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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 ICUs so that they can continue to offer routine care while treating COVID patients.
At UMass Memorial Medical Center, residents have been pulled from electives and outpatient services to help in the emergency department or with overflow teams. "We're still in emergency status," said Taylor Shortsleeve, MD, an internal medicine resident, in early February. "We were just approved for another 12 days."
Amid these contingency plans, having medical students graduate early and join hospitals as freshly minted physicians appears to be at the very bottom of the list. "It's highly doubtful we would get to the point where we had exhausted all the other tiers of mobilizing the physician workforce," said Braddock of UCLA.
Timing Is Everything
Another barrier to replicating last year's early graduations is simply timing. Unlike the initial surge of COVID cases and hospitalizations in the United States, this year's spike predates Match Day, which will take place on March 20. "That's kind of the real end of the requirements," said Flotte.
When COVID patients flooded hospitals last spring, medical students were largely ready to graduate and function as first-year residents. "That 2-month difference on the calendar was big in terms of whether we had students who would truly be prepared to just plug right in," Flotte said. "It was kind of a perfect storm."
During the peak in hospitalizations this winter, students were still interviewing at residency programs and completing their required rotations. Some may be catching up on graduation requirements after Match Day, owing to all the disruptions over the past year. "I would be surprised if a large percentage of students could graduate early," said Geoffrey Young, PhD, senior director for student affairs at the Association of American Medical Colleges.
Hoesley, the dean from the University of Alabama, said students might want to take on extra rotations in the ICU or sign up for other clinical electives this spring. "They may need additional time all the way up to graduation day to make sure they're ready to go for their internship," he said.
Osteopathic students have an additional hurdle because they haven't been able to take their final clinical evaluations, according to Jeffrey Morgan, DO, dean of the A. T. Still University–School of Osteopathic Medicine in Arizona. Administrators and faculty are still coming up with other means of evaluating students "and will likely need to use any remaining enrollment time to achieve that," Morgan told Medscape Medical News by email.
Last Year's Early Graduates Reflect
Many of the early graduates from last year who are now working as first-year residents said there isn't the same need in hospitals as there was before. "We needed bodies, and we provided that," said Shortsleeve, one of the early 2020 graduates from UMass Medical School. "This year, I don't think we need that."
Shortsleeve doesn't regret ending his education early, because he was excited to become a doctor at a time of such urgency. "This was climactic in a sense," he said. "I was thrilled to join in, and I would not have changed that decision."
Jason Yang, MD, another early graduate from UMass Medical School, said he signed up to work in the hospital as soon as he realized how bad things might get. He was struck by how isolated COVID patients were, not being able to see their families. "I thought, if they were my family member, I would want as much help as possible," he said.
Yang started working at UMass Memorial in mid-April. To conserve PPE and minimize exposure risks, he checked on COVID patients by sitting just outside their rooms and using an iPad. He reviewed their vitals, lab data, and electrolyte levels and called families to provide updates and answer questions. "If there was a best part, it would be chatting with the patients every day just to make sure they know there is someone there for them, and same thing with the families," he said.
Crucially, early graduates from UMass Medical School still had time off from the hospital before their residency programs began. "We didn't go anywhere, but it was still nice to just rest up," Yang said.
Having that break is vital, said George Ciociolo, MD, another internal medicine resident at UMass Memorial. "The first time in the last 4 years that a medical student can actually relax and take a breath is after they get matched."
Although he graduated early, Ciociolo ultimately decided not to join the workforce before his residency started last spring because he had just had a child. He didn't want to risk infecting his newborn daughter or live apart from his family. "It was a hard decision for me to say no because I felt like I was letting down the hospital. I felt like I was letting down the profession," he said.
Now, he treats COVID patients nearly every day. "The pandemic is going to be around for a long time," he said. "Everybody will have their chance to work during the pandemic, even it's on July 1."
Fourth-Year Students Aren't Waiting to Help
Although this class of fourth-year medical students likely won't be serving as licensed physicians before their residency programs begin, many are eager to support COVID relief efforts in other ways. They've written children's books about the pandemic, reviewed ongoing emerging research, and performed concerts for patients and the community.
Meg Yirefu, a student at the University of Maryland School of Pharmacy and a resident at John Hopkins, is one of many trainees around the country who coordinated volunteer efforts. She helped organize a network of over 300 medical students, nursing students, and pharmacy students across Baltimore to provide aid to healthcare workers. In the spring, the volunteers helped with childcare, got groceries, and picked up medications. "I was helping out with walking a dog for one of the pulmonary physicians at Hopkins," Yirefu recalled.
Later, the group coordinated PPE drives for Baltimore's health department, and recently, a health center in the city reached out for help with making buttons to give patients after they've been vaccinated as way to promote public health messaging. Now, Yirefu and students across the country are training to administer COVID-19 vaccines.
"Our students have stepped up in huge ways to support our community in the pandemic," said Hoesley, from the University of Alabama. "It's truly been all hands on deck. The graduating early piece — I'm not sure that provides a lot of significant help to the problem."
Lexi Krupp is a journalist who covers science and health stories for audio and print. Her work has appeared in Science Vs, Popular Science, Audubon Magazine, public radio, and elsewhere. You can follow her on Twitter @KruppLexi.
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Cite this: Early Med School Graduations: Why This Year Is Different - Medscape - Feb 12, 2021.