Jerrel Catlett’s eyes narrowed on the large intestine, a sloppy, glowing object the color of which matched the stool inside. He decided to isolate the organ, and it expanded on his screen as the parts of the body surrounding it receded – the gallbladder pale green with bile, the ribs white and curved like half moons.
“My old boss used to tell me that if I did that, I would be so impressed by the complexity of the human body,” said Catlett, 25, a freshman at the Mount Sinai Icahn School of Medicine. pointed to the image of a body on his laptop screen. “But it feels like something is missing from the experience right now.”
For generations, medical students have been initiated into their training through a ritual that is as bloody as it is impressive: the dissection of corpses. Since at least the 14th century, doctors have improved their understanding of human anatomy by examining cadavers. In the midst of the coronavirus pandemic, cadaver preparation – like many practical aspects of the medical curriculum – became virtual with the help of three-dimensional simulation software.
Of the country’s 155 medical schools, a majority switched at least part of their first and second year curriculum to distance learning during the pandemic. Nearly three-quarters offered virtual lectures, according to a survey by the Association of American Medical Colleges, and 40 percent used virtual platforms to teach students how to interview patients about their symptoms and record their medical history. Although dissection was a more difficult challenge, nearly 30 percent of medical schools, including Mount Sinai, used online platforms to teach anatomy.
Although medical students in many states have been eligible for and have been able to obtain vaccines, some have not yet fully turned to face-to-face learning. The school administrators said they would rather wait until the Covid case rates continue to fall. Some face-to-face training, such as clinical skills practice, has largely been resumed.
Medical schools adapted last year with inventive approaches to clinical training. Case Western Reserve University School of Medicine and Stanford used virtual reality technology to teach anatomy. Columbia University’s Vagelos College for Doctors and Surgeons offered students the opportunity to virtually shadow doctors and attend telemedicine appointments. And last fall, students at Baylor College of Medicine were videotaped physical exams describing what actions they would take personally, according to Dr. Nadia Ismail, Assistant Dean of Baylor’s Curriculum: “Now I would hit you on this part of the knee and that’s the reflex I would see. “
The Keck School of Medicine at the University of Southern California chose to have faculty members dissect corpses with body cameras so students could watch from a distance. The bodies were also imaged with three-dimensional scanners so that students could practice manipulating the types of images produced by magnetic resonance imaging and CT scans.
“When the faculty came up with it, I said, ‘Oh my gosh, that’s amazing,” said Dr. Donna Elliott, Vice Dean of Medical Education at Keck. “These scanned three-dimensional images are roughly the kind of imaging you as a clinician use.”
Educators recognize that despite the promise of new technology, there is a sense of loss for students who are unable to be in person in hospitals, classrooms, and section laboratories. “The medical school classroom is the clinical setting, and it’s so tight right now,” said Lisa Howley, senior director, strategic initiatives and partnerships at AAMC. “That worries me.”
Students said they were a little frustrated as they watched pressure increase on frontline providers without their being able to help. “We know more than the average person, but we generally feel powerless,” said Saundra Albers, 28, a sophomore student in Columbia.
Both faculty and students recognize that observing organs moving on a laptop screen is not the same as removing them one at a time from a human body. “A corpse’s body parts wouldn’t look as smooth and perfect as they would on a screen,” said Catlett. “Let’s say the body was an alcoholic. You may see cirrhosis of the liver with bumps and ridges covering the liver.”
He and his classmates know they missed a medical rite of passage: “We can’t feel what the tissue is like or how hard the bones are.”
Mr Catlett and his classmates have now been offered vaccines and are starting to resume some personal activities, including the first meeting with patients this month. Your presentations are still online.
Sarah Serrano Calove, 26, is a sophomore at the University of Massachusetts Medical School, which offered a mix of face-to-face and virtual learning in the final semester. Since beginning medical training, Ms. Calove had been eager to practice dealing with patients – taking their medical history and delivering messages of diagnoses – so the transition to learning clinical skills at Zoom was a disappointment.
She was hired to interview a medical actor known as a standardized patient about his financial troubles, virtually having an emotional conversation that she found uncomfortable.
“When you’re on zoom, you can’t tell if the person is clenching their hands or shaking their legs,” she said. “For some of my classmates, the feedback was that we had to show more empathy. But how should I make my empathy known on a computer screen? “
Medical schools have often been unable to get students to practice their skills on medical actors in the past semester, as those actors tend to come from older, retired populations who are at increased risk for Covid-19. Some schools, including the University of Massachusetts, had students take physical exams on their classmates, dispensing with the parts of the exam that involved opening their mouths and peeping their noses.
Ms. Calove was challenged to assess her physical examination skills as she could only prepare by watching videos, while any other year she would have practiced in person for weeks.
“You usually hear lungs wheezing, feel an enlarged liver, and find the edges of the abdominal aorta,” she said. “Hearing an online recording of a heart murmur is different from listening in person.”
Even so, she appreciated the school’s efforts to find out from her and her classmates how they fared as they adapted to partial distance learning.
Some students pointed to a silver lining in their virtual medical education: they understood how to talk to patients about sensitive topics via video, a lesson that is very likely to prove essential as the field of telemedicine expands. Through distance traineeships at schools such as Sidney Kimmel Medical College at Thomas Jefferson University, medical students supported hospital staff by providing virtual mentoring to patients discharged earlier than usual due to the pandemic.
“Other doctors have been taken in depth, but we can practice with this technology,” said Ernesto Rojas, a sophomore at the University of California San Francisco’s medical school. “We learned how to develop a relationship and ask the patient things like, ‘Are you in a place where you can talk privately?'”
Students also said they felt especially motivated to complete their education amid the pandemic. According to the AAMC, applications for medical schools are up 18 percent over the past year
For 22-year-old Prerana Katiyar, a freshman medical student in Columbia, the first few months of medical school didn’t look like she expected. She began the semester at her childhood home in Fairfax, Virginia, sharing lessons from her anatomy classes over dinner with her family. “When my father said his stomach was injured, I was able to talk to him about the quadrants of the stomach,” said Ms. Katiyar.
In the middle of the semester, she had an exciting update for her parents. “My skull finally arrived in the mail,” she said. Ms. Katiyar’s anatomy professor had a plastic model of the skull ordered for each student.
“Now I can see the bony sights and where the nerves are,” she continued. “I’m a very visual person, so it was helpful to trace her with my finger.”