In mid-March, nursing and medical students' clinical experiences with direct patient care were quickly put on hold, leaving schools scrambling to find new ways to continue to train medical professionals.
They got creative, expanding virtual options for classroom learning and finding other, safer experiences for students, including helping to answer COVID-19 hotline calls or consulting with patients via video or phone call.
"The decision to remove medical students from the hospital was a difficult and painful one," said Steven Ricanati, interim vice dean of medical education and associate dean for student affairs at the Case Western Reserve University School of Medicine.
But university and hospital leaders agree that pausing these experiences was the right call for everyone's safety. The schools wanted to ensure there were appropriate patients for their students to work with, safety guidelines in place and a sufficient supply of personal protective equipment so students could learn without depleting hospitals' PPE resources or their faculty's attention, Ricanati said.
Now that the economy is reopening, the anticipated dramatic surge didn't happen and all have had time to put appropriate safety measures in place, many nursing and medical students will return to clinical sites Monday, June 1.
Schools and hospitals collaborated closely to make that happen. The ongoing responsive and proactive adjustments they've made together have become a "dance" of ensuring everyone's needs are met, said Diana Morris, interim academic dean at the school of nursing at CWRU and the Florence Cellar Associate Professor of Gerontological Nursing.
Dr. Debra Leizman, director of medical student education at University Hospitals and the clerkship director of internal medicine, said courses front-loaded the basic classroom-based learning so that by the time students get back to clinical experiences, they can be fully immersed in that.
She also heard from a number of students who knew they couldn't go into the hospital but wanted to be able to help. Leizman helped set up a program through which more than 100 students volunteered thousands of hours to answer calls to the COVID-19 hotline.
Though it took a couple of weeks to figure out how to meet students' educational needs, Cleveland Clinic Lerner College of Medicine was able to successfully pivot to involve students in virtual clinics and virtual hospital rotations as telemedicine use skyrocketed, said executive dean Dr. Bud Isaacson.
As students return to clinical sites, some parts of their clinical experiences will look different going forward. Many schools and hospitals aren't allowing students to work with patients who have or are suspected to have COVID-19, which meant some rearranging of where they would typically do their rotations. Hospitals are also trying to limit the number of people entering a patient's room, whereas previously a large team of trainees could come in.
"Currently, we are saying, 'You know, let's just limit to the bare bones the number of people that need to go into a room,' " Ricanati said. "So that has changed how much education and supervision can happen."
Schools are finding that the quick educational solutions they implemented can be carried into the post-pandemic normal. Patricia Sharpnack, dean of Ursuline College's Breen School of Nursing, said students were thrilled with some of the technology quickly brought on. She expects much will be retained and used in different ways in the future to supplement teaching.
Schools had to work with their accrediting bodies and state boards to modify what activities were allowed that would still meet required learning objectives.
In May, universities were able to graduate classes of nursing and medical students in their final year. Now, they're exploring what needs to be adjusted to ensure that students can still graduate on time next year, which many are confident will happen.
For instance, NEOMED is supplementing the completion of direct patient care for students slated to graduate in 2021 by creating a schedule that will allow them to finish their core clinical rotations next January, explained Dr. Elisabeth H. Young, NEOMED's dean for the College of Medicine and vice president for health affairs.
But there may be delayed graduations. Some students pursuing a Master's of Nursing at CWRU will graduate later than expected, despite efforts to find ways to make up clinical times so they can get into the workforce, Morris said.
"We know that some of them are not going to graduate on time because we just aren't going to be able to fit in all the hours that are required," Morris said.
Returning students to in-person training and keeping them on track for graduation is critical not just for the students but for the needs in the health care sector now and in the future, especially given projected and current shortages across the country for primary care providers, nurses and others.
The past three months have been a crash course for students and educators in adaptation to extraordinary circumstances.
Young, of NEOMED, has spoken with colleagues across the country, all of whom are committed to graduating their classes.
"COVID isn't going to keep that from happening," she said. "And we're not going to graduate a class that isn't prepared to be part of the workforce. We are going to graduate a class that is well prepared, maybe better prepared for a world that's changed. And so I think what COVID has done is it has tested our ability to be innovative, creative and not stuck in a box."
Ricanati said the pandemic has been an "unbelievable schooling on the social determinants of health, disparities and equity."
As start dates near for new classes of first-year nursing and medical students this summer and fall, schools are thinking carefully about how much learning will still be done virtually and what that means for students' ability to establish relationships with their professors and build community among their peers, both of which are critical.
If there is a surge of COVID-19 cases in the fall, Young said she wants NEOMED medical students to be a valuable asset to hospitals. In March, pulling students out of the clinical setting was the best option as everyone faced so many unknowns while they implemented rapid changes to prepare for an anticipated surge.
"I want them to be part of the solution, so in event of a surge, these hospitals will say, 'We need these students, and they can help us,' rather than 'We need to remove the students,' " Young said.
"Medical students pass the pandemic test" originally appeared in Crain's Cleveland Business.
