Education in the time of COVID-19

Aug. 08, 2020

Education in the time of COVID-19: A trainee's perspective

Omar M. El Kawkgi, M.B., B.Ch., B.A.O., with Endocrinology, Diabetes, Metabolism, and Nutrition at Mayo Clinic's campus in Rochester, Minnesota writes about his perspective as a second-year clinical endocrine fellow.

For as long as we can remember as medical trainees, the bulk of learning in our profession happened at the bedside. Indeed we were "residents" of the hospital, practically residing there just a few years ago. As subspecialty trainees, we learned clinical pearls from seeing patients alongside more experienced clinicians.

In the face of a pandemic, our entire fellowship program switched to a remote approach. We expressed our worries to each other: "Will we continue to be exposed to diverse cases crucial to our education? Will my preceptors, previously accessible with a knock on the door, still be available to discuss patient care and, perhaps more importantly, provide me with meaningful feedback to grow from? How will I stay connected to my community of co-fellows whom I normally rely on as my work family?"

In time, we realized we were not alone. We shared, learned and connected with each other through social media. We tweeted back and forth: "What is the best video conference platform for didactic teaching?" We received numerous answers and had to try them all until one worked, but we learned. Similarly, we began to learn how the changes created by this situation supplemented our education rather than detracted from it.

Video visits with patients and preceptors meant real-time observation and feedback of our clinical approach. Content sharing technologies meant we could easily but securely share patient data, images and relevant literature. Triaging endocrine problems in the face of a pandemic prompted critical thinking in us. Lastly, it turned out that a weekly check-in virtual meeting, although not the same as a chat in the fellows' room, could still keep us connected and conversing.

All in all, although not a replacement for the traditional bedside learning, learning at the "screenside" has supplemented our education, and if nothing else, taught us to stay resilient and adaptable.

Education in the time of COVID-19: A program director's perspective

Kurt A. Kennel, M.D., with Endocrinology, Diabetes, Metabolism, and Nutrition at Mayo Clinic's campus in Rochester, Minnesota reviews his observations as a fellowship program director.

As with all challenges, opportunities await. So finds the Endocrinology Fellowship at Mayo Clinic's campus in Rochester, Minnesota, in the midst of an unprecedented disruption to medical education. For safety, resource conservation and due to a pause in nonessential aspects of outpatient practice, most endocrinology fellows worked and learned remotely for the month of April. Management of established patients continued but with clinical scenarios not previously encountered. "Is my elderly patient with osteoporosis at greater risk of infection or fracture if denosumab therapy is delayed in order to stay at home?" A growing list of deferred appointments and new requests thrust fellows into a triage role testing their clinical judgment and, at times, revealing gaps in their knowledge of the course of untreated conditions. Previously a novelty, telehealth — video or phone visits, both inpatient and outpatient — became a staple of practice. Unsurprisingly, the fellows adapted quickly and facilitated the onboarding of faculty to new technology and workflow.

While time to catch up or focus on scholarly pursuits benefited some, the pause in clinical and laboratory-based research required trainees in their research year to adjust their timelines. Similarly, didactic teaching, conferences and journal clubs and in-the-moment sharing of cases and clinical pearls quickly adapted to virtual meetings, which facilitated engagement of participants outside the institution. Finally, maintaining the esprit de corps with social distancing required creativity and typically centered around sharing of personal rather than professional daily events. Stressful in the best of times, celebration of the transitions from medical training to employment, orientation of the next wave of trainees and selection of new fellows now are done virtually. What do each of us remember about such events that was meaningful when conducted in person?

In hindsight, the uncertainties of the early impact of the pandemic on medical education may pale in comparison to the long-term implications. "There are many things we do during patient encounters that are not that important" was an early observation of a trainee "seeing" a patient by e-consultation in the hospital. Whose perspective does this reflect? In contrast, the ability to witness aspects of a patient's home environment during a video visit provided an aha moment for a trainee previously unaware of barriers to diabetes self-care. Sharing of educational content via digital platforms extended the reach of Mayo Clinic faculty and, hopefully, enticed some resident and student-level attendees to consider a career in endocrinology.