Pandemic acts as dress rehearsal for new medical school curriculum

Pandemic acts as dress rehearsal for new medical school curriculum

Dozens of faculty, students and staff at Washington University School of Medicine in St. Louis have committed countless hours over the past three years to planning a new curriculum that will launch in September with the arrival of incoming medical students.

Although faculty, students and staff didn’t know it, they also were preparing for the sudden, unprecedented jolt from in-person to remote learning that occurred in mid-March, when COVID-19 shuttered much of the country, including much of the Medical Campus.

The pandemic shutdown meant that first- and second-year medical students couldn’t attend the required lectures and hands-on lab instruction in anatomy, pathology, histology, microbiology and other basic sciences. Nor could the students participate in small group classes that emphasized other essential medical skills such as communication, medical ethics and conducting patient exams.

Barnes-Jewish Hospital and St. Louis Children’s Hospital, where the MD students train, ceased virtually all nonessential medical procedures in order to curb virus transmission, preserve hospital beds and ventilators for COVID-19 patients and protect student health. This meant third-year students couldn’t finish their clinical rotations — a critical experience that helps physicians-in-training gain core clinical skills and discover the specialties they’re interested in pursuing during the final year of medical school and into residency.

“Everything as we knew it had stopped, and we didn’t know — we still don’t know — the length or the severity of the pandemic’s impact,” said Eva Aagaard, MD, the School of Medicine’s senior associate dean for education and the Carol B. and Jerome T. Loeb Professor of Medical Education. “But we knew we had to continue educating our students so they could transition to the next year of training or to residency, and we know we have to deliver a new curriculum to our incoming students, and it all must be outstanding.”

The new curriculum ensured such goals were met. Not to say there weren’t bumps, because there were. But the foundation of the new curriculum helped to ease the transition to remote learning while also providing an impromptu dress rehearsal that has allowed educators to troubleshoot, tweak and improve the curriculum before its rollout.

Designed to reflect the fast-moving changes in the health-care industry, the new curriculum was less than a year from launching when the pandemic hit. Two of its main pillars include expanding and enhancing technology to promote innovative and effective teaching and learning, as well as fostering a better understanding of the social and economic factors that influence health.

Already in place was much of the medical school’s upgraded, state-of-the-art technology supporting video-based education, as well as its commitment to ending health inequalities and expanding community health efforts. Planning for the new curriculum also had driven the medical school’s collective mindset toward innovation and creativity.

“The time we have spent on designing the new curriculum, and the investments in technology and other resources to support it, meant we were prepared in a way that many other places weren’t,” Aagaard said.

Nearly a year ago, for instance, the medical school debuted the Instructional Design Studio, a 700-square-foot space in the lower level of Bernard Becker Medical Library. The studio includes a formal sound-proof video-recording studio with green-screen technology, as well as a smaller do-it-yourself studio. This allows faculty to record lectures with supplemental and interactive features that the medical school can archive in a digital library and students can access at any time.

“Few medical schools have a studio and dedicated resources to develop and produce educational videos,” said Carolyn Dufault, PhD, assistant dean for educational technology and innovation in the Office of Medical Student Education. “We have spent the past few years working closely with faculty to examine how and why we will deliver parts of the new curriculum through video resources, and to create and produce dynamic, high-quality, clinically relevant video resources to enhance student engagement with course materials and promote meaningful, durable learning.”

The relationships formed between faculty and the Instructional Design Studio team — which includes Dufault; Erin Morris, an educational specialist and instructional designer; and Matt Rice, a veteran videographer — have been invaluable during the pandemic, Dufault said. “Mutual trust and respect had already been established,” she said. “This allowed for a quick pivot when we needed to help faculty move entire classes to a distance-learning format.”

Added Morris: “It especially helped because many of the faculty I had been working with already had the mindset of pushing creative boundaries and trying new things.”

