'I have hope.' Reflections on medical education from the first wave of the pandemic

By Dr. Suzanne Minor

Every month, I receive the evaluation comments written by fourth-year students about their rotations, sites and preceptors. I read through these looking for possible concerns around faculty development and resident development, especially with regards to teaching our students. I want to make sure that if there are any trends, I am on top of them; if there any opportunities, I can quickly work to support faculty as needed.

This past Fall, I read our first evaluations since our students started back after the pandemic. I did not know what to expect. Actually, I expected negative comments to jump out at me. In the months since our faculty had last worked with students, the coronavirus pandemic had ravaged South Florida. Our affiliate hospitals were overwhelmed with COVID-19 admissions and our already busy faculty had borne the burden of caring for sick patients with limited PPE [personal protective equipment]. They had to attend to patients' families through virtual means, and do so while working long hours. They often had to isolate themselves from loved ones to protect them from possible illness. And there was no reprieve in sight. One of our affiliates had asked community physicians to do hospital shifts to [help] overworked hospitalists. I didn't know what students would experience as they returned to the clinical setting.

As I read, I noticed I had been holding my breath and my shoulders were tight with tension. But I didn't need to be worried, after all. I felt my throat catch and a surge of sad happiness, probably a release of pent-up emotions related to this crazy pandemic. The comments by students were amazingly positive. Over and over students spoke about the excellent, high-quality teaching provided. Students on hybrid rotations commented about the incredible learning experiences they received through virtual rounding and cases, plus in-person scrubbing for surgeries. Particular patient care experiences were sometimes cited. I know those hybrid rotations were crafted quickly and with great effort in order to provide optimal learning experiences despite the pandemic. Some faculty took more students than usual yet still provided outstanding teaching and supervision. They were taking on added duties even in this situation, and I imagined that they would probably write quite a few letters of recommendation in the coming months, adding further to their time demands.

There are just a few comments about faculty performance being negatively impacted by COVID-19. Still, those comments are rare. Our dean of clinical education took great care in working with sites to ensure that students would not work with patients suspected of having or diagnosed with COVID-19 and to ensure the safety of patients, students, staff and faculty. COVID-19 admissions slowly declined; students are only able to be in the clinical setting because the numbers were coming down. Yet, in spite of this pandemic, our faculty members are giving their all to students and patients. Not only are faculty teaching during a pandemic, they are teaching well even in this different environment, providing meaningful experiences to learners while also accounting for safety.

As I continue to review the report, I am aware of the halo/horn effect and wonder if students were so grateful to be back in the clinical setting that they are providing more positive comments about faculty that they might have had there not been a pandemic-mandated pause in their clinical training. I also wonder if faculty were just so grateful to have students back that they were nostalgically reminded of the joys and wonders of teaching and passing on our wisdom and passion for patient care to those coming after us – those who will probably be our doctors one day. Whatever the reason, joyous teaching interactions leaped from the report with jubilant aplomb.

The end of the report contains students' comments about the teaching they received from residents. The comments about resident teaching were just as positive and strong. I admit that I shed a few tears when I read comments about our former graduates who are now residents in multiple clinical programs and sites teaching our students in such a challenging situation.

These comments weren't just positive. They detailed specific high-quality teaching moments. I’m so grateful to bear witness to the interpersonal connections at play with each other: patients, students, staff, residents, faculty.

These observations carried through to the personal statements of our fourth-year students applying to residency. So many students were inspired by the physicians that cared for them or their loved ones in their formative years. We are all interconnected. It may sound very “airy-fairy” or New Age, but I notice this connection again and again: physicians inspiring patients to become physicians-in-training, physicians and residents teaching students who will one day become physician educators themselves, patients receiving care but actually who are educators. We are all connected and in this report, I see this so clearly.

I’ve been thinking a lot lately about the interconnectivity of each person within society and on this planet. It is so clear to me during this pandemic that we as a people are only as strong as the weakest link. If just a few people are not wearing masks or are gathering together, the novel coronavirus will continue to spread. But if we follow basic guidelines, we are strong together and our unity-in-action speaks to our interconnectedness.

Medical education and patient care are intricately woven together like a tapestry with every thread contributing its own texture and color to the pattern and strength to the structure. I am so honored and grateful to witness and be a part of the beauty on the report before me because I know that the words that were written are just a glimpse of the overall experience students had at their sites with their preceptors, residents and patients.