Following the suspension of in-person classes and clinical rotations in March due to the threat posed by COVID-19, instructors at Harvard Medical School — including Director of Faculty Development Barbara A. Cockrill — were given just under 24 hours to transition to online teaching.
HMS instructors, many of whom are also clinicians, also faced the challenges of balancing the transition to online teaching and the rising number of COVID-19 cases. This resulted in a rising demand for physicians in hospitals to handle the influx of patients, Cockrill said.
“I spent two weeks in the COVID ICU right after I finished my course. So there was a lot of strain, and still is on the faculty, navigating the needs of COVID and the needs of teaching,” Cockrill said.
Maintaining the “Case Based Collaborative Learning” model unique to Harvard Medical School courses — which involves flipped classroom-style teaching — the instructors of first-year courses designed a Zoom class format where students discussed various case studies and hypotheses in small groups utilizing the breakout room feature. They have continued this model with new first years, who started their school year remotely in August.
First-year medical student Abigail M. Kempf said she has found this style of virtual learning effective.
“We can click buttons to ask for help if we need an instructor to come give us some suggestions,” Kempf said. “It's kind of like them circulating throughout the room in a normal year, and I would say that portion of it has worked really, really well.”
Fellow first-year student Jack Ghannam also said he and his classmates have found they can still discuss course material with one another in class.
“From my own experience and then also speaking to classmates, it doesn't seem like the actual content we're learning is being lost by the virtual conditions,” Ghannam said.
Along with traditional coursework in the classroom, first year medical students at the Medical School also learn how to conduct patient visits, taking medical histories, measuring vital signs, and performing physical examinations in a course called "The Practice of Medicine."
Associate Dean for Medical Education Quality Improvement John L. Dalrymple said he and other members of the clinical teaching staff recognized that while a large portion of clinical skills require in-person learning, some can be taught in an online format.
“Much of that teaching and learning we realized could still be achieved with a virtual experience,” Dalrymple said. “You can still learn a lot of a lot of those clinical skills by interviewing a patient over Zoom or teaching how to do it over Zoom. You could certainly teach communication skills that way. The hardest part though is how to teach physical exam skills.”
Kempf said the clinical aspects of the curriculum are challenging to learn online, even with the adjustments. The students are learning how to perform procedures such as eye examinations in mirrors and reading blood pressures by fastening the cuff on themselves. They are encouraged to practice on family members or housemates.
“[The instructors] are doing the best they can, and they've adopted well, but there are some things you truly can't learn online for medicine,” Kempf said.
Cockrill said course staff are aware of the difficulties in remotely teaching students about the techniques used in physical exams. As a result, instructors plan to focus on clinical skills upon the students’ arrival on campus — which the Medical School hopes will come in January 2021, according to a May announcement.
“The clinical teaching of physical exam kind of skills will be prioritized for getting the students back on campus,” Cockrill said.
While the incoming class of medical students began their first year remotely, second, third, and fourth year students have all returned, engaging in clinical rotations at Harvard-affiliated teaching hospitals.
Nicholas P. Joseph, a third-year student at the Medical School, said the largest adjustment made to the curriculum was the shortening of the duration of each rotation to make up for lost time in the spring.
“The capacity that we can be involved in is pretty much almost exactly the same as it was before,” Joseph said. “Harvard Medical School has done a truly phenomenal job trying to reintegrate its students back into the wards.”
Second-year students at the Medical School starting their Principal Clinical Experience phase of learning — a series of clerkships in different disciplines of medicine including surgery and general medicine — also began learning in-person this fall.
Second-year student Aldis H. Petriceks said additional weeks of training in performing physical examinations needed for their clinical experiences were added to their curriculum to compensate for missed practice from the spring when classes moved online during their first year.
“Our clinical instructors did a really wonderful job of continuing to find creative ways to teach us about diagnostic reasoning and oral presentations and writing medical documentation, but we did miss a lot of time to practice things in person,” Pretriceks said. “They’re giving us more focused opportunities to practice physicals, things of that nature. I feel like that’ll be sufficient to build on for the rest of the clerkship.”
If the pandemic situation heightens and COVID-19 cases begin to rise again, Dalrymple said he anticipates students would be a part of the effort rather than pulled from rotations again.
“In the hospital, now that we have the advantage of knowing what that looks like and being ready to deal with that, I expect that we're going to be able to maintain student safety and their engagement on the team,” Dalrymple said.
“We're all anticipating that whatever comes forward, we'll address it with students as part of that effort,” he added.
—Staff writer Virginia L. Ma can be reached at email@example.com.