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Like many around the country, fourth-year medical students at the University of Massachusetts (UMass) were stuck at home last March. When routine hospital services at UMass Memorial Medical Center halted because of COVID-19, so did students’ clinical rotations. “They said, ‘Look, we’re sitting around doing nothing. We can help,’ ” said Terence Flotte, MD, dean of the Umass Medical School. “And the help was needed.”
As was the case for many programs, the school decided to let students graduate early. More than 50 from UMass received temporary medical licenses from the state and began practicing as physicians in the first weeks of April. “They did important work and really extended the team,” Flotte said.
This winter, COVID cases in Massachusetts well surpassed the levels seen last spring. Many hospitals, such as UMass Memorial, are packed with far more patients than when early graduates were allowed to join their ranks last year. Despite this, leaders at medical schools throughout the United States have come to a similar conclusion about early graduation: Not this year.
“I don’t see any scenario where we would do that in 2021,” said Craig Hoesley, MD, dean of medical education at the University of Alabama at Birmingham School of Medicine, which serves one of most hard hit regions in the country. In hospitals across the city’s metro area, the intensive care unit (ICU) capacity has been above 90% for several months. Only in recent weeks has it dropped slightly.
Still, administrators are opting not to boost the burned-out physician workforce this time around. In part, this is because medical students are now back on much-needed clinical rotations. Hospitals also feel better prepared to handle a surge in patients with COVID than they did last year. Furthermore, administrators say the timing of this year’s surge presents too many logistic obstacles to early graduation.
Now almost a year removed, young doctors who graduated early are reflecting on whether they feel the decision was the right one. Current fourth-year students are finding other ways to contribute in the near term, even if they won’t be serving on the front lines quite as quickly as their peers just 1 year ahead of them.
Back in Rotation
Across much of the country, medical students mostly returned to in-person clinical rotations in June. Even as COVID hospitalizations mounted this winter, students in hot spots like southern California have remained in hospitals for their training, said Clarence Braddock, MD, MPH, vice dean for education at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). He says they’ve been a big help to healthcare teams.
“Even a third-year student contributes a lot. We’ve sort of been reminded of that,” Braddock said. He can’t envision a scenario in which the hospital would send students home again, like they did last year. “The bottom line is, we need them,” he said.
Last spring, students switched to virtual course work because of concern that healthcare workers would fall ill and that hospitals would run out of vital personal protective equipment (PPE). With a better understanding of how the virus spreads, along with more secure supply chains and the rollout of vaccines to healthcare workers, those fears have largely abated.
In places like Maryland, medical school deans have said they plan to keep students at their clinical sites for the rest of the year. That assurance comes after Maryland Governor Larry Hogan urged medical schools to give students the option to graduate early as a way to bolster the state’s healthcare workforce.
The deans of the University of Maryland School of Medicine and Johns Hopkins University School of Medicine, in Baltimore, responded to the governor with a letter rejecting his request that graduations be held early. Instead, they said the continued assistance from students will supplement healthcare teams and give more experienced workers additional bandwidth to care for the sickest patients.
The Last Option
Another reason medical schools ended in-person clinical rotations last year was that many hospitals stopped performing normal services, such as elective surgeries. That interrupted training for students too. “There was really no surgery rotation for the students to go to,” said Flotte, of UMass Medical School. This year, hospitals have shifted physicians’ rotation schedules, reassigned residents and fellows, and rearranged