Christopher Gallivan,¹ Magnus McLeod¹

¹Dalhousie University, Nova Scotia, Canada

Across the globe, clerkship directors and other educators had to deal with the unprecedented chaos caused by the COVID19 pandemic leading to the cessation, modification, and then resumption of clerkship.  This posed a challenge for educators – and students. There had to be a balance between maintaining a safe learning environment for students and ensuring that students had adequate clinical learning experiences but still allowing students to complete their clerkship year in a way that does not completely disrupt the learning of the following cohorts’ clerkship year.  We would like to share some perspectives and lessons learned from the point of view of the internal medicine clerkship program at Dalhousie University.

One thing that certainly took us by surprise was the speed at which things changed during the first wave of the COVID 19 pandemic.  At Dalhousie, for example, we went from a Monday morning introduction for students starting their third of four clerkship blocks with some passing discussion about the evolving pandemic to a Friday briefing that same week that clerkships were suspended indefinitely across Canada.  It was obviously an incredibly stressful time for students; made worse by the fact that for most of their questions (such as how long they will be off, how this will affect their graduation date, how this will affect residency matching), we simply did not have any answers.  During this time, we felt it important to make sure students were receiving clear and accurate messages and not getting different information from different sources. To do this, I found myself communicating much more with my fellow clerkship directors as well as our undergraduate medical education department.  This also led to, what was for me, both a humbling and frustrating experience of having to tell students with legitimate questions or concerns that we did not have answers.  This involved fighting the natural tendency as an educator to answer questions and provide reassurance. Still, in the long run, it was certainly my experience that telling students to wait for more information caused fewer problems than students getting conflicting information from multiple sources.     

As the year progressed it became clear that the turmoil of stopping clerkship would pale in comparison to the challenges of restarting it.  At Dalhousie, after much discussion, it was decided that the final two clerkship blocks of the current class cohort as well as the first block of the following year’s cohort (that which started in the fall of 2020) would all need to be shortened with each department deciding how to give students adequate training in less time.  I came to the profound but obvious realization that it would be impossible to deliver all the content we do in normal year.  I found myself essentially applying “triage” thinking to the curriculum and focusing on the things that were vital or ‘life saving.’ We ended up deciding to keep the full length of what we felt were our core internal medicine rotations of the MTU (Medical Teaching Unit) and our geriatrics rotations while shortening the time for selectives in outpatient and subspecialty medicine.  Although this certainly altered the experience of clerks, I felt we were able to provide students with the necessary learning in core internal medicine patients and illnesses.

Although there were many challenges to this year, it was also an opportunity for educators to improve and innovate.  We were pleased to see how many of our clinical preceptors and other educators were willing to step up and help find creative solutions to keep students engaged.  For example, many of or preceptors involved students in virtual care and remote or phone consults even though these were new for students and preceptors alike.  This allowed students to be part of the learning and innovation process as they worked with their preceptor to navigate the new clinical environment.  Some preceptors also found ways to involve students in patient care using new techniques, such as taking a table into a patient room and showing the physical exam and history without bringing in their whole team of learners.  The ability of our educators to be open and creative undoubtedly helped our students to get back into the clinical environment and resume learning.       

As we look ahead to the ongoing challenges, we can use some of the lessons we learned during the pandemic to prepare for the future.  By focusing on clear and open communication (even if this means telling students we do not have the answers), realizing that education will be different and that we may need to triage to protect the most important parts of our curricula, and being creative and open to new methods of teaching, we can hopefully make 2021 a smoother year.