It’s week 2 of internal medicine ONLINE and I really miss Grady.

I knew internal medicine would be one of the most challenging rotations but also the most interesting because you see everything, especially at Grady.

But, COVID-19 made us switch things up a bit: Pre-rounding on patient through EPIC, presenting by phone and zoom and simply remembering our patients by MRN or last name. I miss actually going to see patients, performing a physical exam and just establishing a rapport with them. Now it’s like, a virtual patient that you ask about and look up information on with no real connection. It’s not how I envisioned internal medicine at all.

Even though I’m home, I still “virtually” have COVID-19 patients. Some teams have seen 10 COVID-19 patients in 2 weeks alone. We discuss the latest updates in transmission, patient presentation and ways our residents and attendings protect themselves. Yes, they use PPE, but it’s so much more than that. Constantly washing your hands and/or sanitizing them throughout the day then going home to your family and hoping you haven’t been infected. Some physicians have an area either in their garage or in the foyer of their house where they remove their clothing from work, bag it and shower immediately to decrease the possibility of exposure to their families. To decrease exposure even more, some suggest staying in a hotel but I just read about Airbnb starting a program for healthcare workers.

I knew sacrifices would have to be made going into medicine as it pertains to your time…you know studying and working. But not to the extent of what our current residents and attendings are going through.

About our curriculum….

I just love the baby yoda memes. LOL. But honestly, our faculty members are doing the best they can with the current circumstances. Our clinical performance is a huge portion of our clerkship grades yet we don’t have much of any clinical exposure. 🤔 I wonder how that one is going to play out. Some medical schools are moving to pass/fail for the remainder of rotations for the year.

It’s easier for schools that are already pass/fail to no longer have the honors, high pass, pail, fail to just switch to simply “pass” but for schools with a grading system you would have to change the grade distribution to ensure fairness and equity for students.

Even for elementary and high school students, the same questions have been raised. School districts and charter schools are expected to figure out their system of grading in a way that doesn’t disadvantage students who lack computers, internet access or other resources they need to participate in distance learning.

The learning environment has changed for all students, if there was anytime to have “academic flexibility” it would be now. Some undergraduate and graduate programs have even waived testing requirements for admissions since the closure of multiple prometric testing centers. Speaking of testing…all of our NBME exams have been pushed back. The LCME, NBME, and AAMC have each issued statements that have supported flexibility in curriculum and graduation requirements allowing medical schools to adapt to the current pandemic and avoid delays in academic progression. With that being said, I can’t wait to see what’s going to happen with the STEP 2 CS exam centers (Clinical skills exam taken before graduation, Pass/Fail, must pass to graduate medical school) have been closed and continue to push back available dates. There are only 5 testing sites in the nation, the dates were already booked till October the last time I checked so how will they be able to accommodate for all the hundreds of students who still need to test. 🤔

The great debate is whether or not to have us medical students enter into this “war zone”. One argument is that we can be trained and learn firsthand how to confront a pandemic. It’s been made clear that this will not be the only pandemic in our lifetime due to the nature of how viruses evolve so the younger generation of physicians could gain a lot from getting involved right now. The other argument is about having limited PPE and if it’s worth exposing medical students to COVID-19. If there is limited PPE, you want to make sure the healthcare providers actually working with PUI’s (Patients under investigation) are protected and not students who aren’t. One of the first clerkships that restricted students from being involved was Surgery. The surgeon and other medical professionals in the room are required to be there and should have enough PPE, not the medical student that’s there to simply observe, cut the suture, hold a retractor or two.

I wish I could be more involved; I get both arguments but it’s out of my control anyway. I’m hoping that we will be back in the mix come May. Hopefully, cases will decline and we will have a better handle on things.

 

-Future Dr. Jones ❤