ACS Medical Student Program identifies COVID-19-related challenges for medical education

The Medical Student Program, which convened virtually on Sunday, October 3, was developed specifically for medical students considering a career in surgery. Sponsored by the American College of Surgeons (ACS) Division of Education and the Committee on Medical Student Education, this year’s program featured  sessions on the following topics: the effects of the COVID-19 pandemic on medical education; transitioning into residency; developing the skills necessary to become an effective teacher; residency interview techniques; and an overview of the 2020 Medical Student Program e-Poster awardees.

The Medical Student program presenters included College leaders, program directors, clerkship directors, and surgical educators at both the medical student and resident levels. It will be available for on-demand viewing through the virtual Clinical Congress meeting platform through December 31.

COVID-19 and medical education

“The effect of the COVID-19 pandemic on medical student education is something that I call the medemic,” said Steve C. Yang, MD, FACS, Baltimore, MD. “We know that normally at this time of year students have submitted their applications, submitted their sub-internships, and are doing away rotations and preparing for interview season. If that was not enough of a difficult process, the pandemic has added unnecessary stress and complexities and obstacles this year.”

This session focused on four topic areas through the lens of the pandemic: clinical rotations, changes in teaching, residency applications, and looking for mentors.

According to James Lau, MD, MHPE, FACS, Maywood, IL, expectations for clinical rotations should be adjusted as some of the core clerkships have been shortened at various institutions. However, Lau also noted that the “opportunities for electives have often been expanded to keep graduation requirements about the same.”

Other panelists noted the move to a pass/fail system by some institutions, and the enhanced use of, and familiarity with, virtual education, including online rotations, has also helped reset expectations regarding clinical rotations.

Addressing changes in teaching due to the pandemic, panelists underscored the importance of simulation-based training and the benefits of remote learning.

“The pandemic has accelerated the changes we already wanted to make,” said Barbara J. Pettitt, MD, FACS, Atlanta, GA. “We’ve been able to consolidate the lectures and add more lectures since there is no travel time between the different hospitals. Doing lectures virtually [allows us to] record them, and now we have a huge archive of lectures and of videos featuring faculty interacting with students.”

Many senior medical students have expressed concern about the residency application process, particularly during the pandemic.

“Some of the changes are logistical,” said Brenessa Lindeman, MD, MEHP, FACS, Birmingham, AL. “Applications are coming out later this year and many programs are having to adjust their timelines for how they are reviewing these applications and when they are scheduling interviews, with many programs planning to conduct virtual interviews.” Panelists also emphasized the need for program directors and applicants to structure virtual or COVID-19-safe, in-person experiences that demonstrate the culture of specific programs.

“My advice to the applicants is relax,” said Paul J. Schenarts, MD, FACS, Omaha, NE. “I think the residency directors understand that this time in history is unique and that all the rules that we have used in the past are probably not going to be as acceptable.”

“I would advise applicants to really focus the rest of their training on some general surgery experiences,” said Dr. Schenarts.  “One of the areas that got cut in most basic clerkships was the elective general surgery cases and that really forms the foundation of what [will be needed] moving forward.”

The panelists suggest that students should not hesitate to advocate for themselves when it comes to securing a mentor during the pandemic.

“Faculty has been as equally engaged and nimble as students about embracing change,” said George Zhang, MPH, Derwood, MD. “Reach out to them…a lot of faculty are willing to meet one-on-one and virtually. As long as we are proactive and flexible with the new processes and workflows, I think the mentor and mentee relationship can continue to be a highly fruitful process for everybody.”

“With all of the virtual meetings [that we are doing], as a faculty member, it’s been easier for me to have more relationships with more students,” said Celeste Hollands, MD, FACS, Lubbock, TX.

From medical student to resident

In a session titled Resident Panel: Transitioning into Residency, presenters summarized their experiences and lessons learned during this phase in their professional careers, including the excitement associated with moving from observer to participant in the operating room; the practice of engaging with medical students as a resident to ensure they are actively learning; the importance of time management in order to adequately and efficiently study and prepare for cases; and the art of cultivating a mindset that is intentional about maintaining personal wellness.