In March, the now ubiquitous Zoom was a novelty for many faculty, students and staff. “Everyone just had to use it and learn,” Morris said. “But because the curriculum-building process has heavily emphasized innovation, faculty embraced ideas about customizing Zoom to their instructional needs — for instance, accessing breakout rooms for small group discussions.”

Third-year students used the breakout features on Zoom and other online technologies as private rooms to take summative exams, attend office hours with instructors and brainstorm with fellow students.

They trained via Zoom in the Wood Simulation Center, which comprises four rooms of the Farrell Learning and Teacher Center that resemble clinical settings and offer mannequins as patients. Led by registered nurse Julie Woodhouse, director of the medical school’s immersive learning centers, the simulation classes involved quadrants on students’ electronic screens offering multiple vantage points of the patient and vital signs.

“The formative, simulated clinical experiences gave students an opportunity to work through some acute scenarios in a safe setting and without a faculty or resident telling them how to manage the situations,” Woodhouse said. “They are allowed to determine diagnosis and patient management by relying on themselves. After each scenario, a faculty member debriefs the actions in the scenario — what the students did well and what they could do to manage the situation better.”

Brittany Novak, a simulation technician, operated the simulator and acted as the patient’s voice, while Woodhouse served as the bedside nurse, following the students’ patient-care instructions.

Students also participated virtually for the Objective Simulated Clinical Exams, which are required after each clinical rotation. They treated patients one on one in Zoom breakout rooms. Their patients were actors who followed a script. After the exam, students wrote patient assessments in an online learning management system called Canvas, while the “patients” scored students using a checklist in Qualtrics, an online survey platform.

“The experiences may have felt artificial or awkward, but I asked the students to think of it like telehealth or an electronic intensive care unit, where the physician is in a separate location from the patient and bedside staff,” Woodhouse said. “The pandemic has put a spotlight on telehealth. It’s likely to continue to play an increased role in patient care.”

Besides the importance of telehealth, the switch to remote learning offered additional lessons for the new curriculum, said Thomas M. De Fer, MD, a professor of medicine and associate dean of medical student education. For example, students favor technology for lectures and test-taking, but they also crave in-person communications. Constant online meetings, known to cause what’s referred to as Zoom fatigue, is real.

“A positive point is that we can make these adjustments to the new curriculum,” De Fer said. “We can better provide a combination of virtual learning that involves interacting with others on Zoom, for example, and virtual learning that allows students to work on their own time, such as video lectures.”

Additionally, the new curriculum will offer students a flexible learning format called hybrid, because it combines face-to-face learning and online learning. “The emergent transition to teaching via an electronic platform did not give us months to think about fancy-schmancy things we might want to do,” De Fer added. “It was a crash course that gave us experience and confidence in online learning, and it taught us important lessons that we will use moving forward.”

The suspension of clinical rotations caused logistical headaches and high anxiety among faculty and, especially, students. But during the three months from mid-March to mid-June, when the third-year students were authorized to complete final rotations, students were provided numerous opportunities in compassionate medicine through assisting community organizations and health-care workers responding to the pandemic.

From first years to fourth years, scores of Washington University medical students volunteered to deliver meals to at-risk quarantined people and COVID patients, babysit the children of health-care workers, and create thousands of face shields and masks. Among other activities, they also assisted with contact tracing at area health departments and offered educational outreach to St. Louis’ African-American and Latino residents, who are most vulnerable to COVID’s adverse effects.

“As a medical student, it was difficult to watch from the sidelines as the pandemic became a worldwide crisis,” said Connie Gan, a rising fourth-year student and president of the Class of 2021. “Other students had similar feelings. This spurred a massive COVID-19 volunteer effort, and, though it wasn’t patient care, it was satisfying to provide public health support to front-line health-care workers. We learned important skills individually and, as an institution, we saw firsthand the enormous impact of community engagement in the region. I believe this momentum will grow as we roll out the new curriculum.”

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