Coping During a Crisis: COVID-19’s Impact on Medical Students

As spring break started in early March of this year, many of my second-year peers ventured off into various corners of the world, ecstatic for a small reprieve from what is traditionally the most challenging part of medical school: board preparation.

As our week-long vacation progressed, dread began to seep in. Conferences were canceled; the first guidelines of social distancing were put in place; travel restrictions were established.

In the span of seven days, all semblance of normalcy had been thrown out the window and thus began the shelter-in-place mandate.
Every medical school expects their students to come prepared with the ability to adapt; to remain flexible and persevere during the highs and lows of medical school… but no one could have prepared us for the challenges brought on by COVID-19.

One by one, we were pulled from classrooms, hospitals and clinics, both for our protection and to reduce the spread of this constantly evolving virus. First-year students were in the middle of one of the most important units in anatomy. Second-year students were preparing for their OSCE’s (Objective Structured Clinical Examination – when medical students demonstrate clinical skills during a series of standardized medical scenarios) and board exams. Third-year students were about to embark on their electives or sub-internships and fourth-year students were anticipating Match Day and graduation. Just as this virus had disrupted the rest of the community and the world, it had proven the medical school way of life was not immune. As with most of the rest of the world, this unfortunate but necessary change created abrupt social isolation for our medical school, followed by a waxing and waning of uncertainty.

As every single aspect of our medical education has changed, I have struggled.

I’ve cried. I’ve gained and lost weight (got to love the COVID 15). I’ve felt frustrated that all I could do was sit in my living room and watch time escape from my control. At times, I have lost my motivation; I have succumbed to my inner saboteur (I refer to her as Brenda, and she reminds me of all my greatest fears and insecurities). But through it all, I have survived.

After spending months on Zoom calls, and weeks studying in preparation for board exams, all while only leaving my apartment sparingly, I reached a breaking point. My exams were canceled and rescheduled three different times, adding another layer of anxiety to what lies ahead.

I thought starting rotations would alleviate the sense of dread that had been slowly building within me since March. Unfortunately, my family medicine rotation shifted to a remote learning experience. While some of my peers were sharing success stories of their first day in clinic, I was trying to accept that I may be asked to spend the “best years of medical school” in my 800 square foot apartment teaching myself what I felt could only really be learned in an exam room. Yet, my medical school is in an area that used to be a COVID-19 hotspot and at one point we were leading the country in new cases per day. I felt ashamed for being angry about being forced into remote learning. Everyone has had to make sacrifices, and I am no exception.

Despite all these challenges, I have adapted.

I decided to take this opportunity to focus on my health, to create a sustainable routine and to make the best of my situation. I volunteered at COVID testing sites, utilizing my ability to speak Spanish to serve one of the populations who have been hit the hardest by this virus. I also participated in a county-wide survey with the local health department to track mask-wearing. Through outreach and education, we watched the community grow from 35% to 95% of the local population electing to wear masks in public. This contributed largely to the eventual plateau we have seen in COVID cases here in Yakima, WA.

I have also found that I’ve regained my passion and excitement for medicine . It was there, all along, camouflaged by the very real and very common student-burnout I was experiencing. My school has advocated strongly to return students to the clinics and hospitals, and I am happy to announce that I have just completed my first week of internal medicine, in a hospital.

But what comes next?

Almost six months have elapsed since the pandemic began its insidious spread into Washington state, and it does not appear to show any signs of slowing. How do we as medical students navigate this new world that we have been thrust into? Every person’s experience during COVID-19 is unique to them, but I would like to share some tips that helped me cope:

• Improvise, adapt, and overcome
  What are you missing out on because of this pandemic? Use your ingenuity to create and adapt opportunities for the “new normal.” For example, during my family medicine rotation, I had more free time than I knew what to do with; studying for shelf exams and participating in remote courses only occupied a fraction of my day. I collaborated with fellow classmates on a project that began as a literature review on a subject we were all passionate about. This eventually transformed into a scoping review with a possible publication in the future.
• Acknowledge and accept the changes in learning and grading
  For some medical students, the shift to remote learning has altered grading systems. Don’t let “pass/fail” lull you into complacency. Even though a percentage or a letter grade will not be demonstrated on your transcript, you should still use your raw score to determine a baseline of your strengths and weaknesses. If you’re in the didactic portion of your education, treat this as board preparation to avoid relearning material. If you’re on a remote rotation, embrace whichever medium you are using and try to make the most of it, because it will only serve you once you transition back into the clinics. Many medical schools have found creative ways to help students demonstrate strong academic progress despite the new barriers in education. These opportunities will prepare you for residency interviews during which you will likely be asked, “So what did you do during COVID?”
• Establish a consistent routine
  Medical school has a reputation for its highly structured environment, so finding a sustainable routine that works for you is crucial to your success. As silly as it sounds, having a consistent bedtime and wake-up time can do wonders for a person. The phrase “you get out of it what you put into it” has never applied so heavily to your medical education as it does right now. Don’t let this pesky virus distract you from your dreams and goals. Through a period of trial and error, I discovered that the following routine works best for me:
  • Wake up,
  • brush my teeth,
  • run 3 miles,
  • take a shower and GET DRESSED,
  • spend the morning studying,
  • eat a tasty lunch,
  • create time for review and extracurriculars in the afternoon,
  • cuddle with my cat,
  • and read a book before bed.
  • Rinse, and repeat.
  • Do what you need to do for both your sanity and your success as a medical student.
• Give yourself some grace
  There will be moments where you feel like you’re not doing enough given the sudden increase in free time. It’s always okay to make time for yourself, your family and your social network, or to get involved with a project that you are passionate about. There are an abundance of resources to help you continue building your CV, but don’t feel like you must complete them all. Go at your own pace, take care of your well-being first, and try as best as you can to not compare yourself to others.

Medical students across the country face a multitude of unknowns. Medical schools must meet the challenges of delivering an education that is normally hands-on in a dispersed, remote, hands-off environment. My medical school has accomplished this in several ways: for the 300+ students in didactics still on campus, students have been assigned to smaller groups with varying schedules so they can rotate through the curriculum in a safe, socially-distant manner. This allows students to learn anatomy, osteopathic manipulation, and clinical skills in person in lieu of remote learning. The faculty has championed having students complete their core rotations, boasting over 80% practicing in regional hospitals and clinics and they have also supported the students’ desire to help the community during this pandemic. Working closely with the Yakima Health Department and Union Gospel Mission Free Clinic, we’ve provided opportunities for free testing and education, a byproduct of which has been to grant students the opportunity to make a difference.

Despite efforts across the nation to modify medical education, I often find myself wondering: How will this continue to affect our curriculum? How long will this “new” normal last? Will this eventually become the “norm?” Will COVID-19 reduce our chances of matching into our desired specialties? What specialties will exist given the economic impact this virus is having on our healthcare system?

I don’t have the answers to these questions, but what I do know is this: the world needs physicians, now more than ever.

We have been selected to meet these new challenges head on. We have the unique opportunity to learn medicine during a global pandemic, and a pandemic of this severity hasn’t occurred since early 1900’s. We also have the unique opportunity to change medicine, as COVID continues to expose our healthcare system’s shortcomings.

Thus, I would argue that this is the perfect time to be studying medicine.

DO Student Spotlight: Polly Wiltz is currently a third-year osteopathic medicine student at Pacific Northwest University of Health Sciences College of Osteopathic Medicine. Learn more MD and DO programs here.