Medical Education in a Post-COVID World
When the COVID-19 pandemic hit, in-person classes stopped and clinical rotations were canceled. The leadership and faculty of the David Geffen School of Medicine at UCLA had to find new ways to teach a discipline that is inherently hands-on. While the pandemic will pass, the ripples of its impact will be felt for years, perhaps decades, to come. Drs. Kelsey C. Martin, dean of the David Geffen School of Medicine at UCLA, and Clarence H. Braddock III, vice dean for education, spoke with U Magazine editor David Greenwald about how the pandemic affected students and what it will mean for medical education in the future.
An op-ed in the Journal of the American Medical Association stated: “The profound effects of COVID-19 may forever change how future physicians are educated.” Do you believe that to be the case?
Dr. Clarence H. Braddock III: The COVID-19 pandemic has underscored how important it is for physicians to understand contagion. Over the past 15 or 20 years, we’ve had more than a few unusual viral contagion events — SARS, MERS, H1N1, Ebola. Going forward, physicians need to have a greater knowledge of how to practice medicine during a contagion, not just in the treatment of the disease, but also knowing how to diagnose these diseases and how to safely deliver care and understanding the modes of transmission for these illnesses. I think this also will alter the modalities of teaching. Higher education in general, and medical education in particular, has been very resistant to thinking about different modalities of teaching and learning, particularly such things as distance learning and remote asynchronous learning. But the pandemic has forced us to find ways to teach that are effective, even if we are not able to all be together in the same space. I think we are going to see a greater recognition that there may, in fact, be some advantages to distance learning.
Dr. Kelsey C. Martin: It has forced innovations in how we use technology to teach. It also has raised consciousness about the important role of public health in medicine. We’ve always known that public health and prevention are critical, but the close ties between public health and medicine are front and center right now. And the pandemic has highlighted the incredible importance and value of biomedical research as we look to identify cures and new treatments, really understand this pandemic and develop approaches to address not just SARS-CoV-2, but also future infectious agents.
Dr. Braddock: As a country, we have struggled in recent years with a declining trust in science, and it’s been remarkable how difficult it has been to manage a contagion like this when so many people in our society lack confidence in the views of experts. It’s mind-boggling, really. But it’s also a clarion call, telling us that we have to figure out a way to bridge that divide. As physicians and scientists, we need to figure out how to regain that trust. If we had had that, I think we’d probably be in a much better place than we are now. We also must have a much better understanding of the determinants of health. This pandemic has put a very harsh light on disparities in access to care, hitting communities of color and of lower socioeconomic status much harder. We have to understand the socioeconomic and structural conditions under which people live that directly affect their health.
Dr. Martin: It’s an unbelievable lesson for trainees right now.
What role, then, should public health play in the education of medical students going forward?
Dr. Braddock: There will be much greater alignment. Medical training has tended to focus on what do you do to bring the best evidencebased care to the patient in front of you; public health is about what do you do to bring the best evidence-based approaches to support the health of communities. Those two things are connected, right? But in medicine, we haven’t thought about that second thing very much. Having a very intentional theme throughout the new curriculum that we are implementing on social and structural determinants of health, ranging from prevention to thinking about poverty, housing inequality, all these factors, will be very much at the forefront.
Dr. Martin: This pandemic has created an opportunity for the deans of all of UCLA’s health sciences schools to work very collaboratively together. One of the efforts that we’ve been engaging in for years is to try to promote more interprofessional education. A physician doesn’t work by herself or himself in the field; they work as part of a team. We are looking at how we can model that in the early stages of medical education. And over the past months, the deans of the nursing school, the dentistry school and the school of public health and I all have been talking about how are we going to have our students re-enter the clinical arena, how are we going to manage their clinical education. Those discussions have enabled us to identify some opportunities where we could develop more interprofessional educational activities.
What did the pandemic do to the experience of current students?
Dr. Braddock: When clinics cut back and nonemergency surgeries were postponed so the health system could focus its efforts on delivering care to patients with COVID-19, students who were on their clinical rotations had to leave the clinical environment and all of their education had to be done remotely. It’s a little hard to imagine that we could teach pediatrics and surgery and general medicine via Zoom, but that is what we were doing within just a few weeks. Going forward, we have to figure out how to do the parts of medical education that do require students to be physically present in the hospital or clinics or labs. That is something we have to do, otherwise we will not be appropriately training the future workforce. Those are concrete impacts. Then there are existential impacts, such as how students today are going to think about their work in relation to the risk that always has come with being a physician. A certain level of risk is part of the ethos of medicine; you know that, and of course you want to mitigate it, but you accept it. But in this current pandemic, that sense of risk definitely is heightened, and many of our learners are struggling with that. There is apprehension, particularly among those who are relatively new to a clinical environment. But even those who are somewhat veterans in the clinical environment are apprehensive about how they are going to meet their ethical commitments of being a physician in the face of elevated risk.
