COMMENTARY

COVID's War Rhetoric Is Harmful to Med Students

Tino Delamerced

Disclosures

September 01, 2020

Before my third year of medical school, the "war" began.

My father is an internist. As I waited to return to medical training, I watched him come home from the COVID-19 "front lines." Each day, he'd leave his N95 mask in the car, change out of his "uniform" in the garage, and immediately hit the showers. At the dinner table, we heard his "dispatches" from the "trenches." He told us about how cases were rising, what treatments they were trying, and how much PPE he had available. I listened in fear.

As I continued my studies at home, I listened to Donald Trump, a self-described "wartime president," speak about "the worst attack we've ever had." I saw the death toll of COVID-19 compared with those of the Pearl Harbor bombing, 9/11, and World War I.

I have come to realize that, as a medical student, it is the war rhetoric now synonymous with the pandemic that has actually scared and shaped me the most. When this all first began, it was that language that made me feel conflicted about how I was using my time. Although I desperately needed to study for my board examinations, I felt a "call of duty" to "serve" somehow. And I wasn't alone.

Like so many of my peers, I felt pulled in opposite directions. Was the "good" med student finding a way to help on the front lines, volunteering and "enlisting" for free? Should we participate in relief work or prioritize our learning? Many of us have tried to do both. But this continued rhetoric of war has made us feel like every day is a tradeoff between helping "the cause" and helping ourselves.

Nearly every aspect of training, from finishing a Step exam to simply completing a rotation, has been made more difficult by the pandemic. Yet the metaphors of war have only promoted an environment in which I have felt pressure to contribute to "the battle" at the expense of myself. We med students already face an unprecedented mental health crisis. In many ways, we are trained to forgo prioritizing ourselves. The new narrative surrounding COVID-19 further drives that potentially deadly message home.

I recently interviewed colleagues at the University of South Carolina School of Medicine Greenville. Medical students Alyssa Guo and Marissa Crum, along with Lauren Fowler, PhD, have begun to document the psychological toll that the pandemic has had on trainees. They shared with me that, according to their recent survey of more than 700 students at 15 medical schools across the United States, a third of respondents reported having moderate to severe anxiety since March. Each med school class has had its own unique sources of anxiety. As a newly minted third-year, I'm nervous about my shift from preclinical to clinical responsibilities.

Students have always had limited personal bandwidth. But the new framework of service pressures us to further self-sacrifice. I admire my classmates who have contributed their time and energy. However, the pandemic has also devastated many of our financial situations. If students decide to take on new, COVID-related work, I hope they won't do it for free.

Earlier this year, a graduation speaker asked trainees to answer "a clarion call," "jump in the trenches," and join "the COVID army." I understand that language creates a much-needed sense of urgency, but most medical students, including myself, didn't sign up for the military for a reason. Suddenly, our career choice has been recontextualized into something entirely different from the very thing that inspired us to pursue it in the first place.

As medical school is now resuming, faculty and others have the opportunity to reframe this pandemic for the next generation of doctors. Student leaders, deans, and speakers should abandon the jargon of conflict and invite trainees to be compassionate toward themselves, foster a positive learning environment, and establish a welcoming school culture. We shouldn't be manipulated into further valuing self-sacrifice before our careers have even begun.

In June, I started rotations. I am grateful to have returned to a regular daily schedule. Thankfully, my father has remained healthy and safe, although I still worry about the coming winter. If the pandemic worsens, will my fellow clinical students and I be sent home indefinitely or be asked to "fight"? Already we have seen our professional counterparts sacrifice and risk so much. Will leaders ask us for more?

The fallout of this pandemic will not be easy for any of us to endure. Authority figures within medicine must help those of us in the medical training pipeline avert burnout. Unlike many other issues, this problem has a relatively easy fix. In recognition of our fears, trials, and vulnerabilities, I hope medical education abandons the use of the militaristic language of self-sacrifice.

Tino Delamerced is a third-year medical student at the Warren Alpert Medical School at Brown University. Before medical school, he studied Latin. He is interested in medical humanities, etymology, and the language of medicine.

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