Medical Student Experience in the Wake of COVID-19 Pandemic and Next Steps

The year 2020 has brought much stunning news. From deadly wildfires and giant hornets to racial injustice and a heated presidential election, there has been no shortage of events to challenge our mental well-being. But at the top of the list is COVID-19, which has universally affected people so much that nowadays conversations often start with “before COVID” and “after COVID.” When quarantine For COVID-19 was implemented and medical student clinical rotations were canceled in March, medical students at Rutgers New Jersey Medical School (NJMS) jumped into action to support the community and front-line workers. We volunteered for childcare, delivery of fresh groceries, collection and production of personal protective equipment, clinical research, and the creation of “wellness spaces” in the hospital.

I volunteered at the New Jersey COVID-19 Hotline. Most callers requested information on testing locations and hours. Others asked which emergency rooms were safe for getting care for their grandparents for emergencies unrelated to COVID-19. Many people avoided the hospital altogether. Back on the floors, I encountered patients who had been severely affected by COVID-19. I distinctly remember the patient with diabetes who needed a below-the-knee amputation due to a worsening ulcer that progressed to osteomyelitis. He delayed care because he was afraid of contracting coronavirus in the hospital.

In June, I was on the consultation-liaison service, and we consulted on a number of cases for anxiety and depression. Many patients had lost their jobs due to the pandemic, and one patient had lost her husband to COVID-19, home, and dog while she was recovering from the virus at the hospital. Psychiatry patients experienced interruptions to their care.

Aside from losing friends and loved ones to COVID-19, we must recognize how the pandemic has impacted people in broader ways. Those who have recovered continue to have lingering symptoms. Others have been affected through socioeconomic impacts or delayed care. Therefore, medical students should approach patients with more humanism and compassion than ever, seeking to learn about their social history and determine how the pandemic has impacted their lives. Because medical students have more time to spend with patients, we should be trained to screen all patients for depression, trauma, domestic violence, life events, and stressors. Also, we should pay particular attention to patients with preexisting mental disorders to prevent progression of their illness.

NJMS students get strong didactics on health equity and social justice. The curriculum and clinical opportunities should be expanded on breaking bad news, palliative care, and bereavement support for patients’ families. Through collaboration with the University Hospital Chaplaincy team, eight senior medical students provided spiritual care and virtual family support to those affected by the pandemic. With the changing public health environment and needs of our community, such learning and experiences should start during the preclinical years for all students.

We know that the pandemic is far from over. The number of COVID-19 cases continues to rise, not only in the United States, but in other countries as well. Eager to return to campus life, many college students have fallen ill with the virus. Rather than becoming lax about following public health guidelines, people need to learn more about the consequences of COVID-19, even if they have already had the virus.

Looking forward, medical students should receive early training on how to critically read research articles in order to be up to date with the latest scientific findings, as we expect that patients will seek care for long-term COVID-related neurological and psychiatric symptoms. Clinical students should be more vigilant about mental health, physical and sexual abuse, and substance abuse. Therefore, we should be equipped with the PHQ-9, Trauma Screening Questionnaire, and Stressful Life Events Screening Questionnaire, and the communication skills necessary for hard conversations. We should also gain experience in other aspects of mental health care such as social work services, community resources, and group or family therapy, whether it is during mandatory clerkships or electives.

We medical students have learned much this past year beyond the usual curriculum. Perhaps the most important skill we have learned is the ability to be flexible and adaptable to an extent that we had never imagined. We stand ready to respond to our patients’ needs, whatever they may be. ■