Schools starting rotations again

[alex.jl1994]

Hot off the press, just got a notification from my school that we'll be going back to patient-care activities by the end of May. Anyone else hear any news from their schools?

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[jurassicpark]

Good to hear! Just of curiosity, who will be providing your PPEs and will you guys see coronavirus patients?

 

[efle]

We've also been notified of resumption of direct care rotations in ~2 weeks. I'm straight up flabbergasted after the AAMC recommendation for virtual residency interviews came out just a few hours ago.

AAMC: You are a dangerous vector and we cannot allow you to visit the cities you might live in for the next 3-7 years.

My school: It is appropriate for you to fly across the country and begin a sub-I with no quarantine period.

No, that is not hyperbole, that is really what they just told us in an email. We are smack in the middle of the northeast chain of urban hotzones and will be hitting the floors by the end of the month.

I can't even begin to reconcile...

 

[longhaul3]

We've also been notified of resumption of direct care rotations in ~2 weeks. I'm straight up flabbergasted after the AAMC recommendation for virtual residency interviews came out just a few hours ago.

AAMC: You are a dangerous vector and we cannot allow you to visit the cities you might live in for the next 3-7 years.

My school: It is appropriate for you to fly across the country and begin a sub-I with no quarantine period.

No, that is not hyperbole, that is really what they just told us in an email. We are smack in the middle of the northeast chain of urban hotzones and will be hitting the floors by the end of the month.

I can't even begin to reconcile...

I don't really see why these decisions are incompatible. As long as you're still following standard stay-at-home practice while you're on rotations, I don't think you're much of a threat to the community. People who have been working in hospitals since the beginning have still had to go to the grocery store, etc. It's a different proposition entirely to work at your home hospital then go rotate at another hospital across the country, and probably worse still to travel to 15 different cities over 8 weeks in interview season and come home in between each trip.

I still don't think med students are "essential" in terms of patient care, but we are getting to the point where 3rd and 4th years will soon be exhausting the buffer they had to get everything they need to graduate on time, so I do understand the push to get back on the wards. The situation inside the hospitals, even in the hardest-hit areas, is returning to normal pretty quickly. It will just be a while before public life will return to normal if we want to keep it that way.

 

[efle]

I don't really see why these decisions are incompatible. As long as you're still following standard stay-at-home practice while you're on rotations, I don't think you're much of a threat to the community. People who have been working in hospitals since the beginning have still had to go to the grocery store, etc. It's a different proposition entirely to work at your home hospital then go rotate at another hospital across the country, and probably worse still to travel to 15 different cities over 8 weeks in interview season and come home in between each trip.

I still don't think med students are "essential" in terms of patient care, but we are getting to the point where 3rd and 4th years will soon be exhausting the buffer they had to get everything they need to graduate on time, so I do understand the push to get back on the wards. The situation inside the hospitals, even in the hardest-hit areas, is returning to normal pretty quickly. It will just be a while before public life will return to normal if we want to keep it that way.

If I'm a dangerous vector, then I'm a dangerous vector. You can't say it's too dangerous for me to fly into the Bay area for an interview, yet also insist it's safe for me to fly from the same place and immediately go on the wards without quarantine.

 

[allantois]

This will go on for months; what's the alternative?

 

[ace_inhibitor111]

I don't really see why these decisions are incompatible. As long as you're still following standard stay-at-home practice while you're on rotations, I don't think you're much of a threat to the community. People who have been working in hospitals since the beginning have still had to go to the grocery store, etc. It's a different proposition entirely to work at your home hospital then go rotate at another hospital across the country, and probably worse still to travel to 15 different cities over 8 weeks in interview season and come home in between each trip.

I still don't think med students are "essential" in terms of patient care, but we are getting to the point where 3rd and 4th years will soon be exhausting the buffer they had to get everything they need to graduate on time, so I do understand the push to get back on the wards. The situation inside the hospitals, even in the hardest-hit areas, is returning to normal pretty quickly. It will just be a while before public life will return to normal if we want to keep it that way.

