Students across the country in all grade levels, from preschool to graduate school, had their educational routines upended by the COVID-19 pandemic and its associated lockdown. As students transitioned to online coursework, they found it more difficult to access their educators. Stressors related to the pandemic, along with distractions at home, created a more challenging learning environment for students.
Stuck in front of a screen without real interaction, both students and their educators saw the experience of attending classes become less valuable and enjoyable. Studies in the United States and across the world have identified wide-reaching negative effects on students’ learning, in addition to widening achievement gaps for underserved communities, as a result of these radical changes. One report found that unfinished learning during the pandemic may reduce current students’ lifetime earnings by $49,000 to $61,000.
In medicine, there were special challenges associated with adapting safety protocols to a field that inherently requires human interaction. Medical education itself was greatly affected as medical schools sought to protect both students and patients by asking students to stay at home. Classes were moved online and rotations cancelled.
Nonetheless, COVID-19 has also resulted in the “Fauci Effect,” with countless students across the country becoming more interested in medicine and public health. Applications to medical schools reached an all-time high in 2020. Medicine is quickly becoming an increasingly popular career choice as more people take an interest in the general public’s health.
Pressure for positive change in medical education has been brewing for many years, but the sudden paradigm shift forced by the pandemic may finally catalyze this transformation in how we educate our future doctors. We will likely see many recent changes persist into the future.
Of course, there are notable superficial changes such as the increased frequency of online and remote lectures along with virtual reality gross anatomy labs. However, there will likely also be changes in terms of the content taught in medical school, the structure of medical education and the relationship between medical students and their training programs.
In terms of content, medical schools will likely shift increased focus towards public health, as the pandemic strengthened the relationship between health care delivery systems and public health professionals. For many years there has been criticism that although medical schools do an excellent job teaching students about disease pathophysiology, differential diagnoses and treatment plans, they do not focus enough on social determinants of health, health policy and patient well-being.
This year we became more aware of the biopsychosocial issues that affect patients’ health. We have an increased understanding of the importance of factors such as geography, environment, race and socioeconomic status. COVID-19 highlighted some of these disparities, as marginalized communities caught the virus at significantly higher rates. These communities had difficulty getting tested, receiving vaccines or getting medical care if they were infected.
The endless media attention surrounding the pandemic added salience to this issue, finally forcing positive change. As the country increasingly recognizes the need for advocacy, students are speaking out and administrators are now engaged in acknowledging and addressing student concerns.
Medical schools have begun supplementing their lecture-based didactic years with real-life experiences, particularly by increasing programming within underserved parts of their communities. By interacting with a more diverse array of patients, students better understand how health care varies for different communities. Over the past several years, medical schools have also improved health policy and inequity education. With a raging political debate surrounding health care insurance over the last decade, medical schools have recognized the importance of doctors understanding insurance and reimbursement. This knowledge helps physicians better inform their patients and make decisions that will account for both the patient’s physical and financial well-being.
Another major shift in medicine that resulted from COVID-related restrictions is an emphasis on telehealth — in fact, telehealth use peaked in April 2020 and has now stabilized at 38 times higher than pre-pandemic levels. Doctors from a variety of specialties began seeing larger portions of their patients remotely, allowing them to reduce in-person interaction and prevent patient-to-patient transmission. Many experts agree that this shift is here to stay. Overall, the reduction in cost and increased access will be helpful for our most marginalized communities.
Due to the lasting nature of this change, medical schools are incorporating more technological training into their educational plans. Classes discussing considerations such as telehealth etiquette, security, privacy and the remote patient experience will better equip medical students for the shift which has already begun to take place. Moreover, in the unfortunate case of another future pandemic, our doctors will be better equipped to seamlessly transition to remote care.
There are also several lasting changes in terms of the structure of the four-year medical education. One notable pandemic casualty is the cancellation of Step 2 CS, defined by the removal of a significant financial burden and associated leveling of the playing field for medical students. The temporary suspension of “away rotations,” another profoundly expensive aspect of medical school, may also continue. Even if away rotations return, they will likely be much less common than the pre-pandemic norm. Finally, a truly significant change made during the pandemic was early graduation, which allowed fourth-year students to voluntarily leave school to help on the frontlines. While this will not necessarily last, it showed that shortening medical school is feasible, and certainly signaled a major paradigm shift. This would again reduce the burdens of tuition and allow students to join their profession earlier.
Finally, medical schools have increasingly demonstrated concern for their students’ mental health and risk of burnout, a growing issue that was accelerated by the recognition of stresses faced by health care workers during the pandemic. For instance, many medical schools implemented new programs to help students meet remotely, whether for fun activities to minimize isolation, or to openly discuss the obstacles they were facing throughout a rigorous education during a pandemic.
Often, the most effective change is catalyzed by a major event which disrupts the inertia of society. Much like every other aspect of our world, COVID-19 precipitated great changes in medical education. Many of these changes amplified ongoing trends, and therefore, they are likely here to stay as we slowly inch towards the post-pandemic future.