Original Article

Impact of the COVID-19 Pandemic on Medical Education during Inpatient Internal Medicine Rounds

Authors: Eva H. Clark, MD, PhD, Trenton M. Haltom, PhD, Jennifer Freytag, JD, PhD, Sylvia J. Hysong, PhD, Bich N. Dang, MD, Thomas P. Giordano, MD, Prathit A. Kulkarni, MD

Abstract

Objectives: Inpatient rounding is a foundational component of medical education in academic hospitals. The coronavirus 2019 (COVID-19) pandemic disrupted traditional inpatient rounding practices. The objectives of this study were to describe how Internal Medicine inpatient team rounding changed because of COVID-19-related precautions and the effect of these changes on education during rounds.

Methods: During February to March 2021, we conducted four virtual focus groups with medical and physician assistant students, interns, upper-level residents, and attending physicians at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, and designed a codebook to categorize focus group commentary.

Results: Focus groups revealed that students believed that certain physical-distancing measures in place early on during the pandemic were ineffective and significantly limited their ability to evaluate patients in person. Residents described increased stress levels related to potential severe acute respiratory-coronavirus 2 exposure and limited time at the bedside, which affected their confidence with clinical assessments. Rounding-team fragmentation precluded the entire team learning from all of the patients on the team’s census. Loss of intrateam camaraderie impaired the development of comfortable learning environments.

Conclusions: This study evaluated Internal Medicine team member focus groups to describe how the COVID-19 pandemic affected medical education during rounds. Academic teaching programs can adapt the findings from this study to address and prevent pandemic-related gaps in medical education during rounds now and during future potential disruptions to medical education.
Posted in: Infectious Disease143

Full Article

Having trouble viewing the article content below? Click here to open it directly.

Images

Download Image

References

1. Rhoads PS. Sir William Osler, aphorisms from his bedside teachings and writings. Arch Intern Med 1961;108:507–508.
 
2. Ashokka B, Ong SY, Tay KH, et al. Coordinated responses of academic medical centres to pandemics: sustaining medical education during COVID-19. Med Teach 2020;42:762–771.
 
3. Newman NA, Lattouf OM. Coalition for medical education–a call to action: a proposition to adapt clinical medical education to meet the needs of students and other healthcare learners during COVID-19. J Card Surg 2020;35:1174–1175.
 
4. Watson A, McKinnon T, Prior SD, et al. COVID-19: time for a bold new strategy for medical education. Med Educ Online 2020;25:1764741.
 
5. Becker NV, Bakshi S, Martin KL, et al. Virtual team rounding: a cross-specialty inpatient care staffing program to manage COVID-19 surges. Acad Med 2021;96:1717–1721.
 
6. Alliance for Academic Internal Medicine. APDIM Residency Program Director Surveys. APDIM Residency Program Director Surveys. https://www.im.org/data/alliance-research-surveys/apdim-program-director-surveys. Published 2020. Accessed June 13, 2023.
 
7. American Association of Medical Colleges. COVID-19: updated guidance for medical students’ roles in direct patient care. https://www.aamc.org/news-insights/press-releases/covid-19-updated-guidance-medical-students-roles-direct-patient-care. Published 2021. Accessed May 5, 2021.
 
8. Rose S. Medical student education in the time of COVID-19. JAMA 2020; 323:2131–2132.
 
9. Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. Lancet Infect Dis 2020;20:777–778.
 
10. Gonzalo JD, Chuang CH, Huang G, et al. The return of bedside rounds: an educational intervention. J Gen Intern Med 2010;25:792–798.
 
11. Stickrath C, Noble M, Prochazka A, et al. Attending rounds in the current era: what is and is not happening. JAMA Intern Med 2013;173: 1084–1089.
 
12. Saldana J. The coding manual for qualitative researchers, 4th ed. Thousand Oaks, CA: Sage Publications; 2021.
 
13. Blankenburg R, Gonzalez Del Rey J, Aylor M, et al. The impact of the COVID-19 pandemic on pediatric graduate medical education: lessons learned and pathways forward. Acad Med 2022;97(3S):S35–S39.
 
14. Enujioke SC, McBrayer K, Soe KC, et al. Impact of COVID-19 on post graduate medical education and training. BMC Med Educ 2021;21:580.
 
15. Lent RW, Brown SD, Hackett G. Toward a unifying social cognitive theory of career and academic interest, choice, and performance. J Vocat Behav 1994; 45:79–122.
 
16. Daniel M, Gordon M, Patricio M, et al. An update on developments in medical education in response to the COVID-19 pandemic: a BEME scoping review: BEME guide no. 64. Med Teach 2021;43:253–271.