What I don’t understand is why the LCME isn’t stepping in and giving schools some direction? It sounds to me like every medical school is doing their own thing based on how worried they are about meeting accreditation requirements. Some are letting students return in June and cancelling AIs in order to get core rotations done. Others don’t have rotations until end of July and are allowing students to do their core rotations later in 4th year or reducing credit requirements altogether. Seems like a mess to me.

 

[MedHopeful09]

Two weeks ago, we were told to expect to be back by late July since they wanted to stagger our return and start with the M4s. But recent leadership meeting minutes report a late June return now, but this hasn't been formally reported to the class.

Has anyone heard about what schools plan to do in the case of another surge in the fall or even in a few months given the wide relaxing of guidelines? It would be insane to return for a few months only to be possibly kicked out yet again.

 

[allantois]

There’s a lot of denial and wishful thinking going on in this country that doesn’t seem to have spared medical educators either. I don’t think anyone has plan of what they will do in case of a very likely second wave

 

[stickgirl390]

Our school is preparing for online instruction with at-home shelf exams in case of a second wave. I don’t fully understand how that is comparable...

 

[longhaul3]

If I'm a dangerous vector, then I'm a dangerous vector. You can't say it's too dangerous for me to fly into the Bay area for an interview, yet also insist it's safe for me to fly from the same place and immediately go on the wards without quarantine.

I misunderstood. I thought you meant flying across the country from your home med school to do an away sub-i at another hospital. Yes, I think it would be more consistent to require a pre-quarantine, but I stand by my argument that bringing you back onto the wards after that is reasonable while promoting travel for aways and interviews is not.

What I don’t understand is why the LCME isn’t stepping in and giving schools some direction? It sounds to me like every medical school is doing their own thing based on how worried they are about meeting accreditation requirements. Some are letting students return in June and cancelling AIs in order to get core rotations done. Others don’t have rotations until end of July and are allowing students to do their core rotations later in 4th year or reducing credit requirements altogether. Seems like a mess to me.

I wonder the same thing. I suspect that all of these solutions fall within LCME requirements and therefore schools have broad discretion. Given how heterogeneous the covid picture is across the US, I think it's better that schools have some discretion. In any case, hospitals are returning to normal quite rapidly even in the worst areas, so I suspect we will see almost all med schools back on the train pretty soon.

 

[7331poas]

Good, there is no clear end game to this quarantine. We flattened the curve, that was the goal. Now is time to start returning to daily living to achieve herd immunity.

 

[Mass Effect]

Good, there is no clear end game to this quarantine. We flattened the curve, that was the goal. Now is time to start returning to daily living to achieve herd immunity.

Yup, go against exactly what every reputable doctor/researcher thinks. That's exactly what we should do.

 

[7331poas]

Yup, go against exactly what every reputable doctor/researcher thinks. That's exactly what we should do.

What do the economists think we should do? Print another 6 trillion to keep our quarantine going?

 

[Shirafune]

My school in the NE is restarting rotations 6/1.

 

[Mass Effect]

What do the economists think we should do? Print another 6 trillion to keep our quarantine going?

Many of them advocated for quarantine back in March. Wouldn't be surprised if they think opening too quickly and/or going for herd immunity rather than social distancing will be catastrophic for the economy.

 

[alex.jl1994]

Good, there is no clear end game to this quarantine. We flattened the curve, that was the goal. Now is time to start returning to daily living to achieve herd immunity.

The curve has barely flattened, and I would be surprised if we didn't see it rise again soon now that so many states are relaxing stay-at-home orders.

