by Kathy Whitney
COVID-19 — and the mandate for social distancing to curb its spread — has meant rethinking how nearly 400 Vanderbilt University School of Medicine students will master the clinical and didactic skills they need to stay on a rigorous track to satisfy both VUSM academic standards and those set forth by the Liaison Committee on Medical Education (LCME).
Within a two-week timeframe, School of Medicine curriculum leaders designed and implemented a brand new course for the second-, third- and some fourth-year students who saw their clinical clerkships and clinical immersion experiences come to a sudden halt. The Pandemic Medicine Integrated Science Course, which covers all aspects of pandemic education, rolled out last week.
“Normally, it would take us months to design a new course, which would typically be offered to a maximum of 24 students after we’d had a chance to pilot it. Now, we have designed a course in two weeks, with no pilot period, and are offering it to 200 students all at once,” said Bill Cutrer, MD, M.Ed., associate dean for Undergraduate Medical Education.
Calling upon his faculty colleagues, who also happen to be among the nation’s top vaccine and infectious disease experts, Cutrer and Kendra Parekh, MD, associate professor of Emergency Medicine and co-course director, with support from Donald Brady, MD, senior associate dean of Health Sciences Education, have designed a course that gives the medical students a front-row seat to myriad aspects of a pandemic.
“From a logistical standpoint, and a greater ‘what’s going on in the world’ standpoint, it made sense to bring them all together and to think through pandemics — what can we learn from the current one, what can we learn from prior pandemics and how can we provide the students an experience that will allow them to learn, as well as make an impact on our patients,” Cutrer said.
The new course pairs foundational science with clinical content. There are three main goals: 1) understanding pandemics, everything from epidemiology through emerging therapeutics; 2) leadership in turbulent times; and 3) evidence, information and data and how to make decisions, especially when there is a lack of data on which to base decisions.
“How do you enable these future doctors to participate in and be part of something historic and something real while also keeping them safe, recognizing their role as students and preparing them for the future?” Brady said, sharing the thought process that went into designing the course. “With the COVID-19 pandemic, we are not dealing with a sprint; we’re not dealing with a marathon. We’re in an ultra marathon of interval training — a mix of sprint and jogging — where we haven’t defined the distance of the race. This provides us all a unique opportunity to help learners think about how they deal with uncertainty at all levels — the uncertainty of the science, with the clinical piece, and the mental task of dealing with uncertainty.”
The clinical content is being addressed through the students’ assistance with telehealth visits and volunteer experiences. The didactic portion is a four-week course. Week one provides foundational content; weeks two and three are a combination of case-based learning, focusing on prior pandemics — the 1918 Spanish flu and the SARS virus. Additionally, the students are self-selecting into one of seven different tracks that allow a nuanced lens through which to view the pandemic. Week four will involve the students in a pandemic simulation exercise when they will share what they learned in their tracks and work in teams.
The seven tracks available to the students are: health inequities and vulnerable populations; population health; communication and information-sharing; ethics; global health; leadership; and emerging therapeutics.
Kathy Edwards, MD, Sarah H. Sell and Cornelius Vanderbilt Chair and professor of Pediatrics, will conduct a live session that will walk the students through what it would be like to create a Phase 3 trial for a new vaccine. Edwards played a key role in the development of the H1N1 vaccine. Students will watch a recorded lecture by Mark Denison, MD, director of the Division of Pediatric Infectious Diseases and Craig-Weaver Professor of Pediatrics, and James Crowe, MD, director of the Vanderbilt Vaccine Center and Ann Scott Carell Professor, on emerging therapeutics and vaccine development, and a recorded grand rounds led by Stephan Heckers, MD, William P. and Henry B. Test Professor and chair of Psychiatry & Behavioral Sciences, on mental health and the pandemic. These are just a few examples of resources that the students and faculty preceptors will access.
“It has given so much creative freedom to our faculty and it has been so energizing and fun to watch them come up with these great ideas. To me this has been a very visible picture of the Vanderbilt culture — that sense of collaboration, working together and solving problems and innovating, and for me this class is that in a nutshell,” Cutrer said. “To have experts from around our campus be willing to hit the pause button on actually trying to solve these problems for this pandemic to teach the next generation of physicians because they recognize how important it is, has been a real gift.”
The first-year medical students, still in the midst of their mostly classroom-based academic year that ends in late July, have transitioned well to virtual learning.
Lectures, typically offered in person, have been recorded and are available online. Case-based learning, usually conducted in small teams, and the physical diagnosis course are being held via virtual meeting software. The anatomy lab is available for individual students to attend according to their own schedule. First-year clinical placements have been suspended. COVID-19 has affected them in other ways as well: in-person study groups halted; some returned home to live with family while studying virtually; many wanting to contribute to the medical efforts, yet not knowing the best route.
“I am absolutely confident the students will be where they need to be. The faculty very quickly jumped on board to get things moving forward. Everything they are going to get during this time will meet the needs to continue the pace they were already on to move to the second year and to graduation,” Brady said. “We have to realize our students are our future. They will be the next generation who will have to deal with future pandemics.”