The Role of Medical Student Government in Responding to COVID-19

Proposing the Community Triad Model to action social accountability in medical schools

This article is the third in a series exploring drivers of social accountability (SA) in medical schools across Canada. Findings from the two previous articles have highlighted a central relationship between community, students, and faculty at medical schools, and led to the emergence of a new social accountability model- the Community Triad Model (CTM). The CTM proposes an interconnectedness between community, students, faculty, and the broader institution, and the pathways through which community-based learning directly and indirectly influences decision-making in medical institutions. This article explores the relationships between the three arms of the CTM by examining the literature on community engagement and SA, as well as by revisiting popular models and foundational SA reports to garner insights into authentic community engagement in health professions education. While there is an abundance of literature demonstrating the impact of community placements on students, there are limited studies describing the influence of communities on faculty and the broader institution either directly, or indirectly via students. The authors recommend that institutions be more intentional in engaging students and faculty, and learn from their experiences with community to shape curriculum, practices, policies, and culture of the broader institution. This study offers an operational model of SA that is easy to adopt and implement. It intends to demonstrate how the components of the triad (students, faculty/leadership, community) function together in the community engagement and social accountability of medical schools.

Clinical support during covid-19: An opportunity for service and learning? A cross-sectional survey of UK medical students

PURPOSE

Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements.

METHODS

We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 'lockdown' period in the UK (March-July 2020). Analysis was informed by the conceptual framework of service and learning.

RESULTS

1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual's experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop.

CONCLUSION

The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.[Box: see text].

Student performance in medical biochemistry and genetics: comparing campus-based versus zoom-based lecture delivery

BACKGROUND

We appraised the effectiveness of online (Zoom) delivery versus live campus-based delivery of lectures in biochemistry and genetics courses and assessed the security of remote versus campus-administered exams.

METHODS

Participants were 601 students entering Michigan State University College of Osteopathic Medicine in 2019 or 2020. The former cohort completed courses and exams on campus, while the latter completed courses online due to the COVID-19 pandemic. For the biochemistry and genetics courses, the same lecturers delivered the same content and used identical exam questions for assessments in 2019 and 2020. The investigators compared percent correct for each question in 2019 and 2020.

RESULTS

This study found 84 of 126 (67%) of the questions yielded little difference (3% or less in % correct) between live delivery and Zoom delivery. For questions whose % correct index differed by 4% or more, Zoom delivery yielded a better performance for 16 questions (13%), while 19 questions (15%) showed live lectures performed better. Seven of the questions (6%) had an identical mode of delivery in 2019 and 2020 (e.g., self-study exercise). These served as "control questions" for which equivalent student performance was expected. The 126 questions analyzed spanned a wide range in the % correct index, from 60% correct to > 90% correct.

CONCLUSIONS

The results suggest that Zoom and on-campus delivery of the content in biochemistry and genetics yielded similar achievement of course objectives. The high concordance, between 2019 and 2020, of the % correct for individual questions also speaks to exam security including online proctoring.

Zooming into the COVID Era Together

The pre-clinical medical school curriculum provides students with extraordinary experiences in preparation to become physicians. However, it was not originally designed to be delivered remotely. The COVID-19 pandemic promptly threw the medical education process into unforeseen circumstances. A model of student-faculty collaboration created to address new challenges and implement practical solutions rapidly is presented. This model was used effectively to respond to pre-clinical educational interruptions that were imposed by the COVID-19 pandemic and maintain high-quality training. Our experience provides valuable insights and lessons learned that can be applied to the ongoing pandemic response and to future educational challenges.