 

[You shall know the Truth]

Cuomo said this:

Cuomo says it's 'shocking' most new coronavirus hospitalizations are people who had been staying home

Early look at data from 100 New York hospitals shows that 66% of new admissions related to the virus are people who were at home, Cuomo said.

www.cnbc.com

 

[efle]

Cuomo said this:

Cuomo says it's 'shocking' most new coronavirus hospitalizations are people who had been staying home

Early look at data from 100 New York hospitals shows that 66% of new admissions related to the virus are people who were at home, Cuomo said.

www.cnbc.com

I must be missing something here - isn't home where we expect most people to get sick? If I go contract COVID at the supermarket or picking up carryout food at a restaurant, I'm not going to feel sick until a few days later, when I will of course be chilling at home.

 

[7331poas]

Many of them advocated for quarantine back in March. Wouldn't be surprised if they think opening too quickly and/or going for herd immunity rather than social distancing will be catastrophic for the economy.

We will just have to see how our economy looks in Q4 then.

 

[Sriddymopboi]

What I don’t understand is why the LCME isn’t stepping in and giving schools some direction? It sounds to me like every medical school is doing their own thing based on how worried they are about meeting accreditation requirements. Some are letting students return in June and cancelling AIs in order to get core rotations done. Others don’t have rotations until end of July and are allowing students to do their core rotations later in 4th year or reducing credit requirements altogether. Seems like a mess to me.

Because how can you apply a blanket statement to the whole country? things are different in Iowa than they are in New York City

 

[Mass Effect]

Because how can you apply a blanket statement to the whole country? things are different in Iowa than they are in New York City

That shouldn't matter. It doesn't make sense to say "you can't go to NYC, but you can go to IA" when you're on a plane with someone from NYC on your way to IA. And it isn't cool to give some places an advantage just because they didn't have the misfortune of being a hotspot. There should be standardization.

 

[AnatomyGrey12]

That shouldn't matter. It doesn't make sense to say "you can't go to NYC, but you can go to IA" when you're on a plane with someone from NYC on your way to IA. And it isn't cool to give some places an advantage just because they didn't have the misfortune of being a hotspot. There should be standardization.

Lol NY arrogance at it's finest. Yes it absolutely does matter. You don't need a sledge hammer to put in small screws.

For the record I think places are opening a few weeks too soon, but it's absolutely ridiculous to claim that the entire country needs to be treated the same when each state has circumstances that are drastically different.

 

[CyrusHabs7695]

That shouldn't matter. It doesn't make sense to say "you can't go to NYC, but you can go to IA" when you're on a plane with someone from NYC on your way to IA. And it isn't cool to give some places an advantage just because they didn't have the misfortune of being a hotspot. There should be standardization.

 

[stickgirl390]

I must be missing something here - isn't home where we expect most people to get sick? If I go contract COVID at the supermarket or picking up carryout food at a restaurant, I'm not going to feel sick until a few days later, when I will of course be chilling at home.

Many hospitals are tracing exactly who transmitted the virus to who, and what they’re finding is one family member contracts the virus in public, and spreads it to the rest of the family at home. Hence, more people contract it at home.

 

[Mass Effect]

Lol NY arrogance at it's finest. Yes it absolutely does matter. You don't need a sledge hammer to put in small screws.

For the record I think places are opening a few weeks too soon, but it's absolutely ridiculous to claim that the entire country needs to be treated the same when each state has circumstances that are drastically different.

Wow, the NY arrogance must be profound since I'm not from NY.

And this thread is about ROTATIONS and RESIDENCY, not about general population. And yes, I maintain that med schools and programs in IA shouldn't allow sub-Is when programs in NYC don't. It doesn't make any sense whatsoever if the real reason you're not allowing sub-Is is to avoid spreading the virus, especially when you're going to an Iowa hospital on a plane with a guy from NYC and can just as easily spread the virus in that Iowa hospital when you land.

There should be a standard rule on aways and sub-Is.

 

[allantois]

 

[stickgirl390]

According to our admin, AAMC cancelled their weekly meeting until May 14 so they can gather data/interpret when it will be safe to allow clinicals to start again. So the soonest we’ll know anything is May 14.

