Healthcare and Learning in a COVID-19 Era
By Luke McCabe-O’Donnell DMSG Student Intern
University of Colorado-Denver
When the World Health Organization declared the COVID-19 outbreak a public health emergency January 30th, 2020 the American healthcare system changed overnight. The global pandemic has altered both the way patients are receiving care and the teaching platforms used to educate prospective healthcare professionals.
One of the biggest changes to the way patients are receiving care has been the sharp adoption of telemedicine for non-emergency services. According to research published in the February edition of Health Affairs,
“30.1% of all outpatient visits were provided via telemedicine from January 2020 to June 2020. The weekly number of telemedicine visits rose by a 23-fold increase during the same time period” (Weil, 2021).
The immediate adoption of telemedicine stemmed from a necessity to keep patients safe that did not require in-person care. Despite complications from a rushed implementation, the dynamic environment of patient care during the COVID-19 pandemic has led the American healthcare system to recognize value in telemedicine in certain settings. A study by Harvard Medical School and RAND Corporation suggests,
“Behavioral health issues and chronic conditions were responsible for the largest increases in telehealth utilization during the pandemic. In particular, higher relative increases were observed for unscheduled behavioral health and chronic illness visits” (MGMA, 2021).
Similarly, in a recently published study by HealthAffairs,
“Specialty physicians including endocrinologists, gastroenterologists, neurologists and pain management physicians reported the highest levels of telemedicine use from January to June 2020. That study also found that optometry and physical therapy were the least-used specialties for telemedicine in that same period” (MGMA, 2021).
Virtual Learning and Prospective Healthcare Professionals
In the same way that treating patients is not always ideal using telemedicine, virtual learning is not always ideal when educating prospective healthcare professionals.
Early distribution efforts of FDA-authorized vaccines began December 14, 2020 as part of the Emergency Use Authorization (HHS, 2021). Initially, vaccines were distributed strategically for those deemed essential workers. This strategy has helped clinicians safely return to treating patients but manufacturing shortages and waiting periods created issues for students striving to receive clinical experience. Throughout the past academic year, prospective healthcare professionals from all backgrounds have had to remain agile while adapting to virtual learning.
Virtual learning is impacting nearly all avenues of healthcare but premedical students, medical school students, and medical school faculty have been facing an especially difficult set of challenges.
Premedical students have had to become creative while gaining exposure to the medical field. The American Medical Association explains that due to strict social distancing guidelines,
“there are fewer opportunities to engage in the humanistic activities, to shadow and volunteer to demonstrate one’s passion for medicine. These changes may impact the next generation of medical students, who will become the next generation of residents, surgeons, and surgeon educators” (Murphy, 2021).
A recent study conducted by Kaplan Test Prep draws from a sample of 400 pre-meds. The primary goal of the study was to gauge the impact of the global pandemic on the mental health of aspiring health professionals. The study found:
- Nearly 40% of survey respondents had considered dropping their pursuit of a career in medicine because of stress in the premed process.
- 26% of premeds said they experienced stress “pretty much always,” while 45% said they experienced it “frequently.”
- More than half of respondents said “self-medicating” (using alcohol or other drugs) is a common problem among their premed peers who are trying to deal with stress (Murphy, 2021).
Medical School Students
In addition to premed students, medical students have been facing a multitude of unique challenges. The article “Medical Student Education in the Time of COVID-19” from The Journal of the American Medical Association discusses the typical structure of medical school classes and provides an overview of new challenges.
“Traditionally, students convene in physical settings during the first 12 to 18 months for interactive problem-solving or discussions in small groups. The last 18 months of medical school may be individualized, with students participating in advanced clinical rotations, sub-internships prior to residency, or scholarly projects. COVID-19 has the potential to affect students throughout the educational process” (Rose, 2020).
Social distancing guidelines and patient safety standards are creating many limiting factors for students in clinical environments. Dr. Rose cites: lack of COVID-19 testing, diminished value of education (cancelation of surgical procedures and routine appointments), the transition to telehealth formats, and lack of adequate personal protective equipment as major challenges for current medical school students (2020).
Medical schools in the United States have been focusing on adapting to the latest government recommendations and striving to develop solutions to improve the delivery of virtual learning. Rapid developments in telemedicine and innovations in nontraditional healthcare delivery methods are changing the way that medical school students are being educated.
“What then could educators do to create experiences for students who are usually assigned to inpatient or outpatient rotations? The options are continually evolving but may include consolidating and moving clinical didactic sessions online earlier to allow for later entry into the clinical environment; creating and using available virtual cases; modifying the academic calendar to exchange later experiences (eg, scholarly work) and defer clinical rotations; and involving students in the telehealth environment, including electives based on experiences students are pursuing to enable them to assist and learn in this critical situation” (Rose, 2020).
Faculty and Leadership of Medical Schools
Faculty and leadership of medical schools have been enduring mental health challenges associated with virtual learning platforms. Dr. Rose highlights several universal challenges of virtual learning in medical school,
“the transition from the workplace or medical school setting to home results in isolation, an increased use of email, and struggles with establishing boundaries between work and home, which could affect faculty, students, and support staff” (2020).
Additionally, the everchanging environment has caused organizational changes for leadership of Medical schools. Complications distributing FDA authorized COVID-19 vaccines have likely disrupted student curriculum plans and created a need for new requirement standards.