Students as Community Vaccinators: Implementation of A Service-Learning COVID-19 Vaccination Program

While the COVID-19 pandemic has caused major educational disruptions, it has also catalyzed innovation in service-learning as a real-time response to pandemic-related problems. The limited number of qualified providers was primed to restrict SARS-CoV-2 vaccination efforts. Thus, New York State temporarily allowed healthcare professional trainees to vaccinate, enabling medical students to support an overwhelmed healthcare system and contribute to the public health crisis. Here, we describe a service-learning vaccination program directed towards underserved communities. A faculty-led curriculum prepared medical students to communicate with patients about COVID-19 vaccines and to administer intramuscular injections. Qualified students were deployed to public vaccination clinics located in under-served neighborhoods in collaboration with an established community partner. Throughout the program, 128 students worked at 103 local events, helping to administer 26,889 vaccine doses. Analysis of a retrospective survey administered to participants revealed the program taught fundamental clinical skills and was a transformative service-learning experience. As new virus variants emerge and nations battle recurrent waves of infection, the need for effective vaccination plans continues to grow. The program described here offers a novel framework that academic medical centers could adapt to increase vaccine access in their local community and provide students with a uniquely meaningful educational experience.

Curricular changes and interim posts during Covid-19: graduates' perspectives

BACKGROUND

During the COVID-19 pandemic UK medical schools facilitated the early graduation of their final-year medical students to 'Foundation interim Year 1 (FiY1) doctors' through amendments made to curricula and final assessment. Such changes gave opportunity for evaluation. This study therefore aimed to explore 1) graduate perspective on the implementation of FiY1 and 2) how changes to course structures have affected self-reported preparedness for work.

METHODS

Questionnaire surveys using Likert scale and free-text responses (n = 45), and semi-structured interviews (n = 7) were conducted with FiY1s from two UK medical schools contrasting in the amendments made to course structures. Data were analysed using quantitative methods and thematic analysis; 44% (n = 20) of respondents believed that governing health bodies had not communicated sufficiently prior to starting work.

RESULTS

Graduates who had sat modified practical and written examinations reported 'legitimacy' and feeling more prepared compared to having not sat examinations (practical 100%, n = 17; written 88.3%, n = 15). Graduates from both schools agreed that carrying out assistantships as originally scheduled would have made them feel more prepared (91.1%, n = 41).

CONCLUSIONS

The implementation of FiY1 was largely well received by graduates yet assistantship programmes may fulfil a similar role in normal times. Medical schools and governing bodies must ensure effective communication channels exist with students in order to better prepare them for their first posts, especially in times of crisis. Additionally, final examinations contribute to feelings of preparedness for work and instil a sense of legitimacy, a finding which is relevant to working within the current programmatic assessment structure.

Impact of COVID-19 on Medical Education: Perspectives From Students

This article provides an overview of issues facing medical students in such key areas as communication, preclinical and clinical education, increased isolation, disruption to time-based curricula, inequities in virtual learning, racial trauma, medical student activism, increased conversations surrounding race and racism, LGBTQIA+ students, dual-degree students, and the virtual residency cycle. This article described challenges navigated by medical students during the COVID-19 pandemic, as well as triumphs resulting from the disruption and actionable recommendations in key areas. While the pandemic presented new challenges for medical students, it also uncovered or exacerbated long-standing problems. The intent is for medical schools and institutions to use these recommendations to create learning environments that do not depend on medical student resilience. The main takeaways for medical schools are to: (1) maintain an individualized and learner-centered ethos while remaining dynamic, flexible, and ready to embrace both immediate and incremental changes; (2) maintain open lines of communication; (3) implement policies and practices that support students' academic, physical, and mental well-being; (4) engage and support students who bear historically disadvantaged identities on the basis of race, ethnicity, sexual orientation, gender, or disability; and (5) support creative and collaborative partnerships between medical institutions and students to ensure the ongoing evolution of medical education to meet the needs of learners and patients.

