COVID-19 spurring permanent curriculum changes at medical schools

Medical schools are significantly changing their curriculums as they try to navigate the complexity of training the next generation of clinicians during a worldwide pandemic. Some of the modifications are likely to stick around long after COVID-19 is gone. 

Medical school leaders say the pandemic has encouraged them to be more innovative and re-think some traditions of medical education. Changes include transitioning courses to virtual settings, having smaller groups participate in anatomy dissections, requiring students to wear personal protective equipment during clinical rotations and allowing them to participate in telehealth visits alongside a physician. 

“COVID-19 has kind of shaken the box,” said Dr. Steven Scheinman, dean of the Geisinger Commonwealth School of Medicine in Scranton, Pa.

The school was planning changes to its curriculum prior to COVID, in particular moving all its courses away from lecture to discussion classes. COVID-19 accelerated that, and even brought forward new components to the curriculum that leadership plans to keep, Scheinman said.

For instance, one part of Geisinger’s curriculum has students participating in small group discussions with a physician to review real-world patient cases and how they’re handled in the health system. But it was often difficult to book the most sought-after physicians because of their busy schedules. In response to COVID, the school transitioned to Zoom web conferencing for the group discussions, giving physicians more flexibility to participate.

“I don’t know if we would have thought of Zoom if it hadn’t been for COVID,” Scheinman said. 

Other schools are also finding unexpected benefits to changes COVID-19 forced them to implement. Among them is Indiana University School of Medicine, which has revamped its clinical clerkships for third- and fourth-year students.

Prior to COVID, students had clinical rotations with didactic courses to supplement the clinical experience. In March, when clinical rotations were suspended, the school quickly moved the didactic courses online. When those students returned in late June to complete their clinical rotations, they said they felt more comfortable and knowledgeable about what they were seeing since they had so much background from the didactic courses. Given that positive feedback, IU School of Medicine plans to teach the didactic courses to students prior to the start of clinical rotations.

“Students seemed to be more prepared (for clinical rotations) and … to hit the ground running more than what we had in the past,” said Dr. Brad Allen, senior associate dean of medical student education at IU School of Medicine.

Web-based learning hasn’t been perfect. At Dell Medical School at the University of Texas in Austin, first-year students, who started at the end of June, weren’t bonding or forming connections through web conferencing, which was concerning because Dell’s curriculum relies heavily on robust and meaningful discussions, said Dr. Susan Cox, the school’s executive vice dean of academics.

Because of these concerns, Dell is in the process of bringing the first-year students back to campus in mid-September. The school has a large auditorium that can hold 125 people. Each class will have 50 students, allowing room for social distancing.

Some activities, such as simulated patient clinics, can’t be shifted to an online experience and students must still come to campus. Schools have responded by providing students with masks, gloves and face shields as well as decreasing the number of students in a grouping. Partnering with an affiliated health system has been key to ensuring medical students have adequate PPE, said Dr. Badrinath Konety, dean of Rush Medical College in Chicago.

Rush also requires students coming on campus for classes to use an app that surveys users for COVID symptoms.

Cadaver dissections in the first year are also being rethought, with smaller groups than in years past. And rather than segments of the course being sprinkled across the fall semester, IU School of Medicine transitioned to a block course at the term’s start to ensure students will complete it before potential surges during flu season. Dissections will now be complete by the end of September. 

“We are trying to get our students through things where they need to have face-to-face activity” with other students, Allen said.

For its part, Geisinger is doing a combination of in-person and virtual dissections for students. Geisinger discovered a cadaver simulation tool online last spring when it abruptly had to end brain dissections because of COVID-19. Students and staff responded positively to the online platform for its detail and realism. “In many ways, the simulation illustrates the anatomy better,” Scheinman said.