2020 MEDICAL YEAR IN REVIEW
COVID-19 and Pre-Clinical UME at UIW School of Osteopathic Medicine By Adam V. Ratner, MD, FACR
Medical school has surely changed since I was a student way back in the last millennium. Back then, in the first two years of medical school, we spent hours every weekday sitting in lectures while trying not to daydream. At night and on weekends we crammed and binged, trying to memorize the material that we would purge onto the next test and shortly thereafter, forget. At the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM), our case-based, team-oriented, student-directed learning curriculum is built on active engagement and interaction between medical students and faculty facilitators. Every Monday through Friday morning, first and second-year medical students work in small groups and larger teams with faculty facilitators to learn, discuss, and critically think through clinical situations, their basic science and socioeconomic underpinnings, and humanistic consequences. This curriculum requires the presence and active engagement of students at a far higher level than just sitting in a classroom or watching a video screen. That said, since the inception of the school we had debated the merits of allowing students who were unable to attend a session for personal reasons or mild illness to be able to join sessions remotely. The founding leaders of UIWSOM had made the investments in the appropriate IT infrastructure to allow the use of technologies to support remote learning. In early 2020, the leadership at UIWSOM began discussing the potential effects of a possible epidemic on our medical school. When it became apparent that the COVID-19 pandemic had reached San Antonio by the second week of March, we were prepared. Our office of Medical and Interprofessional Education trained the faculty, staff, and students in the art of Zoom teleconferencing. We converted our highly interactive live curriculum into a virtual one, literally over a single weekend. I remember I was most concerned about adequate bandwidth and power of the Zoom servers, but my fears were unfounded. All things considered, the transition has been astoundingly successful but, of course, not perfect. The lack of in-person interaction has created a myriad of challenges. Without in-person guidance and oversight it’s not possible to convey the nuances of performing ideal history and physical examinations or osteopathic manipulative techniques. The good news is that students are learning practical telemedicine skills much earlier now than in the past.
Just as importantly, the lack of real person-to-person interaction adds to loneliness and isolation among medical students. Most medical students (and faculty) are able to develop strong camaraderie with colleagues. This camaraderie just isn’t quite the same on Zoom teleconferences. From its inception, UIWSOM has always emphasized the humanism required to be a caring and effective physician. One way we support physician humanism is this through addressing the behavioral health needs of medical students and faculty. We have increased our behavioral health resources and created new programs to address these mental health challenges in the COVID-19 learning environment. As of the time I write this (late October 2020), we are developing a thoughtful and controlled plan to bring our pre-clinical medical students back on campus for the hands-on clinical skills training they have missed in the past few months. We will continue to seek the best possible balance to continue our mission of creating the next generation of sorely needed, primary care physicians while seeing the resurgence of COVID-19 cases across the country and the world. Stay tuned. Adam V. Ratner, MD, FACR is Professor of Radiology, Health Policy, and Medical Humanities and Assistant Dean of Strategic Initiatives at UIWSOM. He is also Chairman of The Patient Institute and 2019 President of the Bexar County Medical Society
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