COVID-19 Response Column: Exploring the Effects of COVID-19 on Health Professional Education

Replication Cycle

Summary by Alex Powell, G2: This image depicts the infection cycle of a coronavirus in a cell. In the case of SARS-CoV-2 (the causative agent of COVID-19) and some other coronaviruses, infection would occur in a cell with the surface protein ACE-2. ACE-2 functions as a receptor for the surface-exposed spike protein on the coronavirus. This is a + sense virus, which means that the RNA is ready to be translated upon release from the virus after entering the host cell. The viral polymerase then functions to replicate viral RNA, which will go on to be translated and ultimately form the new virus to be released from the host cell and propagate infection.

Introduction

Similar to last year, we wanted to explore the impact of COVID on health professional education—now more than a year since the start of the pandemic. What remains a constant issue that students experience? What is no longer an issue—what is now at the forefront?

We asked the same two questions and then compiled responses by class year.

1. “What educational or professional challenges has the coronavirus brought to you at this stage in your career? You can discuss your current thoughts and uncertainties, if/how your educational plans or goals have been affected, and your hopes going forward. Answer in as few or many words as you’d like.”

2. “Additionally, has the coronavirus situation contributed in any way to your education or professional development? If so, please identify.”

Below are the responses.

COVID-19 Responses, 2021

Class of 2024

“I think the biggest educational challenge has been navigating a changing curriculum. With COVID, the schedule had to adapt the curriculum to in-person social-distanced (for example, splitting up neuro, or wearing Personal Protective Equipment (PPE’s) for the Practice of Medicine course), or completely virtual. I think the COM has been successful largely, but I think the rate at which things change has led to a bit of whiplash. In terms of other challenges, I'm one of the M1 BCS Social Chairs, and it's been super hard to try to find stuff to do. We've done a decent job of planning some safe in-person events, but the more casual in-person get-togethers I'd love to be able to plan are pretty much an impossibility. There's a lot of steps that need to be taken and approval that needs to happen in order to certify an official class event as COVID-safe, and this limits what we can do. Also, I am a bit ashamed to say this, but I haven't met every person in the class yet. As the social chair, I feel like it's kind of a responsibility of mine, but it's been very hard this year. I think in general it has impacted the social development of the class, which I think does impact our professional and personal development overall.” -Timothy Davis, College of Medicine

“I mean, I learned a lot about viral epidemiology. If I had a dollar for every time a friend or family member asked me something about COVID or the vaccine, I'd be able to pay off my student loans. But I actually really love researching and answering health-related questions so it kind of confirms to me that I chose the right career. I love learning about the immune system, but I'd rather have not learned about it through a global pandemic.” -Timothy Davis, College of Medicine

“It's been used as an excuse for poor planning and execution. I would definitely say my educational/professional growth has been stunted.” -Anonymous, College of Medicine

“I missed my birthday. Kind of sad.” -Anonymous, College of Medicine

“Having to take all of my classes online was pretty challenging. I prefer in-person classes, because it’s easier for me to focus, and it’s a place where I can get to know my classmates.

“I also haven’t been able to do as much volunteer work as I usually like to. I like to volunteer because it’s a nice study break, and I get to meet and help people, but this past year has made it tough as there were not many opportunities.

“Our white coat ceremony was hybrid, and I was not able to celebrate with my family and friends in person. It’s also been difficult because I haven’t been able to go home as much, and my family had been my main support group.” -Anonymous, College of Pharmacy

“While COVID-19 brought many challenges, there have been some unexpected positives. Virtual meetings have been easier for me with my busy schedule. I don’t have to take the time to travel to meetings, and I can attend from the convenience of my home. I also feel like the Kingsville and College Station COP campuses are close this year because all of our events are together on Zoom!” -Anonymous, College of Pharmacy

Class of 2023

“My educational challenges are the social hardships that have come along with the coronavirus. I feel like all of my former relationships were slightly hindered because I couldn’t see people or properly learn from them. All of my pre-clerkship courses weren’t straightforward. We would always and only have past video lectures, which were not as useful as some would hope, and we experienced troubles with Zoom, etc. Now that I’m in clerkship, I see the gaps I have in my knowledge because of it, and my self-confidence has suffered. I have actually been doubting myself and my abilities to stay in this profession, because I haven’t felt a connection to either my preceptors or my professors before now. Without that connection, a teaching moment can be perceived as a personal attack—personally, that’s how it has been for me.” -Anonymous, College of Medicine