 

[ace_inhibitor111]

Because how can you apply a blanket statement to the whole country? things are different in Iowa than they are in New York City

I think you’re misconstruing my point. The LCME is the organization that gives accreditation to medical schools based on benchmarks each medical school has to follow (core rotations, core conditions, etc). It makes no sense for different medical schools to have different standards of accreditation regardless of their individual situation. They should relax requirements for everyone or at least give some sort of update on what is needed to maintain accreditation as that is literally what deans fear the most and guiding most of their decisions so far. A lot of my town hall meetings start with “I doubt the LCME will allow...” but it’s still just guesswork at this point.

 

[deleted480308]

Good to hear! Just of curiosity, who will be providing your PPEs and will you guys see coronavirus patients?

It is important you understand that everyone who sees patients will see coronavirus patients. You might not know who they are but you will see them

 

[Goro]

What do the economists think we should do? Print another 6 trillion to keep our quarantine going?

The Great Depression showed us we can survive an economic meltdown. A Spanish flu pandemic is far more dangerous.

And herd immunity only comes from Vaccination programs.

 

[hallowmann]

It is important you understand that everyone who sees patients will see coronavirus patients. You might not know who they are but you will see them

Truth. I've been exposed to multiple Covid pts on the floors or in the clinic, only to find out a day or so later when they spike a fever or a positive assymptomatic screening test comes back. In fact, I think the HCWs on our Covid floors are actually contracting it less than those on the other floors because they are completely decked out with shield, gown, N95 or CAPR. Fortunately we're keeping distance when possible and now have shields and a mask at all times now when in-house.

 

[deleted480308]

The Great Depression showed us we can survive an economic meltdown. A Spanish flu pandemic is far more dangerous.

And herd immunity only comes from Vaccination programs.

Or from the mass of the population getting it (and all the survivors now having antibodies)

 

[hallowmann]

Or from the mass of the population getting it (and all the survivors now having antibodies)

I honestly think we'll have a vaccine before that happens, at least for the majority of the country. Enough people are scared of going out, and I suspect this is going to be the fastest vaccine ever produced (wouldn't be surprised if we have one by next Spring).

 

[JibsGuy52]

It’s only a matter of time before 90 % of health care workers gets coronavirus. Will they all develop COVID? No. Arizona, Miami, New Jersey all doing antibody tests that are coming back sometimes as high as 25% percent of the sample size had antibodies.

Now, do medical students really need to be in hospitals and allowing for easier transmission? Probably not. We are unpaid and solely there to learn. This will all just make the residency curve learning curve steeper.

 

[SurgDoc95]

The Great Depression showed us we can survive an economic meltdown. A Spanish flu pandemic is far more dangerous.

And herd immunity only comes from Vaccination programs.

You did not actually just use the Great Depression as an example...wow

 

[Goro]

You did not actually just use the Great Depression as an example...wow

We're entering one right now.

I'm at risk for COVID...your rights end where my lungs begin.

 

[SurgDoc95]

We're entering one right now.

I'm at risk for COVID...your rights end where my lungs begin.

What an incredible thing to say.

 

[Lawpy]

You did not actually just use the Great Depression as an example...wow

Yeah that post is why i try to avoid economic discussions on SDN

 

[SurgDoc95]

Yeah that post is why i try to avoid economic discussions on SDN

Zero point to economic or political discussions on here. The comparison just caught me off guard.

 

[md-2020]

Out of curiousity, for the schools starting up again in the near future, what functional or measurable benchmarks/indicators for adequate student protection, safety are being implemented? Since exact return dates are all kind of random subject to change at any time, given each school's curricular timeline, location etc. Students are not employees. Employees i.e. doctors/nurses are not even being adequately protected in many instances yet. Students are young, sure, but many have all sorts of predisposing underlying health conditions or risks which may exacerbate COVID infections.

