Training to be a Doctor in the Age of COVID-19

Baylor Med student David Vien is working in an emergency room in Houston’s Texas Medical…

Baylor Med student David Vien is working in an emergency room in Houston’s Texas Medical Center. It’s March 2020 and across the country from New York City to Seattle, the threat of COVID-19 is finally becoming real to millions of Americans.

The Houston area’s first case has been discovered in Fort Bend County, sparking some fears of uncontrolled viral spread. But only a couple miles away, the rodeo is welcoming thousands of cowboy boot-scootin visitors every night, eating, dancing and breathing all over each other.

The fourth-year student wonders if the patients walking in have been infected with this new virus — and if they are, how easy it would be for him to be next. In the ER, the risks of contracting the virus as a healthcare provider are especially high. Patients with urgent conditions can’t always be screened for the virus before intake, and at the time, there was uncertainty about whether screening could even be effective.

Is today his last day working in the emergency room or will he be here again tomorrow, an accidental frontline hero in the face of a suddenly imminent epidemic?

As the days went on and the number of reported cases mounted, it was a question medical school administrators were forced to face as well. On the one hand, learning medicine in the middle of a pandemic could be a unique and invaluable learning experience. But doctors cautioned that suspending rotations would help minimize viral exposure and spread.

In the end, Baylor like medical schools in other Texas cities decided to suspend clinical rotations for two months to minimize viral exposure. And Vien, now applying to post-graduate residencies, is glad they did.

But he and other medical students weren’t just interrupted in their practical experiences. When they returned to the hospital halls, a lot of new regulations were in place. Lectures and tests went virtual. Far fewer face-to-face encounters with patients. Shortened rotations.

COVID-19 has robbed these medical students of certain experiences and rites of passage. It has truly made for an unprecedented learning experience; but then again, nothing about this year has been expected. Although their education has been limited in some ways, these students are witnessing the inside of a medical field turned on its head, in a moment that will likely define the future of healthcare.

Pivoting to Telehealth

Chris Wong, a third-year medical student, had just started his clinical rotations in January and was in the middle of a pediatric rotation when COVID-19 hit Houston.

“We really appreciated that our [school] administration had the foresight to take a step back, and say, ‘let’s figure out what we’re getting into before you guys go back in there, because we don’t want you to be the cause of a super spreader event or something like that,’” Wong said. The medical students restarted their rotations in May. “Since then, I feel like there’s no better time to learn than during the pandemic because you really see a lot of the system and where the stressors are in the medical system.”

Vien said suspending rotations for two months was likely the right choice, but that even after the students returned, personal protective equipment proved to be scarce.

“There were lots of times where students were put in some [uncomfortable situations], where people didn’t get great PPE sometimes,” Vien said. “There was one rotation where I had to reuse a N95 mask for a week, because we didn’t get any formal N95’s from the hospital.”

In May, Vien started a new rotation in a family medicine clinic. Typically, a student in this rotation would see and perform physical exams on 15 to 20 patients during this segment of their training. Under COVID-19 restrictions, Vien said he spent about 85 percent of the time talking to patients on Zoom.

“It was really different from a classical medical education,” Vien says. “I didn’t get to do a lot of hands-on things. But I got to experience what I think will be the future of medicine.”

Telehealth, a practice where doctors consult with patients remotely over a video platform, has become a vital part of the medical field during the pandemic. Even after COVID-19 spread is no longer a significant issue, Vien said he believes that telehealth’s convenience and ease of access will convince physicians to keep the practice around.

Wong says that when the students were able to return to the physical space of the hospital, it was to a changed environment.

“All the different hospitals have their own methods of limiting spread,” Wong said. “The hallways are completely silent, but if you go into the units, every single room is full. The nurses are working nonstop. It just feels … it doesn’t feel as lively.”

Vien said that the limits on what medical students are allowed to do because of the pandemic has hampered his ability to prepare and train in some ways.

“In the ER, you need to get up close to hear breath sounds, especially if they’ve been through a trauma, like a gunshot wound or a stab wound,” Vien said. “As medical students, we weren’t allowed to see those patients because the school deemed that a risk to us, so I didn’t get much experience with emergent settings. Patients were hand-selected as safe for me to see.”

According to Wong, medical students are now spending about two-thirds of the time students normally would spend in the hospital. To make up for the two-month suspension, most rotations have also been shortened.

“We have had a lot of exposure [to the medical setting] but not as much as students in the past because they’re really trying to keep us out of hospital if we’re not doing things. They’re creating more distance and staggering shifts,” Wong said.

While the first and second year medical students’ training has been less affected because they’re still in the academic portion of their education, second-year student Sydney Garrett said that some aspects of the training that are normally done in-person, like anatomy lab, have had to be adjusted.

“I think it’s a bit more challenging [learning anatomy remotely through photos], because it can be hard to orient yourself, you don’t know what direction is up or where an organ is placed in a body,” Garrett, a University of Texas McGovern student, said. “I think a lot of people, myself included, learn best hands-on, with a body you can look through and identify different structures on a 3D plane. Just learning from pictures is harder without the level of three dimensionality – but it’s not impossible.”