“I think being one year into COVID, things are more stable now. The changes that were made last year, such as requiring students to wear eye protection and a face shield in addition to a mask during OSCEs, were jarring at first, but now I'm used to it. Same with wearing a mask and eye protection in every patient room at the hospital, wearing N95s in the ER, and not seeing any patient that has tested positive for COVID. Nothing has really changed with the protocols in the last couple of months for us, so while it was a big adjustment last year, this year it has become the ‘new normal.’” -Anonymous, College of Medicine

“Attending lectures on Zoom has made things a lot more convenient for me because I don’t have to commute to school. However, it has made focusing a lot harder since I am not in the classroom setting.” -Anonymous, College of Medicine

“At this point, I have trouble remembering what school was even like before COVID. It seems habitual now that every time I leave my apartment, I put on a mask and eye protection before going to clinical rotations. I don't even have to consciously think about it. Things are on autopilot for me now, whereas last year at the start of COVID things were a lot more stressful and uncertain about how my medical education would be affected.” -Anonymous, College of Medicine

Class of 2022

“It has been hard for me because I am an extrovert, and not being able to see people in class or when studying has been a big challenge. To get through the year, I have had to turn to things like art and music a lot more.” -Marshal Covin, College of Veterinary Medicine

“To add to my husband’s post, since we are both in professional school and now have to take big exams at home, we now have to have someone on "Floof Watch." Basically, when one of us is taking an exam, the other has to be home to make sure that the cats, Cookie and Nugget (mostly Nugget), don't become distressed because one door in the entire house is closed. This was discovered the hard way during my Psychiatry NBME when Nugget decided to sit outside of the door and meow for 10 minutes; his meows were heard over a white noise machine and ear plugs.” -Brianna Covin, College of Medicine

“Starting clerkships in the middle of COVID created an interesting ethical dilemma where I had to decide between continuing on medical education at the risk of my own health and the health of my family members. Ultimately, I decided not to take a break and to be extra cautious when interacting with my loved ones not in medicine. Overall, it is hard for me to decipher what the impact on my education has been because we weren’t really halted in our clinical training. Sure there were less sick visits, but I would say we have gotten the chance to become ultimately familiar with normal medical visits. It also forced us to pay attention to mental health in every visit in every clinic, and for that I’m infinitely grateful." -Astha Mittal, College of Medicine

Class of 2021

“If it wasn’t for Covid, I would have been a psychiatrist. At the end of my third year when Covid hit, I had plans to go directly into my fourth year and do away rotations in psychiatry, since that was the field I’d chosen to pursue. In response to the pandemic, the medical school offered students, especially those living with immunocompromised or otherwise vulnerable individuals, the opportunity to apply to the MD plus program. My partner was pregnant and ended up delivering our newborn 7 weeks early. At the time, not much was known about the virus, especially in regard to its effects on children or newborns. I took up the school’s offer, applied for, and got into the MD Plus program. A few weeks in, having been away from the hospital for a few months, I noticed very distinctly that what I missed most from my rotations—what I, in fact, longed for, was the OR. The time I spent at home, not only was a gift because I got to spend time with my newborn, but it reaffirmed my love for surgery.” -Jordan Garcia, College of Medicine

“I applied to orthopedic surgery and did not match in the 2021 match cycle. In my reflection, an element of not matching can be attributed to coronavirus’ effect on the orthopedic surgery application cycle. 

“Away rotations are a crucial part of orthopedic surgery match. They are considered a four-week interview. We didn’t have the opportunity to complete these rotations and develop rapport with programs of interest. 

“The average number of interviews decreased in this match cycle for orthopedic surgery. Based on metrics, I am not a top tier applicant, but I also was not reaching. There is speculation this occurred because top tier applicants and those from top tier medical schools obtained the most interviews. They did not have to cancel this year with interviews being virtual. My end result ended up being fewer interviews than expected.

“Personally, I wanted to earn my spot through hard work. Viable orthopedic surgery applicants are hard-working individuals. I now recognize this may not set an applicant apart. My professional mindset developed from experiences as a student-athlete in high school and college where opportunities are earned. 

“The limitations imposed by the pandemic meant maintaining and utilizing relationships with mentors became more valuable. They are able to vouch for you as an applicant, speaking to the person you are. I did not recognize how the value of mentorship increased due to the decrease in opportunities to form meaningful relationships away from a home institution.