Dr. Martin: I think one way to respond to that is for us to utilize resources like our simulation center to help train students in things like how to use PPE correctly to prepare them for when they are put in a situation where there might be some risk. There’s also been a significant impact on the career trajectory of students. All of our interviews for incoming students are being done remotely. Fourth-year students often go to other institutions for clerkships to see if it is a place where they might want to go for their residency, but they aren’t able to do that this coming year because of travel and quarantine restrictions. Board exams have been delayed. The MCATs have been delayed. So, in a career where there are many steps and hurdles that one has to overcome, there now is an added layer of uncertainty. This is a critical moment, and we have to do whatever we can to inspire our students and to support them in any ways that we can to make sure they are successful in their training. The need to prepare future physicians has never been as essential as it is now.
What will the new academic year look like?
Dr. Martin: It will be unlike any other. In response to the challenges posed by COVID-19, our curricular affairs team has designed and executed a hybrid educational model that prioritizes safety while enabling essential in-person learning experiences. Our orientation for incoming students was entirely virtual and focused on community building and the adverse health effects of structural racism. Our first-year students are attending in-person sessions in accordance with carefully laid out safety protocols. For all sessions that do not have a critical handson component, students are learning remotely. To minimize density on campus, second-year students can opt-out of all in-person instruction or engage in the hybrid model. Geffen Hall may not be bustling with its usual campus activities, but our innovative spirit continues to unite and uplift our medical school.
How did students respond to the pandemic?
Dr. Braddock: When students realized what was happening, there was a spirit of altruism and an eagerness to help and contribute in some way that was deeply powerful and moving. A group of students got together and formed what they called the L.A. COVID Volunteers to organize a childcare network for health care workers who were on the frontline. And these same medical students connected with students and faculty in the engineering school who were using 3D printers to make the parts for plastic face shields, and our students set up a face-shield assembly operation in Geffen Hall. We know as leaders of the medical school that when you select students to enter, they have altruism and commitment to service, but to see it blossom that way in a situation like this — it is nothing short of inspirational.
Dr. Martin: You see students whose whole training has been turned upside down, and they are finding ways to be a part of the solution and to contribute in any way they can — it was inspiring and heartwarming. It filled me with hope.
Has the pandemic marked a turning point for students in how they think about their future careers?
Dr. Martin: I think it is the combination of the pandemic and the killing of George Floyd, and the movement has drawn needed attention to structural racism in our country and how that intersects with COVID-19 and with health disparities. I do believe that it’s been a turning point for not just students, but also for our house staff, our faculty, our physician-scientists and scientists. I think there is much more thought now about what we need to do differently to make sure that there is real equity in health care. I think it is a moment when there will be a change finally.
Dr. Braddock: I agree. That juxtaposition has had a profound impact, and many people are thinking quite differently about what role the issue of addressing racism will play in their career. I hope that is something that is going to reverberate for a long time.
Is there a teachable moment in this?
Dr. Martin: Yes, I think the teachable moment has been in how we stay flexible and adapt to uncertainty and a situation in which we are not completely in control.
Dr. Braddock: Sometimes, when you have a moment of crisis, it brings with it a certain clarity of focus and purpose that’s quite remarkable.
Are you hopeful?
Dr. Martin: I’m realistically hopeful. Certainly, I am distressed by all the suffering that’s been going on, and I’m discouraged by the fact that we’re not able, on a national level, to manage this pandemic in a way that is ideal, but I’m hopeful because there’s such an acknowledgment of the need for change, and there’s such an acknowledgment that we need to figure out ways to work together to identify effective testing strategies, effective public health measures, effective therapies for COVID-19 and that we are, I hope, going to address some of the more chronic issues in society that have become so apparent during this time. I naturally am an optimist, so I really do believe that human beings — and this is very true of the David Geffen School of Medicine and our faculty and our students and trainees — have the creativity, the brilliance and the commitment that are required to address these issues.
Dr. Braddock: The thing about a large crisis is that it brings out both our better angels and our worst demons, and we’ve seen a little bit of both. The lack of coordinated response, the polarization that has gone on, those things have been very discouraging. But then you see how people step up to the challenge and commit themselves to doing the work that needs to be done. As Dean Martin said, we see it in our faculty and in our students and our trainees — the students who volunteer to do childcare, the researchers who are champing at the bit to get back in the lab to start working on therapies and cures, our infectious-diseases specialists who have been working tirelessly to advise us and keep everyone safe, our trainees and faculty and nurses who have been putting on their PPE every day to care for patients — everyone pulling together in whatever way they can to help and to try to make things better. Our better angels emerge, and they transcend our worst demons, and that is what gives me hope.