Innovation and Missed Opportunities in Internal Medicine Undergraduate Education During COVID-19: Results from a National Survey

Abstract

BACKGROUND: COVID-19 disrupted undergraduate clinical education when medical schools removed students from clinical rotations following AAMC recommendations. Clerkship directors (CDs) had to adapt rapidly and modify clerkship curricula. However, the scope and effects of these modifications are unknown. OBJECTIVE: To examine the effects of the initial phase of COVID-19 on the internal medicine (IM) undergraduate clinical education. DESIGN: A nationally representative web survey. PARTICIPANTS: IM CDs from 137 LCME-accredited US medical schools in 2020. MAIN MEASURES: Items (80) assessed clerkship structure and curriculum, assessment in clerkships, post-clerkship IM clinical experiences, and CD roles and support. The framework of Understanding CrisisResponse (Royal Society for Encouragement of Arts, Manufactures, and Commerce) was used to determine whether curricular modifications were "amplified," "restarted," "let go," or "ended." KEY RESULTS: Response rate was 74%. In response to COVID-19, 32% (32/101) of clerkships suspended all clinical activities and 66% (67/101) only in-person. Prior to clinical disruption, students spent a median of 8.0 weeks (IQR: 2) on inpatient and 2.0 weeks (IQR: 4) on ambulatory rotations; during clinical re-entry, students were spending 5.0 (IQR: 3) and 1.0 (IQR: 2) weeks, respectively. Bedside teaching and physical exam instruction were "let go" during the early phase. Students were removed from direct patient care for a median of 85.5 days. The sub-internship curriculum remained largely unaffected. Before the pandemic, 11% of schools were using a pass/fail grading system; at clinical re-entry 47% and during the survey period 23% were using it. Due to the pandemic, 78.2% of CDs assumed new roles or had expanded responsibilities; 51% reported decreased scholarly productivity. CONCLUSIONS: Curricular adaptations occurred in IM clerkships across US medical schools as a result of COVID-19. More research is needed to explore the longterm implications of these changes on medical student education and clinical learning environments.

The Impact of Online Learning In The Internal Medicine Rotation Among Medical Clerks During The Covid 19 Pandemic and Lockdown

“…In the United States, results from national survey of all medical schools with regards to the internal medicine exposure during Covid 19 pandemic showed that bedside teaching and physical examination activities were "let go" during this period and students were not allowed from direct patient care. [32] This was also adapted by the UST-FMS for the medical clerks in the emergency room settings, ambulatory care, endoscopy, pulmonary and dialysis units/.…”

“…In the same USA national survey, most students agreed that the pandemic had definitely disrupted their internal medicine direct patient exposure, and even stated that they should continued with normal clinical exposures during this pandemic even to accept the risk of infection with COVID-19 if they returned to the clinical setting [32].…”

Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19

“…This lack of effect on NBME subject exam performance has also been previously described for other subject examinations [ 12 ]. The study by Alexandraki et al also suggests that shortened IM clerkship time due to COVID-19 closures did not objectively affect exam performance on the NBME Medicine subject exam [ 13 ]. However, it did have other effects on medical students as they struggled to see the required clinical experiences and diversity of cases during the shortened time period.…”

Why Are Students Appealing Clerkship Grades? A Multischool Root Cause Analysis

“…Purpose: As educators in undergraduate medical education, we seek to maximize student learning, grading transparency and fairness, and provide useful information to residency programs that support continued professional development. In recent years medical schools have encountered disruptions to curricular and assessment operations, in part due to the impacts of COVID-19 1 and the change to a pass/fail-scored United States Medical Licensing Examination (USMLE) Step 1. Medical schools have also developed an increased awareness of long-standing systemic inequities in the grading of nonmajority racial groups.…”