“I am completing a research year in orthopedic surgery with plans to reapply in the 2022 match cycle. Eventually, I would have had an event that caused me to gain this perspective about the importance of building relationships in the professional world. Coronavirus just caused it to present sooner rather than later.” -Brendan Holderread, College of Medicine

COVID-19 Responses, 2020

Class of 2023

College of Pharmacy

“Testing is difficult, finals and benchmark at the end of the year are uncertain. I was also looking forward to many labs, which we will no longer be able to do.” -Anonymous

“I have learned to be more flexible with this situation. I am also connecting more with my classmates in our area about troubles with classes.” -Anonymous

“Last semester was about learning to adjust to grad life. This second semester I was finally getting used to the speed until the coronavirus situation occurred. This does have its pros and cons. Pros being I get to stay at home with my family. Cons now starting the adjusting process over at home. I feel like I can speak for a lot of my classmates in saying that it is very hard to separate your school life from your home life especially being at home during this quarantine. My level of focus during class is significantly lower due to my parents and siblings all having to work from home. My goals are unfazed, but I do have worries with the qualities of my education.” -Anonymous

“This situation has affected my testing skills especially. Some administration decided to disable the back tracking option for exams. I completely understand where they are coming from as they do not want students sharing answers, and they say this resembles the NAPLEX style of exam. However, we are professional students and we respect the Aggie honor code. Additionally each exam based on a couple subjects is not the NAPLEX. While taking an exam, some solutions don’t come to me until I’ve gone through the entire exam. Some questions are several paragraphs long and I purposely skip them to go through the less time consuming questions. After taking my first “no back tracking” exam, I felt an enormous amount of anxiety and my score reflected that. Coming from someone who strives to get A’s, this coronavirus situation really is affecting my professional development.” -Anonymous

College of Medicine

“There has been a lot of discussion about how grading will change since we are currently ranked and graded on a H/P/F system. Our Introduction to Disease block was graded on a S/U system with no rankings, which seems like it could set a precedent for future blocks. There is a lot of current uncertainty about the best way to evaluate students during the preclinical years and a lot of stress as we wait for the curriculum committee to make their decisions, while students still have to study for exams like normal.” -Anonymous

“This pandemic has made me value things more, and it has shown me just how much we don’t value social interaction. All things said, it has shown me that there are more things than just studying. Granted I enjoy being a student, but I realize how much of my life has been passing me by. It makes me question if I died tomorrow, would I be content with my past year and a half just studying?” -Anonymous

“With all that is going on I have been having difficulties keeping my mental health where it needs to be because of my family, my friends, and just everyone because you have no idea what could happen tomorrow. With a mood disorder everything is continuously stressful, and medical school exacerbates that, and this pandemic gives it a new level. All in all, I think now is a stressful time and I am having a hard time adjusting to anything or having motivation for school as I don’t have as much space, privacy, silence, or resources.” -Anonymous

“This situation has taught me that there is more to life than just medical school. I think we all know that, but medical school can be all-consuming when you’re on campus for the majority of the day, every day. Since being at home, I’ve re-connected with old friends, I’ve maintained friendships that have dwindled since I started medical school, and I talk to my family much more often. Being at home because of the coronavirus has decreased my motivation to study but simultaneously broadened my perspective on the importance of keeping up with those you care about outside of medical school.” -Anonymous

“I never liked being a homebody. I like to be outside and feel the sun rays penetrate my skin as I stand there and feel the air whispering in my ear. It brings me happiness, and it brings me back to life. School has been difficult for me, but I haven’t given up and I’ve been trying not to. I try to think that this pandemic is just another boulder standing in my way until I walk across the stage, trying to stop me, but yet I choose to fight it and fight hard. Most people don’t mind staying at home but don’t need the rays of the sun either; I need more than just a back yard to study in and a porch to stand on.” -Anonymous

Class of 2022

College of Pharmacy

“Didactic education has suffered through this ordeal as this transition to a completely online setting was not expected. However, this situation only reinforced the notion that my future career is necessary for the community.” -Zachary Shenkir

“Although didactic education has suffered and courses that normally would not be heavily associated with viral infections are overtaken, the actual experiences in the field for those of us lucky enough to work or to be allowed on rotations are extremely valuable.” -Zachary Skenkir  

College of Medicine

“For me, the hardest thing about COVID-19 is having to sit on the sidelines. I chose to become a doctor to help in moments like these, and it’s hard to be at home while so many people are sick and in need. However, I am incredibly fortunate that I and those I love are healthy. I remind myself that during this time, my job is to study hard for STEP so that one day I can be there to serve and help others in such a great time of need.” -Anonymous