“As infection rates increased, schools began to remove students from the clerkship environment and on March 17, 2020, the Association of American Medical Colleges provided guidelines suggesting that medical schools support pausing clinical rotations for medical students. Additional unknown academic issues will require attention, including standardized examinations when testing centers are closed, the timeline for residency applications for current third-year students, and the ability to meet requirements for certain subspecialties prior to applying to residency (eg, away rotations)” (Rose, 2020).
Resuming Traditional Learning Techniques
Resuming traditional education of healthcare professionals will be dependent on several global health factors. A healthcare leader and experienced public health expert David C. Pate, M.D., J.D., takes a rational viewpoint regarding the uncertainty of education in his two most recent blog posts. He outlines that surges or waves of COVID-19 infection occurring in various regions of the United States complicate early projections and make global health evaluations released by government authorities difficult to validate (Pate, 2021).
Dr. Pate along with many global health experts believe that the most productive action that educational communities can take is to foster the distribution of the COVID-19 vaccine. In order for the American educational system to safely return to in-person learning, herd immunity will likely be a primary factor. The principle of herd immunity is explained by a recent article from Harvard Medical School,
“Herd immunity occurs when enough people become immune to a disease to make its spread unlikely. As a result, the entire community is protected, even those who are not themselves immune. Herd immunity is usually achieved through vaccination, but it can also occur through natural infection” (Harvard Health, 2021).
Dr. Pate highlighted experts in global health initially estimated that somewhere between 60% and 70% of the population needs to be immune in order to achieve herd immunity. More recently their estimate has raised to near 90% (2021). As of June 11th, 2021 only 47.4% of Colorado residents and 43.1% of American’s are fully vaccinated (CDC, 2021).
A public health emergency demands a collaborative effort from all industries, not just healthcare or educational settings. Health networks, assisted living homes, employers, academic institutions, government assistance programs etc. must work as one cohesive unit to improve access to the COVID-19 vaccine. Many academic institutions are going beyond vaccinating students to do their part in the difficult challenge of achieving heard immunity. For example, beginning April 15th the University of Colorado-Denver COVID-19 initiative called “Lynx Together” opened vaccination efforts to all family members of CU Denver students, faculty, and staff in the Auraria Campus’ 5th Street Garage.
Summary and Conclusion
Healthcare professionals striving to receive an education in both clinical and administrative roles must remain agile during this time of transition. Developments in telemedicine and increased usage of medical wearables will continue to change the way providers are caring for patients. Experts like Dr. Rose believe the emergence of new technologies in telemedicine expand access opportunities for patients and have the potential to change healthcare education.
“The Covid epidemic may represent an enduring transformation in medicine with the advancement of telehealth, adaptive research protocols, and clinical trials with flexible approaches to achieve solutions. There are many examples whereby learning from difficult experiences (eg, emergence of HIV, response to disasters) changed discovery, science, and patient care. This is not only a time to contribute to the advancement of medical education in the setting of active curricular innovation and transformation, but it may be a seminal moment for many disciplines in medicine (Rose, 2020).
Centers for Disease Control. (2021, April 14). COVID Data Tracker: COVID-19 Vaccinations in the United States. Retrieved from https://covid.cdc.gov/covid-data-tracker/#vaccinations
Harvard Health Publishing. (2021, April 9). Preventing the spread of the coronavirus: Physical distancing, masks, and other preventive measures. Retrieved from https://www.health.harvard.edu/diseases-and-conditions/preventing-the-spread-of-the-coronavirus
HHS. (2021, April 23). COVID-19 Vaccine Distribution: The Process. Retrieved from https://www.hhs.gov/coronavirus/covid-19-vaccines/distribution/index.html
MGMA Staff. (2021, February 11). Is the telehealth boom set to continue in 2021? Congress and consumers will help decide. Retrieved from https://www.mgma.com/data/data-stories/is-the-telehealth-boom-set-to-continue-in-2021-co
Murphy, B. (2021, January 12). How the pandemic has spiked stress for many med school applicants. Retrieved from https://www.ama-assn.org/residents-students/preparing-medical-school/how-pandemic-has-spiked-stress-many-med-school
New York Times. (2021, April 18). Colorado Coronavirus Map and Case Count. Retrieved from https://www.nytimes.com/interactive/2021/us/colorado-covid-cases.html
Pate, D. (2021, February 22). No, We will not have Herd Immunity by April. Retrieved from https://drpatesblog.com/2021/02/22/no-we-will-not-have-herd-immunity-by-april/
Pate, D. (2021, April 1). It Will Get Worse Before It Gets Better. Retrieved from https://drpatesblog.com/2021/02/22/no-we-will-not-have-herd-immunity-by-april/
Rose, S. (2020). The Journal of the American Medical Association. Medical Student Education in the Time of COVID-19. https://jamanetwork.com/journals/jama/fullarticle/2764138
Weil, A. (2021, February 23). Podcast: Yes, COVID-19 Changed Telemedicine Use — But It’s Complicated. Retrieved from https://www.healthaffairs.org/do/10.1377/hp20210218.85534/full/
About the Author:
Luke McCabe-O’Donnell is a Student Intern with Denver Medical Study Group. He is currently obtaining his Master’s in Business Administration with a specialization in Healthcare Administration at University of Colorado-Denver. (Expected graduation date: Spring 2022)