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 Table of Contents  
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 83-84

COVID-19 pandemic: Medical education is clinging on a knife's edge!

Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados

Date of Submission13-Aug-2020
Date of Acceptance24-Aug-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Md Anwarul Azim Majumder
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AIHB.AIHB_88_20

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How to cite this article:
Majumder MA. COVID-19 pandemic: Medical education is clinging on a knife's edge!. Adv Hum Biol 2020;10:83-4

How to cite this URL:
Majumder MA. COVID-19 pandemic: Medical education is clinging on a knife's edge!. Adv Hum Biol [serial online] 2020 [cited 2021 Apr 17];10:83-4. Available from: https://www.aihbonline.com/text.asp?2020/10/3/83/295847

The current COVID-19 pandemic has created challenges in medical education and has had profound medical, political and financial impacts around the globe.[1] Since February this year, most of the countries across the world have experienced abrupt disruptions in the delivery of medical education and training due to the COVID-19 pandemic.[2] Strict and widespread lockdowns and social distancing have catalysed the transformation of curriculum delivery into fully online modes.[3],[4] This is problematic for medical schools as, traditionally, medical education and training have relied on face-to-face learner interaction. Furthermore, certain competencies may not be realised in the absence of laboratory, practical and clinical/bedside teaching sessions.

Medical schools are now facing practical and logistical challenges towards continuing their academic activities, as many of those around the world have restructured their teaching, assessment, clerkships and residency training in a significant manner amidst the pandemic.[5],[6] This unusual situation has presented unprecedented challenges in medical school assessment and examination.[1],[5],[6],[7],[8] Clinical placements and training have been suspended due to the concern raised for the safety of patients and students. Students may potentially spread the virus when asymptomatic and may acquire the infection during training in hospital settings.[2],[9],[10] Hence, it is now urgently required to examine how the pandemic affects learning environments, and to identify potential implications of this unexpected emergency for the future preparedness of medical education.[2] It is clearly evident that students will be affected throughout the educational process, and, as a result, the delivery of learning in medical schools will change in the future. Social distancing will limit students' ability to attend lectures, practicals, laboratories, problem-based learning sessions, clerkships and other modes of in-person teaching. Medical schools are considering migrating towards asynchronous “anytime/anywhere” learning methods.[2] Therefore, policymakers need to work to limit the impact of the pandemic on the progression of students by prioritizing teaching and assessment, working with local stakeholders to make appropriate contingency arrangements and making adjustments in teaching and planned assessments.[11]

However, the discussion is currently ongoing regarding how clinical education in hospital settings could be implemented so that students can have meaningful clinical experiences and meet clerkship goals and objectives while satisfying the requirements of licensing and accrediting bodies.[12] In March/April 2020, the Association of American Medical Colleges strongly recommended that “medical students not be involved in any direct patient care activities”[10] and 'medical students' participation indirect care of patients with or without known or suspected COVID-19 must be voluntary, not required.”[13] It was also suggested that any clinical activities involving patient contact should use personal protective equipment to minimize the potential spread of the virus and protect students.[10],[14] In response to canceled clerkships, many medical schools during that time successfully transitioned to online learning using web-based cyber classrooms, videotaped vignettes, audiotaped recordings, virtual patients, online chat rooms, videoconferencing and telemedicine sessions and webcasting to replace clinical teaching.[1],[15] As a result, students missed some clerkships, had limited exposure to various specialties, and missed the chances of networking and guidance provided by faculty.[6] The extended period of time suspended from clerkships deprived students of essential clinical decision-making and empathetic patient care skills, which are required to be successful in clerkship and beyond.

The progression of final-year medical students to internships is especially crucial in times of healthcare crisis.[7] In that context, some medical schools have opted to assess progression through open-book examinations.[8] However, developing assessment strategies sufficient to determine competency for graduation from medical school is a significant challenge under the pandemic conditions.[1],[7],[8] Medical schools in the UK have been urged to fast-track final year medical students by waiving requirements for clinical examinations and drawing on alternative methods of assessment.[9] This challenge is uncharted territory for medical schools; furthermore, there is limited evidence to guide medical education in this crucial time.

The pandemic presents a number of stressors for students preparing for examinations. Social distancing, non-conducive home environments for study and family conflicts may provide barriers to learning.[4],[16],[17] Academic delays and clerkship cancellations may incite acute stress disorders, fear and panic, emotional distress and other mental health disorders among medical students.[1],[18],[19],[20] Moreover, a novel, unfamiliar examination format poses additional pressure and increases the opportunity for academic misconduct resulting from either open or closed-book assessment formats.[21],[22] All these uncertainties concerning their education and assessment can generate stress and anxiety and social distancing contributes to the experience of loneliness.[4],[16],[17],[21],[22]

This unprecedented situation may forever alter the landscape of medical education. As such, the training and education of medical students may need to be approached with a fresh line of thought. It is essential that medical schools should ensure that medical students continue to receive the knowledge and skills required to practice medicine as competent and safe clinicians.[1] Medical schools also need to work to limit the impact of the pandemic on the progression of students by prioritising teaching and assessment, working with local stakeholders to make appropriate contingency arrangements and make adjustments in teaching and planned assessments.[11]

Conflicts of interest

Dr. Md Anwarul Azim Majumder is in the Editorial Board of Advances in Human Biology.

