This article is the second installment in a series examining how students are spending spring quarter.

Medical students are slowly adjusting to a virtual learning environment after Stanford Medical School suspended all in-person classes and clinical rotations involving patient contact. So far, students say, the shift has been largely successful: Medical students are finding alternative ways to help their community and strengthen their passion for medicine even while they cannot work directly in the hospital. 

“COVID-19 has put medical students in a weird situation where we want to help, but are seen as a waste of limited PPE [personal protective equipment] in the hospital,” said Georgia Toal ’16, a second-year medical student. 

Rebecca Bromley-Dulfano ’18 M.S. ’18, a first-year medical student, echoed Toal’s sentiments. 

“These measures are being taken so that students stay safe, and even though we are grateful for this consideration, many of us wish that we could be of more help during this pandemic,” Bromley-Dulfano said.

But with their in-person clinical rotations cancelled, many students, particularly those graduating this year, wonder if they will be prepared to enter the medical workforce. 

“The in-person clerkship experience is valuable for developing content expertise and appropriate judgment in a way that can’t be fully replicated over the internet,” said Kevin Li, a fourth-year medical student. “I am somewhat concerned that my fund of knowledge and clinical experience in the areas of my remaining clerkships will be weaker due to the virtual education setting.”

Bromley-Dulfano said that third- and fourth-year medical students are typically taking patient histories and performing basic medical procedures. This hands-on interaction with patients is “invaluable for developing the skills needed to become a doctor,” she said. 

To combat these challenges, medical school professors have been working to adapt their teaching to create an enriching virtual classroom experience.

“We have moved our didactic teaching to an online format, using Zoom classrooms that range in size from four to five students in a seminar up to about 90 students in a required class that uses lectures,” said Neil Gesundheit, senior associate dean for medical education and professor of medicine. “For clinical skills development for our first-year medical students, we have postponed those sessions to the fall quarter when we believe social distancing will be relaxed.”

Gabriela Ruiz-Colon, a first-year medical student, said that while online classes are definitely an adjustment, she feels much more optimistic than she did at the start of the quarter. 

“I was a bit concerned since this would all be so new, but three weeks in, my concerns have been totally assuaged,” she said. “Our course directors have effectively transitioned the usual in-class experience into a virtual one.” 

For example, Ruiz-Colon said, Daniel Bernstein — the course director for the cardiology block, who is known for guiding students through reading EKGs during his office hours — has continued to hold the popular sessions online.  

“Prior to the quarter starting, a lot of second year students raved about Dr. Bernstein’s office hours,” Ruiz-Colon said. “I was concerned that this would perhaps not occur given the Zoom format but was pleasantly surprised when he transitioned the session to be virtual so that we could still simulate ‘going up to the board’ to read the EKG. It’s a terrific learning opportunity.”

Toal agreed that the transition to online classes was “pretty smooth.” She particularly appreciates that students remained in their same collaborative groups, which she said adds a level of comfort to this new learning environment. 

Toal also said that she appreciates the ability to ask questions anonymously through the Zoom lecture format. 

“In a normal in-person lecture we may have had five to 10 questions from the crowd, but now we are having 30-100 questions,” Toal said. “I think this stems from both the anonymity creating a safer space for people to not feel like their questions will be judged as well as having everyone online at the same time.”

She also said that she has begun to feel more confident in her own abilities to serve as a resource for information about COVID-19 in her community back home. 

“Typically I view myself as knowing not nearly enough about medicine yet, just at the beginning of training,” Toal said. “However, as friends and family ask me about this pandemic, I have explained it in a way they understand and convinced them to take this more seriously. They have gone on to convince others. Seeing this impact helped me realize the influence I have on my community even as only a second-year medical student.”

While they wait for their in-person clinical clerkships to resume, students say that COVID-19 has given them the opportunity to reflect on the U.S. healthcare system and take part in supporting physicians and healthcare workers from home. 

“What is clear is that this pandemic is revealing some large gaps between the medical and public health systems in the U.S.,” Bromley-Dulfano said. “The health economic impacts of COVID are huge. Millions of Americans have lost their health insurance in the last few weeks. Hospitals, clinics and community centers across the country are struggling financially.”

Students have also taken on various initiatives to help the COVID-19 response. 

“It’s been amazing to see how medical students have stepped up to help in ways outside of patient care: collecting PPE from community members, helping run tests, leading research about the prevalence of COVID-19 in our community and supporting the healthcare workers on the front lines with meals and childcare,” Toal said. “This just reinforces that healthcare really is a team effort.”

As they look towards their future medical careers, many students say that the pandemic has inspired them to work harder so that they will be more prepared to handle similar situations when they enter the workforce. 

“We are very fortunate to be able to continue with our education, and the whole situation is extremely motivating for all of us to learn this material and learn it well, then get through soon so that we can help as needed the next time,” Bromley-Dulfano said. 

Ruiz-Colon said the pandemic has helped her realize that medicine is less about memorizing concepts and more about preparing to tackle the unexpected.

“Oftentimes, as students, we want clear cut answers,” she said. “It’s satisfying to have an algorithm of ‘if x, then y’ — but what COVID-19 has taught me is that there will be new threats that appear in our career where we do not have the answers to. This means that as students, it’s up to us to not just learn the facts, but more importantly, learn how to think.” 

Li, who is graduating this year, said that he has been deeply inspired by the bravery and selflessness of the medical community during this pandemic. 

“The dedication and professionalism with which medical providers have approached their work during this time has highlighted the unique strength and spirit of our community,” he said. “I’m looking forward to starting residency so that I can contribute in a meaningful way as we recover from the pandemic.”

Contact Sophia Nesamoney at nsophia ‘at’ stanford.edu.