surgeons weren’t able to confirm if they love to operate, nor were budding psychiatrists able to assess their passion for treating mental illness. Burnout is a pressing issue in medicine. Choosing the appropriate specialty is extremely important. The halt to rotations may lead to students applying for a specialty that isn’t the best fit due to incomplete exposure, which would be a risk factor for burning out later in training.
Another short-term consideration in this pandemic is with respect to our most important clinical rotation, the “sub-internship.” On service, students immerse themselves and function near an intern level. Arguably, the most clinical growth occurs here, priming students for residency training. The pandemic has deeply impacted these crucial rotations. For instance, certain rotations were outright canceled, such as in the ICU. Other effects include reduced surgical volumes, being restricted from seeing patients under investigation for COVID (which, currently, is a sizeable percentage of patients), and being caught in the middle of monumental educational changes, such as telemedicine and virtual learning. Clinician educators are juggling the demands of this complex clinical landscape while maintaining their teaching responsibilities. This undoubtedly sacrifices the protected time and quality of education for medical students. Indeed, it is clear to see that for the Class of 2021, this “COVID-effect” may lead to numerous downstream consequences.
Lastly, the broader effects of this pandemic must be considered. The decision to remove learners during this pandemic represents the truth of what has been slowly happening to medical education across the country for years. The role of the medical student has become more passive in each subsequent year, culminating in learners being completely expendable in a time of crisis. A “leash” for learning opportunities is granted to each medical student, one that allows them to participate in patient care while under direct supervision. In the last few decades, this “leash” has become shorter secondary to a myriad of reasons, as described in the article, “Four Horsemen of the Medical Education Apocalypse.” This translates to more passive learning experiences for students, including shadowing, an activity typically performed prior to medical school. Patient care cannot be learned through observation or passive learning. And yet, this is where medical students across the country are finding themselves more often than they would like.
There is no single culprit responsible for this shift in medical education. However, two, in particular, should be noted. The first is the culture of defensive medicine, or more bluntly, CYA (cover-your-ass) medicine. This culture has been insidiously infusing itself within the modern health care system for decades. The fear of being sued for malpractice is ever-present. Undoubtedly, this has led to hesitations in allowing medical students to be involved in patient care. Another important consideration is our capitalistic health care system. In an era when physicians are being pressured by hospitals to see more patients, coupled with intense bureaucratic demands and documentation requirements, it is no secret that learners slow down productivity and drive down the bottom line. As a result, education suffers.
What is the consequence of all of this? The “finish line” keeps getting pushed back further and further. More resident physicians are deciding to pursue fellowship before becoming an attending. For instance, in the field of general surgery, 80 percent of residents decide to pursue a fellowship. It is unclear how this will affect patient care in the future. Undoubtedly though, it begins at the medical student level. The decision to remove medical students from the hospitals in the midst of this crisis is the ultimate reflection of a much larger problem, that being, the regression of the role of medical students.
It has been 13 years since I played football in middle school. I have eight years of post-secondary education and a mountain of student loan debt. Yet when reflecting on all that has happened, I can’t help but have similar feelings to what I experienced all those years ago, pacing back and forth on the sideline. I am beyond excited to move forward in my training, to fulfill that oath that I swore. But I also realize serious change needs to happen, both for our own sake and for our patients.
Clayton Korson is a medical student.
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