Oakland University William Beaumont School of Medicine’s rising fourth-year medical students are about to start their final year in medical school following only a slight delay caused by the COVID-19 pandemic.

That’s according to the team of OUWB officials who got creative in making sure the students stayed on track despite the unexpected, six-week absence from the clinical settings as a result of the pandemic.

Those efforts included “deconstructing” clerkships, creating new electives that allowed M3s to take fourth-year electives early, and shortening the amount of time spent in a clinical setting.

Cynthia Ledford, M.D., associate dean for Undergraduate Clinical Education and professor in OUWB’s Department of Foundational Medical Studies, said students acclimated “quite well” to the unique ending of their third year of medical school.

“I do think it was a relief to be back in the clinical setting doing normal things, even though they’re not exactly doing it in a normal way,” she said. “It’s just so much quieter on the (Beaumont Health) campus. It’s so much less crowded. And everyone’s wearing a mask.”

Like their Class of 2021 peers across the nation, OUWB students begin their final year of medical school about a month later than previously expected.

“Students are officially back on clinicals, which we are all very happy to see,” said Amy Smark, M.D., assistant dean for Medical Education, M4, and assistant professor of Emergency Medicine, OUWB. “It was challenging for them and for us not to have them there…the students I’ve spoken to are just so happy to be back in the hospital setting.”

Smark, who worked several shifts the week students returned, said students told her just how pleased they were to be back at it.

“Even though they understand that their role has to be to step back a bit in certain situations, they were just so happy to be back and they expressed that so clearly to me,” she said.

‘An incredibly steep learning curve’

Though COVID-19 forced all of OUWB to adjust, it was particularly troublesome for M3s, who average about 55 hours of work a week as they ramp up learning. Much of the time is spent in a clinical setting.

In early March, when the COVID-19 pandemic began causing things to shut down, M3s were in a time of transition.

Neurology, psychiatry, and OB-GYN clerkships were a week or so from wrapping up.

Eight-week clerkships for surgery, pediatrics, and internal medicine had just started.

All clinical aspects of the clerkships were put on pause due to COVID-19.

The potential for numerous problems existed.

Not only were students missing out on the learning experiences that can only be gained as part of a hospital medical team, but they also faced the possibility that their final year of medical school could be impacted.

Among other reasons, the process of applying for residencies begins in June.

For these reasons, Ledford said having students simply wait out the pandemic and do nothing was never an option.

‘All COVID, all the time’

OUWB leadership — with input from student representatives — quickly moved to an online-based learning system that allowed for M3s to continue with non-clinical learning. That included practicing some of the basic clinical skills, reviewing how to make a diagnosis, how to interpret tests, and more.

The idea was that the M3s would be able to focus entirely on the required clinical aspects of their respective clerkships when conditions allowed. Further, because they already did the book work associated with their clerkships, time in the clinical setting could be reduced to allow the M3s to stay on track.

Before students could get back into those clinical settings, however, Ledford said there were four primary variables officials took into consideration.

Two of the variables were ensuring there was enough personal protective equipment for the entire health care team, and making sure there was enough testing available.

Another factor considered in helping M3s get back to their clerkships was making sure the rate of infection due to COVID-19 was no longer trending upward (i.e. the curve had to be flattened).

“We had to feel like we were getting to a point where we were controlling the epidemic and people on the front line no longer had to put all of their energy into just keeping patients alive,” said Ledford. “At the beginning of the surge, it was all COVID, all the time.”

The last variable was making sure there were enough non-COVID-19 patients.

“We had to have a variety of patients and resume all of health care to make it an educationally meaningful experience for our students,” said Ledford.

Conditions were favorable enough for requirement in early June, which is when the students were able to return to the clinical setting and wrap up their respective clerkships.

“All of them should be back on track by the end of July,” said Smark, who explained that it’s important to note that the situation isn’t exclusive to OUWB.

“The residency application process is pushed back a month,” she said. “This wasn’t just our school. This was the entire nation. Everybody has made accommodations.”

Preparing for another surge

As cases of COVID-19 continue to impact states nationwide, including Michigan, OUWB officials have taken steps to ensure the school’s next class graduates on time.

Ledford said those efforts included allowing soon-to-be M4s to take electives they would normally only be able to take as fourth-year medical students.

“That gives them more flexibility in their fourth year, which already has a tremendous amount of flexibility to move things around if they need to,” said Ledford.

Additionally, electives were created that give students even more opportunities to earn needed credits.

The three new electives are: Care of the LGBTQ Patient; Addiction Medicine; and Public Health. Students can take the electives online and on their own time.

Steps also have been taken to keep the next class of M3s (Class of 2022) on track.

Specifically, the curriculum for the 2020-21 school year has been compressed.

Those efforts have been led by Pradeep Kaminoulu, M.D., assistant dean for Medical Education, M3, OUWB.

“This is preparing for a second surge and if we do need to pull the students out (of the clinical setting) for any reason, it gives us some flexibility to do that without causing a significant interruption in their M3 year,” said Kaminoulu.

Kaminoulu said the team he led essentially looked at the M3 clerkships and determined where some elements of the clinical experience could be trimmed “and still deliver the same clinical objectives.”

Each clerkship (with the exception of neurology) was shortened by a week, he said.

Should OUWB’s M3s be able to remain in the clinical setting as scheduled, Kaminoulu said the students would simply be able to get a jump on their M4 electives, continue studying, or even take a break.

Ledford said all of the changes to the schedule for next year’s M3s and M4s have been communicated through town hall-style virtual meetings as well as regular emails.

“We wanted to be sure we understood their concerns and that they understood our decision-making process,” she said.

Ledford said it has been especially tricky at times due to the uncertainties associated with the COVID-19 pandemic, but she feels it has “worked out very well.”

“The classes have been very responsive, collaborative, and understanding,” she said. “And honestly, it’s helped all of us work together and be more adaptable.”

For more information, contact Andrew Dietderich, marketing writer, OUWB, at [email protected]. 

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