  References Top

Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: A systematic review.In Vivo 2020;34:1603-11.  Back to cited text no. 1
Rose S. Medical student education in the time of COVID-19. JAMA 2020;323:2131-2.  Back to cited text no. 2
Goh P, Sandars JA. Vision of the use of technology in medical education after the COVID-19 pandemic. MedEdPublish 2020;91:49.  Back to cited text no. 3
Gallagher TH, Schleyer AM. “We signed up for this!” – Student and trainee responses to the Covid-19 pandemic. N Engl J Med 2020;382:e96.  Back to cited text no. 4
Ferrel MN, Ryan JJ. The impact of COVID-19 on medical education. Cureus 2020;12:e7492.  Back to cited text no. 5
Akers A, Blough C, Iyer MS. COVID-19 implications on clinical clerkships and the residency application process for medical students. Cureus 2020;12:e7800.  Back to cited text no. 6
Sam AH, Reid MD, Amin A. High-stakes, remote-access, open-book examinations. Med Educ 2020;54:767-8.  Back to cited text no. 7
Jervis CG, Brown LR. The prospects of sitting 'end of year' open book exams in the light of COVID-19: A medical student's perspective. Med Teach 2020;42:830-1.  Back to cited text no. 8
Iacobucci G. Covid-19: Medical schools are urged to fast-track final year students. BMJ 2020;368:m1064.  Back to cited text no. 9
Association of American Medical Colleges. Interim Guidance on Medical Students' Participation in Direct Patient Contact Activities: Principles and Guidelines. March 23, 2020. Available from: https://www.aamc.org/system/files/2020-03/meded-March-30-Interim-Guidance-on-Medical-Students-Clinical-Participation_0.pdf. [Last accessed on 2020 Aug 12].  Back to cited text no. 10
The General Medical Council. Information for Medical Students. Available from: https://www.gmc-uk.org/news/news-archive/coronavirus-information-and-advice/information-for-medical-students. [Last accessed on 2020 Aug 12].  Back to cited text no. 11
Chandra S, Laoteppitaks C, Mingioni N, Papanagnou D. Zooming-out COVID-19: Virtual clinical experiences in an emergency medicine clerkship. Med Educ 2020:10:1.  Back to cited text no. 12
Association of American Medical Colleges (AAMC). Guidance on Medical students' Participation in Direct Patient Contact Activities. April 14, 2020. Available from: https://www.aamc.org/system/files/2020-04/meded-April-14-Guidance-on-Medical-Students-Participation-in-Direct-Patient-Contact-Activities.pdf. [Last accessed on 2020 Aug 12].  Back to cited text no. 13
Miller DG, Pierson L, Doernberg S. The role of medical students during the COVID-19 pandemic. Ann Intern Med 2020;173:145-6.  Back to cited text no. 14
Association of American Medical Colleges (AAMC). LCME Update on Medical Students, Patients, and COVID-19: Approaches to the Clinical Curriculum; 2020. March 20, 2020. Available from: https://lcme.org/wp-content/uploads/filebase/March-20-2020-LCME-Approaches-to-Clinical-Curriculum.pdf. [Last accessed on 2020 Aug 12].  Back to cited text no. 15
Torda AJ, Velan G, Perkovic V. The impact of the COVID-19 pandemic on medical education. Med J Aust 2020;14:1.  Back to cited text no. 16
Theoret C, Ming X. Our education, our concerns: The impact on medical student education of COVID-19. Med Educ 2020;54:591-2.  Back to cited text no. 17
Usher K, Bhullar N, Jackson D. Life in the pandemic: Social isolation and mental health. J Clin Nurs 2020;29:2756-7.  Back to cited text no. 18
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 2020;287:112934.  Back to cited text no. 19
Mahase E. Covid-19: Mental health consequences of pandemic need urgent research, paper advises. BMJ 2020;369:m1515.  Back to cited text no. 20
Araújo FJ, De Lima LS, Cidade PI, Nobre CB, Neto ML. Impact of Sars-Cov-2 and its reverberation in global higher education and mental health. Psychiatry Res 2020;288:112977.  Back to cited text no. 21
Sahu P. Closure of universities due to coronavirus disease 2019 (COVID-19): Impact on education and mental health of students and academic staff. Cureus 2020;12:e7541.  Back to cited text no. 22


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