Rapid Mobilization of Medical Student Volunteers to Administer Vaccines During the COVID-19 Pandemic

In December 2020, the first COVID-19 vaccines were approved for emergency use by the U.S. Food and Drug Administration, and vaccination efforts rapidly launched across the country. Concurrently, New York City experienced an increase in COVID-19 hospitalizations. This created an immediate need to inoculate frontline workers in a strained health system that lacked sufficient personnel to meet the demand. In response, New York State permitted medical students with appropriate clinical experience to administer vaccinations. Albert Einstein College of Medicine students rapidly stepped in to administer vaccines and serve as clinic navigators. Student leaders at Einstein collaborated with Montefiore Medical Center to rapidly implement a student vaccination initiative. Medical students underwent virtual and on-site training regarding COVID-19 vaccines and their administration. In January 2021, students began to staff vaccine clinics across the Bronx. By July 2021, 291 out of 830 eligible medical and Medical Scientist Training Program (MSTP) students (35.1%) had volunteered >2400 h. Of the 291 volunteers, 77 (26.5%) worked as vaccinators and administered approximately 2929 COVID-19 vaccines from January to May 2021. We demonstrate success using the concept of Entrustable Professional Activities (EPAs) in the context of training medical students in a specific clinical skill. Our framework resulted in the administration of approximately 2929 COVID-19 vaccines from January to May 2021. The authors believe that this framework can be implemented at peer institutions to alleviate the burden on hospital systems and outpatient clinics vaccinating their communities against COVID-19, or to meet future clinical needs.

Covid-19 crisis impact on the next generation of physicians: a survey of 800 medical students

BACKGROUND

Many initiatives have emerged worldwide to handle the surge of hospitalizations during the SARS-CoV-2 pandemic. In France, the University of Paris North called on its medical students, whose status makes them integral members of the healthcare staff, to volunteer in their capacity of medical students and/or as nurses/nursing aids in understaffed intensive care units and other Covid-19 services. We attempted to evaluate their commitment, whether the pandemic affected their certainty for the medical profession and career choices, and how they scored their sadness and anxiety levels.

METHODS

The University of Paris North took a weekly official census of the involvement of 1205 4th-6th year medical students during the first lockdown in France. Six weeks after the lockdown began (May 4th), an e-questionnaire was sent to 2145 2nd-6th year medical students. The survey lasted 4 weeks and documented volunteering by medical students, the association between the pandemic and certainty for their profession, their choice of medical specialty and factors that influenced sadness and anxiety scores.

RESULTS

82% of 4th-6th year medical students volunteered to continue their internship or be reassigned to COVID-19 units. Of 802 2nd-6th year students who completed the e-questionnaire, 742 (93%) volunteered in Covid-19 units, of which half acted as nurses. This engagement reinforced the commitment of 92% of volunteers to become physicians. However, at the peak of the outbreak, 17% had doubts about their ability to be physicians, while 12% reconsidered their choice of future specialty. Finally, 38% of students reported a score of 7/10 or more on the sadness scale, and 43% a score of 7/10 or more for anxiety. Neither study year nor service influenced sadness or anxiety scores. However, gender influenced both, with women scoring significantly higher than men (p < 0.0001).

CONCLUSION

Medical students of the University of Paris North who made an early and unconditional commitment to help hospital staff handle the pandemic constituted a powerful healthcare reserve force during the crisis. Although the vast majority remained convinced that they want to become physicians, this experience came at a significant psychological cost, especially for women. Alleviating this cost would improve future crisis responses.

Systematic review of medical student willingness to volunteer and preparedness for pandemics and disasters

OBJECTIVE

This systematic review aimed to estimate the willingness of students to volunteer during a disaster, and how well-prepared medical students are for volunteering by assessing their knowledge and medical school curriculum of disaster and pandemic medicine.

RESULTS

A total of 37 studies met inclusion criteria including 11 168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%) and 5 evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD=21.7%, range=26.7%-87.8%, n=2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (p<0.0001). We identified a number of modifiable barriers which may contribute to this heterogeneity. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD=15.1%, range=37.1%-87.0%, n=2985). 36.8% of 76 medical schools curricula included teaching on disasters. However, students only received minimal teaching (2-6 hours).