Although they can take their classes remotely, Parnaz Daghighi, who is also a second-year student at McGovern, said losing the structure of school has made the already difficult course load more challenging.

“Virtual schooling has been kind of insane,” Daghighi said. “It’s interesting to be in a circumstance where you feel like your administration is just as lost as you are, but I don’t blame them. Nobody knows how to prepare for something like this, this wasn’t in the books.

“As a student, you kind of lean on the structure and foundation of your school to be able to be some kind of comfort — at least you know how things are going to go, how they’re supposed to be. That’s kind of all we have, because everything else is so chaotic. I didn’t realize how important [the structure is] to us until we kind of lost it.”

Scared They’d Give COVID to Their Patients or Families

Every time Vien would finish a rotation, he would wait two weeks before seeing his family even if he felt healthy, just in case he was an asymptomatic carrier. Even then, he wore a mask and distanced himself.

“There have been quite a few scares for me too, where people who I’ve worked closely with have come down with a headache and a fever, and it turned out to not be COVID,” Vien said. “Those scares always catch you by surprise. There’s nothing to do but wait for the test and you have anxiety for everyone you’ve interacted with for the past two weeks.”

Wong said that medical students were mostly concerned with accidentally giving the virus to their patients or fellow doctors.

“We weren’t all too worried about getting it ourselves, but we were very, very worried about giving it to our patients, because we see a lot of people, we go from one clinical setting to another, we switch hospitals maybe two or three times a month,” Wong said. “And so there’s just that inherent risk of being a vector for the virus.”

Both Vien and Wong said that many of the doctors and nurses they worked with contracted COVID-19.

“It is surprising,” Wong said. “You’ll talk to someone one week and then two weeks later you’ll get in touch with them and they’ll be like, ‘yeah I got COVID.’ There was actually a team I was working on in June and [a few weeks later], I heard from another team at the new hospital I was working at that everyone on that old team had gotten exposed and tested positive for COVID. And we were like, oh my gosh we missed the infection window by like one week.”

Vien said that he doesn’t believe the health system should expect medical professionals to risk death to treat  their patients.

“I think that the medical system should provide care to patients without requiring people to be heroes,” Vien said. “Because even if you’re being a hero you’re still risking your life. And that’s a great thing and a lot of doctors and student doctors look up to that, but I don’t think you have to risk your life to take care of patients. As a medical professional you have a responsibility to your patients but the health system should be helping the doctor and the patient without creating an unnecessary burden.”

Daghighi was shocked when she contracted the virus in June. Although she says she was lucky to have mild symptoms and privileged to have her own apartment to quarantine in, dealing with the grueling work of medical school on top of her fatigue showed her just how demanding it was to be training to be a doctor in the midst of a global health crisis.

“It was definitely hard to keep up with my school work while I was dealing with COVID-19,” she said. “As a medical student it’s kind of like, if I’m going through something really hard physically, mentally, and emotionally, I don’t have the luxury of just rolling up into a ball and laying in bed for a day. Nobody would stop me, but I would pay the price.”

Luckily for Daghighi, medical classes are built so that students can watch lectures remotely at home. Still, it’s already difficult to memorize thousands of flashcards without the exhaustion of fighting off a viral infection.

“It was really hard to fight against what my mind and my body really wanted during those two weeks, which was to do nothing and lay down and rest,” Daghighi said. “But unfortunately, you know, in this life that I’ve chosen, the demands are really high and I’m still trying to figure out how to balance being an actual human being and trying to become a doctor.”

But the pandemic has also reminded these medical students why they chose this path. Garrett said the pandemic has affirmed for her that medical school was the right choice.

“At the beginning of the pandemic, it was frustrating to be at home and not be able to do anything to help,” Garrett said. “It’s nice to know that if something like this happens again, I will be equipped to go out and help fight, make people healthier and help them recover. It’s nice to see people on the frontlines and recognize that that could be me in a few years.”

All four students emphasized that the pandemic has worsened inequalities in healthcare.

“COVID is not a great equalizer as people say,” Wong said. “It really affects people who are already at risk for more chronic diseases and shorter life expectancies. And so that really reminds me of my motivation of why I entered medical school, to be able to work against health disparities and work towards health equity.”

Vien said that working as a medical student during COVID-19 has shaped him in a more significant way than he could have anticipated.

“I got to see what it was like for health systems to be stressed, I got to see what effective medical leadership looks like, I got to see what examples my teachers set,” Vien said. “A lot of the doctors I worked with went through a great personal sacrifice to keep seeing patients.”

From his point of view as a doctor-in-training, Vien’s prognosis is far from rosy.

“COVID-19 is going to be a reality that we face as doctors in the future,” he said. “There’s a possibility that it’s here to stay even with the vaccine, because the flu has a vaccine. So the reality is — this is the new normal.”

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