In the session Becoming a Teacher, panelists discussed the transition that all medical students experience as they make the jump from medical student to resident—adopting the role of the instructor. This session addressed the skillset necessary to offer productive feedback and how to teach technical skills.

“Teaching is important because it is how you provide care, it is how you interact with your colleagues, and it [is a contributing factor] in your assessments and evaluations throughout your residency programs,” said Jeremy M. Lipman, MD, MHPE, FACS, Cleveland, OH. “Being a better teacher means you are going to be a better resident.”

Adnan Alseidi, MD, EdM, FACS, San Francisco, CA, highlighted the role of feedback. “Feedback is important because it is hard to estimate your own ability, and because it helps us identify our blind spots,” Dr. Alseidi said. He described the characteristics of formative feedback—it is planned, specific, timely, objective, relevant, and balanced.

Dr. Schenarts noted that a component of effective teaching, especially if the topic is unfamiliar to the instructor, is to keep it simple and to limit the presentation to five main concepts to avoid overloading the learner.

Dr. Lindeman outlined a general strategy for teaching technical skills—the Zwisch Scale, a model that features four levels with increasing autonomy: show and tell, active help, passive help, and supervision only. She also identified the importance of pre-briefing, de-briefing, and setting a time limit for intraoperative teaching as approaches to instruction in the operating room.

“Pre-briefing is the interaction prior to the procedure that allows a trainee to communicate and a supervisor to assess trainee understanding of the procedure, anticipate challenges, discuss special circumstances, and negotiate aspects of procedure performance,” Dr. Lindeman said. “Following the demonstration of the procedure, there is a de-brief, which is the interaction immediately after the procedure to reflect on the trainee’s performance and assess progress toward the learning goals. And setting a timer for intraoperative teaching is helpful for steps in which a trainee maybe struggling. You want to provide a space for them to struggle safely because that is often where great learning happens, but you also recognize you can’t take another 15 minutes on this step of the procedure.”

Preparing for the virtual interview

The session Residency Interviewing Online: Looking Good from the Waist Up! summarized key guidelines for interview preparation and covered the topics of attire, technology, and questions medical students should pose to discern the culture of a residency program.

Panelists suggest interviewees wear professional attire, practice answering challenging questions, and record themselves to determine potential areas of improvement.

From a technology standpoint, it is advised to set up all devices in advance, verify internet connectivity, invest in a webcam if necessary, and have an extra pair of ear buds or headphones available the day of the virtual interview.

When a medical student is unable to visit a program in person, panelists suggest asking the following questions to determine specific details about the program:

  • How does the program compare with others in the same category (academic, community)?
  • What are the program’s strengths and what makes it unique?
  • What kind of feedback is available from past graduates?
  • What is the institution’s educational philosophy?
  • How are services covered for resident didactic and curricular time?

2020 Medical Student Program e-Poster winners

More than 200 abstracts were submitted this year—a record number—in three distinct categories: clinical science; basic science research; and outcomes, innovation, and education. The abstracts were subjected to rigorous peer review with multiple scoring from several different reviewers. From this pool, the top 45 e-Posters may be viewed via the Medical Student Program Posters session.

The 2020 Medical Student Program e-Poster winners are as follows:

  • Basic Science: Samantha Prince, Madison, WI: “GSK2593074A Blocks Progression of Existing Abdominal Aortic Dilation”
  • Clinical Science: Sahaja Atluri, Kansas City, MO: “Effects of 16-Plus-Hour Prone Ventilation on Lung Donations in Organ Donors with Death by Neurological Criteria”
  • Education, Innovation, or Outcomes: Jacob Hubbuch, Lexington, KY: “Ventral Hernia Repair with Soft Tissue Excision Impacts Costs and Outcomes”

The ACS Division of Education invites students from all four years of medical school to participate in the Medical Student Program, which is featured annually at the ACS Clinical Congress.