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Medical Education Post COVID-19

April 30, 2020
By: 
Marcel D’Eon
Professor
Department of Community Health and Epidemiology at the University of Saskatchewan, Saskatoon and Editor of the Canadian Medical Education Journal
Rachel H. Ellaway
Professor
Community Health Sciences and Director of the Office of Health and Medical Education Scholarship in the Cumming School of Medicine, University of Calgary
Maria Athina (Tina) Martimianakis
Associate Professor
Department of Paediatrics and Scientist and Associate Director of Collaborations and Partnerships, Wilson Centre, Faculty of Medicine, University of Toronto
Director of Medical Education Scholarship
Department of Paediatrics and Scientist and Associate Director of Collaborations and Partnerships, Wilson Centre, Faculty of Medicine, University of Toronto
Tim Dubé
Assistant Professor
Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke

The COVID-19 pandemic has demonstrated that most countries and their health systems were not prepared to deal with a health emergency of this kind. We also know that there will be other such disasters, perhaps another pandemic or a climate change emergency. In response to the COVID-19 pandemic, medical schools and universities around the world have also been disrupted and have had to modify their teaching models. While these adaptations are likely temporary, we believe undergraduate medical education (UME) programs should carefully consider fundamental changes to better prepare for the next emergency.

Some short-term changes:
Medical school curricula will respond to this pandemic by placing greater emphasis on public health and preventative medicine and the social determinants of health. While anti-oppression education and community outreach initiatives are already part of the socially accountable mission of Canadian medical schools, their place of importance should be significantly expanded to more effectively serve populations who are severely affected during public health crises.

A fundamental realignment of the UME program is desirable:
The COVID-19 pandemic has clearly confirmed the need for a rapidly deployable reserve of clinically prepared medical students to augment the health care workforce. When the next local or global crisis confronts us, our students must be better prepared to assist physicians and other frontline healthcare providers. We realize that there are many reasons why medical students have not been immediately utilized to support the health care workforce. However, given that these issues can be resolved, our medical students will need to be prepared to assume a meaningful and supportive role alongside licensed health professionals when need requires it.

There is evidence that we have not prepared our medical students very well (John, 2017). We therefore need to engage our students in learning basic medical practices at the start of their training. By this we mean applied knowledge, skills and attitudes in areas such as:
● distinguishing between normal and abnormal presentations and viral and bacterial infections for common and/or critical patient situation
● establishing a therapeutic relationship and conducting an effective patient interview using the most effective communication skills (especially non-verbal)
● helping patients, families, colleagues, and self manage grief and trauma (particularly important during disasters but always useful in health care)

Responsive leaders can proactively improve medical education in the long term with more clinically relevant and rewarding student experiences that better meet our social contract. Medical practice first, some argue (Weston, 2018), is a more effective way to form, educate and train medical learners: it is more motivating and allows for successful integration of biomedical science with clinical presentations and treatments. Furthermore, when the next emergency occurs, learning these basic medical practices will not be interrupted since they will already be in place. As we have witnessed, learning about the biomedical and social sciences can be accomplished online during a pandemic. Learning the basics of medical practice at the outset will also better prepare students for their clinical learning experiences in later phases of training, and it will make the MD degree more accessible for students with diverse educational and personal backgrounds (rather than favouring those with biomedical science degrees). It will also mean that, when needed, our medical students will be ready to provide respite and aid to an exhausted and overwhelmed medical workforce. UME will experience less disruption of educational programs and student progress when the next disaster falls upon us.

The Association of Faculties of Medicine Canada has been working on an initiative to focus on and re-organize the teaching and assessment of core professional skills to facilitate the transition to residency. (AFMC, 2020). The COVID-19 pandemic will inject some urgency into their efforts. To this welcomed transformation we add only the recommendation that these be introduced, taught, and assessed as early as possible.

Conclusion:
After SARS we heard calls for heightened readiness of public health and health systems for the next pandemic (Thompson, 2003) and for better preparation for disasters generally (Smith et al, 2012; John et al, 2017; Kim et al, 2018). But, with few exceptions (Krane et al. 2007), they went unheeded. After the tandem tragedies of the Spanish Flu and WW I came the Roaring 20s. After WW II, wartime practices of admitting students from diverse backgrounds and women were abandoned (Ludmerer, 1999). While COVID-19 has been and will continue to be a significant catalyst for change in UME, it will be challenging to ensure that the adaptations will be sustained over time (Coyne, 2020).
This moment in history calls for bold thinking supported by robust evidence and a renewed commitment to the social contract between medical schools and the populations they serve. Undeniably, current and future medical students are learning firsthand what we cannot forget or ignore, that they need to be prepared to respond rapidly to the next global or local disaster.

References:
Association of Faculties of Medicine Canada/l’Association des Facultés de Médicine du Canada. AFMC Entrustable Professional Activities for the Transition from Medical School to Residency. 2020. (https://afmc.ca/sites/default/files/pdf/AFMC_Entrustable_Professional_Ac...). Accessed April 17, 2020.

Coyne, A. This changes everything, unless it doesn’t. Globe and Mail April 10, 2020. https://www.theglobeandmail.com/opinion/article-this-changes-everything-...
John A, Tomas ME, Hari A, Wilson BM, Donskey CJ. Do medical students receive training in correct use of personal protective equipment? Medical education online. 2017 Jan 1;22(1):1264125.

Kim HS, Park JH. Predictors of MERS-related preventive behaviors performance among clinical practice students in a tertiary hospital. Journal of the Korea Academia-Industrial cooperation Society. 2018;19(9):174-85.

Krane NK, Kahn MJ, Markert RJ, Whelton PK, Traber PG, Taylor IL. Surviving hurricane Katrina: reconstructing the educational enterprise of Tulane University School of Medicine. Academic medicine. 2007 Aug 1;82(8):757-62.

Ludmerer KM. Time to heal: American medical education from the turn of the century to the era of managed care. Oxford University Press; 1999 Nov 11.

Smith J, Levy MJ, Hsu EB, Levy JL. Disaster curricula in medical education: pilot survey. Prehospital and disaster medicine. 2012 Oct;27(5):492-4.

Thompson DR. SARS--some lessons for nursing. Journal of clinical nursing. 2003 Sep;12(5):615.

Weston WW. Do we pay enough attention to science in medical education? Canadian medical education journal. 2018 Jul;9(3):e109.