Online clinical training that can't be "practical"
"This is a nightmare for the medical students of the class of 20021." Jack Berg, a senior majoring in plastic medicine at the University of Kentucky, said.
After the COVID-19 outbreak in the United States in March, all the students who were attending clinical training were suddenly "kicked out" by the hospital. Berg revealed that in less than two weeks, almost all clinical training of medical students in the United States turned to online learning. "It's like we are on the sinking Titanic."
Jack Berg is so worried because clinical training for medical students in the third and fourth years is very important in the United States. The third year is the time for American medical students to complete the "core clinical business", and the fourth year is the year for medical students to train key specialties according to their favorite majors and career plans.
Megan Mesinger, a senior medical student at Western Health Science University, shares the same concerns as Jack Berg. She says she studies at home most of the time. Due to the epidemic, she has missed about 400 hours of clinical practice training. "I feel that I have left behind a lot of homework."
Robert kidder, chairman of association of american universities Orthopedic Medicine Branch, said that the situation of medical students is really difficult. About14 of American medical students are studying for a doctorate in orthopedics, and both hands-on training and general health training for patients are indispensable.
However, at this stage in the United States, even hospitals and clinics that have resumed routine medical services, except for patients related to COVID-19, other patients will basically not appear in hospitals for fear of infection. In other words, even if the hospital allows medical students to go back to the hospital for training, there are no patients "to see".
Alison Whelan, chief medical education officer of the American Medical College Association, said that this has become a challenge for medical students to participate in clinical training. In addition, in the high-incidence areas of COVID-19, formal medical staff in hospitals and other medical institutions do not have enough personal protective equipment, so medical students are forced to study online at home.
Unpractical remote clinical training is undoubtedly equivalent to "no training" for medical students, but the problem will eventually be solved.
American medical college association changes clinical training guidelines
In August 14, the American Association of Medical Colleges updated the clinical training guide for medical students, but the major medical schools have not yet started school.
AAMC believes that medical students can still go to the hospital for clinical training during the epidemic, but it is not necessary for medical students to participate in daily patient care.
AAMC suggested that medical colleges should at least do the following two things:
First, ensure the personal protective equipment of medical students. The supply plan of personal protective equipment in the affiliated hospitals of medical colleges must cover the needs of medical students. Before medical students start clinical training, the hospital has the responsibility to ensure the supply of personal protective equipment. If medical students have to wear personal protective equipment in positions related to rotation, but the department cannot provide it, medical students cannot participate in any clinical training that has direct contact with patients, nor can they participate in any other courses that have contact with patients.
Second, ensure that the number of patients who have completed clinical training and the number of clinical instructors who are responsible for supervision can be met. In the process of medical students participating in clinical training, medical schools need to provide practical security to minimize the risk of medical students being infected with COVID-19 virus; Medical students' clinical training must be recognized by the education committee of medical colleges and universities, which is "a clinical skill that can only be achieved by participating in clinical training".
Alison Whelan said that whether students can graduate on time is very important for the growth of doctors, but during the epidemic, whether students can successfully complete their studies is also a continuous and complicated task.
However, major medical colleges in the United States say that junior medical students can still complete most clinical rotation courses as usual. Art Papier, a professor of dermatology at the University of Rochester School of Medicine, said: "When they become residents, they still need a lot of training and study. I think the lack of clinical training caused by the epidemic can be completely compensated. "
Previously, a survey conducted by AAMC on 55 medical colleges in the United States/KLOC-0 showed that more than 80% of the colleges planned to "send back" junior and senior students for clinical training before the end of August, while freshmen and sophomores would receive online learning most of the time.
Medical schools are also trying to arrange for students to go back to the hospital.
Six indicators determine whether students can participate in clinical training.
Medical students from Oregon Health and Science University resumed clinical training in late June, but it is still uncertain whether they can successfully complete the whole school year due to the unstable epidemic situation. Therefore, OHSU has formulated six criteria to decide whether medical students should stay in the hospital.
These six criteria are:
1. Number of patients. There are not enough patients in the hospital for treatment, which can not meet the training needs of medical students. If the number of patients falls below 50% before the epidemic, OHSU will consider suspending the clinical training of medical students.
2. Ability to achieve learning objectives, that is, whether the clinical environment at this stage meets the educational objectives of students to achieve clinical training.
3. The number of clinical instructors in charge of supervision. For example, if all cardiac surgeons are isolated due to COVID-19 infection, and students who receive clinical training in cardiac surgery cannot complete the training, in this case, clinical training will also be suspended.
4. Personal protective equipment. OHSU monitors the inventory of personal protective equipment through the dashboard. If the inventory of personal protective equipment is below a certain standard and the supply is difficult to keep up, then clinical training will also be suspended.
5. Hospital conditions. 60% OHSU medical students have clinical rotation in off-campus medical institutions. "These students are like guests of these medical institutions. If the host says,' If you can't keep the guests, then these guests must leave'. " George Megicano, senior deputy director of OHSU Education, said.
6. Signs that hospitals are overwhelmed, including the positive detection rate of hospital patients and the existing number of patients in COVID-19. If these indicators are high, the governor of the state may issue an order, including limiting the number of medical students participating in clinical training.
Unlike OHSU, icahn school of medicine at mount sinai allows junior medical students and senior medical students to participate in clinical practice together. Michelle St. Willis, senior deputy director of education management in medical college, said that senior students with one year's experience can provide guidance for junior "novices" and they can also learn from each other.
Florida State University School of Medicine chose to use technology to provide "realistic" distance clinical training for medical students. Take anatomy as an example. The medical school of this university requires teachers to wear cameras on their bodies. When dissecting, the camera can follow the teacher's anatomy angle and send it to the students who are watching and studying in the distance, so as to achieve the effect of students' on-site learning.
Daniel alban, a medical student who is about to return to the hospital for clinical training, said that in the new school year, all medical students are "mice" and the experimental results are unknown.
References:
1.KHN: Medical students "feel very backward" because of video-induced interruption of training.
2.AAMC: guiding the participation of medical students.
3.AMA: Medical students: These six factors aroused the interest in clinical training.
4.AAMC: COVID- 19 during returning to school.