Med schools, students adapt to new normal

As the public focuses on school openings in the fall, third- and fourth-year medical students are already back at their studies. 

Mollie Sivaram, a third-year student at the University of Toronto, says that while she had initial concerns, so far the program is going well.

“I don’t think I’m getting a lesser education, but it is definitely a different experience (from before the shutdown),” she says. “I think initially I was a little bit concerned. You have all these thoughts about is it going to be really different? There have been a couple of changes but some of it feels like the thing you left.”

Besides, says Sivaram, “How many doctors can say that they did medical school during a pandemic?”

The students have a limited window to learn core clinical skills and determine their future specialty – things not possible to do virtually.

The entrance of the University of Toronto, Canada.

Dr. Patricia Houston at the UofT’s Faculty of Medicine says the school has a plan in place to ensure students get a proper education.

“A revised curriculum and rotation schedule was developed to ensure that all students obtain all the necessary competencies needed for progression in the program and graduation in the spring of 2021,” says Houston.

“This was an essential step forward for the next generation of healthcare providers, all of whom are ready to face new protocols and challenges with courage and skill, as our vigilance continues in the face of COVID-19.”

The Canadian Federation of Medical Students (CFMS) says that the medical schools have done a good job of adapting.

“Strong leadership and innovation from the medical schools in collaboration with students contributed to a quick, effective and proactive adaptation to the ‘new normal,’” says Adel Arezki, executive vice-president of the CFMS.

“In general, students have been very positive about how things are going and we are optimistic that schools have worked to ensure effects on overall quality on education are minimal.”

The changes will be more apparent for the UofT’s first- and second-year students who start classes in September. First-year students will do more of their learning online to start and be gradually brought into direct in-person learning as or if restrictions are lifted. Second-year students will start with a mix of online and in-person rotations and also will ease into more in-person classes as restrictions are lifted.

The third- and fourth-year students have had direct patient care as usual since the start of clinical rotations July 6.

At McMaster’s Michael G. DeGroote School of Medicine, third-year students returned to classes on July 6 and have picked up from where they left off in their clinical rotations back in March, says Assistant Dean Dr. Rob Whyte.

Whyte says that while most of the program’s content can be “readily and effectively” moved online, learning to provide direct patient care “does not translate as easily.”

At the Northern Ontario School of Medicine (NOSM), Dr. Sarita Verma, the school’s dean, president and CEO, says that for the safety and health of its students, the school will try a “blended education model” that includes structured in-person clinical and laboratory sessions as well as online group sessions and community-focused learning.

NOSM has moved its September orientation week online and launched its first virtual CampMed in June, a summer program in which students attend a variety of sessions on different aspects including wellness, medical imagery, wilderness first aid, etc.

Joanne Musico, Director of Communications and External Relations at NOSM, says the Virtual CampMed has been such a success with 127 participants that the school is considering continuing it in the future.

McMaster’s first-year class will begin with most of the coursework online, a change from a typical year in which students would have face-to face patient interaction as early as the first few weeks of a school year. Now, patient interaction will be through online video calls. If the pandemic situation improves, in-person clinical learning can take place beginning in January.

The second-year class will have some direct patient learning but it will be less than in a typical year with a significantly increased online component. Residency rotations are moving forward for third-year students as required by national standards and formal teaching components have been converted to virtual platforms or adapted to small group formats permissible within physical distancing recommendations.

Houston at the UofT is confident that there will not be an effect on learning.

“We do not anticipate any residual educational gaps this academic year,” she says. 

“Through all of this uncertainty and change ahead, our community’s health and safety remain our highest priorities. This includes an ongoing commitment to mental health and wellbeing.”

But this is both an unprecedented and unpredictable situation for medical schools – who are often usually slow to change – and the downstream effects on learners are unknown.

As NOSM’s Verma explained in a May 5 blog, The COVID-19 Rubik’s Cube: Planning for Re-entry, “Medical education does not bend easily to disruptions as the progress through the program is time sensitive, inflexible and relies on flow through to meet the demands for a steady, predictable output … Matching learner needs, accreditation requirements, and site capacity will be a challenge but one we are willing to take up.”

However, despite the move to online classes, there will be no change to the tuition rate for medical schools.

Houston says this is because “academic programs continue to be delivered through alternative means and we are making significant investments in virtual learning and educational supports.”

Rishi Bansal, a first-year student in McMaster’s program, says that while he understands why tuition needs to remain the same, he hopes some of the money is directed to online learning.

“Doing a rapid curriculum redesign and restructuring and trying to make sure that all aspects are valuable online is going to be time and resource-intensive so I understand it from that perspective,” Bansal says. “I just hope that the tools and platforms that they have invested in will live up to that expectation.”

Rishi adds that he is looking forward to the opportunities that come from being a medical student during a pandemic.

“I feel lucky to be stepping into the field in such a key moment in history,” he says.