“2020 is wild because so many people are falling ill or dying from a disease, and we are taking precautions to distance ourselves from them and study. While I understand the need for physical distance, this is at the heart of what we all aspire to fight against, and it disappointed me to feel that I was doing nothing about this—that history would pass and someone who champions the welfare of humanity and health did nothing.” -Megan Badejo 

“I’m getting questions from my little brothers, my old coaches and athletic directors, and anyone who thinks I might have an understanding of what’s happening. In this, I found that this is our role as student doctors too: to share our knowledge, because we have more knowledge about what may be going on than the general public.’’ -Anonymous

“The pandemic opened the public eyes to healthcare, but it also re-opened mine to the health system, how it relates to what I am studying, and all of the disparities that are easily forgotten; the pandemic makes them stark.” -Anonymous

“As an M2, I’ve been in dedicated STEP study for the entirety of the COVID pandemic so far. This has been a blessing in some ways as I’m able to study uninterrupted for STEP with the added fuel that one day I want to be one of the frontline health workers working to save lives, but the uncertainty of survival and safety of my friends, families, and humans looms at the forefront of my mind.” -Astha Mittal

School of Public Health

“I have experienced more professional challenges than educational. I teach courses and now with them being switched to online I've spent a great deal of time setting up courses or re-doing lectures to create a recorded version to post for students. In-class activities and assignments have also had to be revamped in a very short period of time. As far as doctoral studies, the main challenge has been setting aside time to get all posted readings and discussions done since these items are no longer happening in a live class setting.” -Anonymous

“I have been able to learn new online platforms and new ways for making information available to students in an online class setting.” -Anonymous

Class of 2021

College of Pharmacy

“All classes and tests have been moved to online. There are tons of technical issues faced every day that make it difficult to have a complete lecture. All service learning activities have also been canceled, making it impossible to fulfill the required hours for graduation. There are also major concerns about APPE rotations maybe being pushed.” -Anonymous

“Doing exams, assignments and homework all at home have become difficult for me.” -Eric Soto  

“It’s taught me more about how to be more responsible in learning and reviewing everything more thoroughly.” -Eric Soto 

College of Medicine

“Hard to confirm specialty choice if you can't do rotations in it during the end of Career Discovery period. Can't plan for away rotations well.” -Anonymous

“Being an M3, the next few months are very critical for preparing residency applications. We were finishing up career exploration when we were pulled out of clinical rotations. I had just started on an elective where I was hoping to get a letter of recommendation. Given the current circumstances and the uncertainty of it all, it has definitely affected how I plan to move forward. However, it’s difficult to adjust plans since we don’t know how long social distancing will go on for. There’s a lot of stress around how to move forward with finishing up core rotations, taking Step 2 CK/CS, away rotations, and getting letters of recommendation. But I try to keep in mind that everyone nationwide is in the same boat and that it is not in our hands. Accommodations will definitely be made so I’m trying to focus on strengthening my applications through available means such as studying for rotations and STEP 2, working on research projects, and staying involved in volunteering.” -Anonymous

School of Public Health

“Online classes—the new format—disrupted previously outlined syllabi deliverables and objectives. The uncertainty about summer practicum (internship) requirements, programs I've applied to have changed their opportunities.” -Romyssa Hashim 

“Concern for my family affected by the international response. It's an underlying stress affecting my focus and sleep.” -Romyssa Hashim 

Class of 2020

College of Medicine

“Adaptability is essential to our success as medical students, professionals, and beyond, and I believe as a class our response to COVID-19 has shown nothing less than such. As a class, we have remained professional in the face of changes like clinical rotations being transformed from on-site to remote and having abbreviated Match Day and graduation ceremonies. Nearly 86% of our voting class elected to allow for early graduation to enable those willing to volunteer during the pandemic. Although an early graduation was not permitted, the message is clear that the field of medicine is soon to welcome a class of selfless, driven interns ready to give back and serve our community as health professionals.” -Hanna Fanous

“This public health crisis highlights the critical need for improved communication and trust between healthcare officials, political figures, and our community as a whole. As I continue my education in medicine, I will actively find, create, and then engage in opportunities that contribute to the mission of bridging such existing gaps.” -Hanna Fanous

A Message from The Synapse

We thank you all for your responses; they were very enlightening and eye-opening. We appreciate your allowing us the chance to highlight how this pandemic is impacting your lives and share it with others.

This may all soon come to an end, but in the meantime please stay safe and maintain proper social distancing.

Sincerely, Your Synapse Team

The Synapse is sponsored by the Department of Humanities in Medicine at the Texas A&M University College of Medicine.