CONCLUSIONS

This study demonstrates that there is a large number of students who are willing to volunteer during pandemics. However, they are unlikely to be prepared for these roles as overall knowledge is poor, and this is likely due to minimal teaching on disasters at medical school. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. There is a need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared to perform these roles safely.

Coming Together: How Medical Students, Academic Administrators, and Hospital Administrators Approached Student Volunteering During the COVID-19 Pandemic

The COVID-19 pandemic caused dramatic interruptions and shifts to medical education, but students at schools nationwide responded by volunteering to support their physician educators on the frontlines. Relationships between student leaders, school administrators, and hospital administrators were key to the successful creation and organization of volunteer responses. This perspective piece from medical students, as well as hospital and medical school leadership, explores the evolving relationships in the creation of Rutgers New Jersey Medical School's Student COVID Team. By reflecting on choices made by each group in parallel points in time, the piece highlights where interests and actions aligned and diverged.

Changing Medical Education, Overnight: The Curricular Response to COVID-19 of Nine Medical Schools

Issue: Calls to change medical education have been frequent, persistent, and generally limited to alterations in content or structural re-organization. Self-imposed barriers have prevented adoption of more radical pedagogical approaches, so recent predictions of the 'inevitability' of medical education transitioning to online delivery seemed unlikely. Then in March 2020 the COVID-19 pandemic forced medical schools to overcome established barriers overnight and make the most rapid curricular shift in medical education's history. We share the collated reports of nine medical schools and postulate how recent responses may influence future medical education. Evidence: While extraneous pandemic-related factors make it impossible to scientifically distinguish the impact of the curricular changes, some themes emerged. The rapid transition to online delivery was made possible by all schools having learning management systems and key electronic resources already blended into their curricula; we were closer to online delivery than anticipated. Student engagement with online delivery varied with different pedagogies used and the importance of social learning and interaction along with autonomy in learning were apparent. These are factors known to enhance online learning, and the student-centered modalities (e.g. problem-based learning) that included them appeared to be more engaging. Assumptions that the new online environment would be easily adopted and embraced by 'technophilic' students did not always hold true. Achieving true distance medical education will take longer than this 'overnight' response, but adhering to best practices for online education may open a new realm of possibilities. Implications: While this experience did not confirm that online medical education is really 'inevitable,' it revealed that it is possible. Thoughtfully blending more online components into a medical curriculum will allow us to take advantage of this environment's strengths such as efficiency and the ability to support asynchronous and autonomous learning that engage and foster intrinsic learning in our students. While maintaining aspects of social interaction, online learning could enhance pre-clinical medical education by allowing integration and collaboration among classes of medical students, other health professionals, and even between medical schools. What remains to be seen is whether COVID-19 provided the experience, vision and courage for medical education to change, or whether the old barriers will rise again when the pandemic is over.

COVIDReady2 study protocol: cross-sectional survey of medical student volunteering and education during the COVID-19 pandemic in the United Kingdom

BACKGROUND

The coronavirus disease 2019 pandemic has led to global disruption of healthcare. Many students volunteered to provide clinical support. Volunteering to work in a clinical capacity was a unique medical education opportunity; however, it is unknown whether this was a positive learning experience or which volunteering roles were of most benefit to students.

METHODS

The COVIDReady2 study is a national cross-sectional study of all medical students at medical schools in the United Kingdom. The primary outcome is to explore the experiences of medical students who volunteered during the pandemic in comparison to those who did not. We will compare responses to determine the educational benefit and issues they faced. In addition to quantitative analysis, thematic analysis will be used to identify themes in qualitative responses.

DISCUSSION

There is a growing body of evidence to suggest that service roles have potential to enhance medical education; yet, there is a shortage of studies able to offer practical advice for how these roles may be incorporated in future medical education. We anticipate that this study will help to identify volunteer structures that have been beneficial for students, so that similar infrastructures can be used in the future, and help inform medical education in a non-pandemic setting.

TRIAL REGISTRATION

Not Applicable.