Medical student rotations amid COVID - Welcome to medicine little grasshopper.
I learned a valuable lesson about mentoring medical students during clinical rotations amid the COVID pandemic...and it's not as easy as you think.
I have been in medical education, either in it or teaching it, for 20 years. I have spent countless hours doing lectures, giving Hospital Grand Rounds, or leading bedside teaching rounds to those who want to follow in my footsteps as a clinical expert. But some are just trying to survive, trying to check off another day until they can get to a rotation that better suits them. We have all been there.
The other day I had a third year medical student join my Graduate Medical Education team on July 1st. I love enthusiastic learners and this young woman fit that bill. She asked me about expectations and objectives for the rotation from the very first day but one thing really stood out to me immediately, she was almost paralyzed with fear and intimidation.
It had been some time since I had seen or helped teach a learner that demonstrated that level of insecurity. I worried for her. As the rotation progressed, day after day, I learned about this woman's past and how she had immigrated to America at the age of 4. She was raised with little but sought a medical education that was sure to give her success and stability....and she was making it. She was bright and respectful and reliable. As I continued to learn about her past, I asked her about her experiences during COVID in the past year and then....it hit me. She had never actually touched any patient as a healthcare learner until our very first day together. She voiced her apprehension in connecting the dots between strictly on-line medical education during a time of extreme social isolation to that of a competent, hands-on junior physician learner who was knowledgeable....and most of all...present.
How do we help these learners successfully cross this bridge and is it still leading to a life medicine had promised? We are in the midst of a global pandemic. Young medical professionals are entering into actual clinical, hands-on medicine during a scary and very uncertain time. I relate this kind of awakening to when I joined the military in 2001. I entered into Active Duty the summer before my first year of medical school and months later our Twin Towers were hit in a terrorist attack that would result in a war lasting decades, resulting in thousands of lives lost. I watched the World Trade Center fall to the ground and I was overcome with emotion asking myself, "what have I done?" I knew the landscape of my career had been drastically altered. I was uncertain and I was scared. Medical students today might also find themselves asking "what have I done?"
What could I do to help?
My student and I talked ...and we talked. I sought first to understand better and what I learned was her trepidation in caring for patients was deeply rooted in the concern for making mistakes, spreading COVID-19 or getting ill herself. From there, I came up with a plan.
1. We discussed how to approach patient interactions and how to stay safe while doing so using appropriate PPE in different clinical settings. I learned that this had not yet been reviewed with her or her colleagues because all of their education up to this point had been in a virtual environment. I needed to fill in the gap.
2. We discussed principles of basic human interaction in this new era of mask wearing such as how masks affect our communication and what are the challenges in establishing credibility when you can't shake someone's hand or when a mask is covering half of your facial expressions. While the eyes and mouth are the most expressive and therefore informative regions of the face, facial expressions are only part of message delivery. I find myself using more hand gestures, body language and descriptive language to come across as approachable and friendly in a way that will ease patient's anxiety.
3. I reviewed the fundamentals of the physical exam, in depth and in detail. We did multiple physical exams together until she felt comfortable to do them on her own. These skills are typically taught during the second year of medical school and while tele-education was in full swing during the initial height of the COVID outbreak, this potentially reveals an area in which we could have done better but remains a challenge.
4. We explored her why. We were able to dig deep into why she sought medical education, where she was and where she was going. She was able to reaffirm her commitment to this profession and reflect how and why she got here in the first place. I helped her explore other ways to maintain her healthcare relevancy outside of clinical medicine because life is dynamic and knowledge is power...and it's never to early to think outside of the box.
Throughout her rotation, I saw her thrive. She achieved a level of confidence I was not sure was possible and through it all, she also taught me a thing or two, for which I will always be grateful.