I am currently located in the greater NYC area, home institution in CA. From my understanding of both locations (I understand middle America may feel differently) the in-hospital situation is absolutely not suitable for student involvement at present. Given the general concensus amongst most medical experts in the media/in my personal circle that our accelerated reopening of some aspects of the economy/reduced adherence to social distancing by people over time will lead to continued increasing of cases into the summer, I am most intrigued to try and comprehend why some schools send students back in now. What am I missing?

 

[Goro]

Out of curiousity, for the schools starting up again in the near future, what functional or measurable benchmarks/indicators for adequate student protection are being implemented? Since exact return dates are all kind of random subject to change at any time, given each school's curricular timeline, location etc.

I am currently located in the greater NYC area, home institution in CA. From my understanding of both locations (I understand middle America may feel differently) the in-hospital situation is absolutely not suitable for student involvement at present. Given the general concensus amongst most medical experts in the media/in my personal circle that our accelerated reopening of some aspects of the economy/reduced adherence to social distancing by people over time will lead to continued increasing of cases into the summer, I am most intrigued to try and comprehend why some schools send students back in now. What am I missing?

Our clinical deans are having near nonstop discussions about this.

Everything seems to circle back to what is safe for the students, and at the top of the list are having enough PPE, and the number of COVID cases in the area.

 

[md-2020]

Our clinical deans are having near nonstop discussions about this.

Everything seems to circle back to what is safe for the students, and at the top of the list are having enough PPE, and the number of COVID cases in the area.

Yeah, I just cannot for the life of me comprehend how some schools (in places I can take a guess at from familiar SDN user responses) have decided now is the time. And how they arrived at that decision.

 

[Goro]

Yeah, I just cannot for the life of me comprehend how some schools (in places I can take a guess at from familiar SDN user responses) have decided now is the time. And how they arrived at that decision.

The data is just as murky to my colleagues!

 

[efle]

Out of curiousity, for the schools starting up again in the near future, what functional or measurable benchmarks/indicators for adequate student protection, safety are being implemented? Since exact return dates are all kind of random subject to change at any time, given each school's curricular timeline, location etc. Students are not employees. Employees i.e. doctors/nurses are not even being adequately protected in many instances yet. Students are young, sure, but many have all sorts of predisposing underlying health conditions or risks which may exacerbate COVID infections.

I am currently located in the greater NYC area, home institution in CA. From my understanding of both locations (I understand middle America may feel differently) the in-hospital situation is absolutely not suitable for student involvement at present. Given the general concensus amongst most medical experts in the media/in my personal circle that our accelerated reopening of some aspects of the economy/reduced adherence to social distancing by people over time will lead to continued increasing of cases into the summer, I am most intrigued to try and comprehend why some schools send students back in now. What am I missing?

My school is sending back sub-I's first and resuming other clerkships in July (makes no sense to me, you'd think subI would be more dangerous than other cores).

We apparently do not need any quarantine after flying into the city, we can just go straight onto the wards. Policy will be that we don't see any patients on PPE precautions, both to save PPE and avoid COVID exposure.

So I guess we're just going to have an "acting intern" experience where we stand outside the rooms for 50% of rounds and can only be responsible for any admissions that are unlikely to need any PPE precautions.

Franky their behavior screams "we need to resume sub-I's ASAP to make sure all MS3s have one under their belt by ERAS, and the fact that we're a hotspot in the middle of our peak be damned"

 

[md-2020]

My school is sending back sub-I's first and resuming other clerkships in July (makes no sense to me, you'd think subI would be more dangerous than other cores).

We apparently do not need any quarantine after flying into the city, we can just go straight onto the wards. Policy will be that we don't see any patients on PPE precautions, both to save PPE and avoid COVID exposure.

So I guess we're just going to have an "acting intern" experience where we stand outside the rooms for 50% of rounds and can only be responsible for any admissions that are unlikely to need any PPE precautions.

Franky their behavior screams "we need to resume sub-I's ASAP to make sure all MS3s have one under their belt by ERAS, and the fact that we're a hotspot in the middle of our peak be damned"

To be honest, to me this also screams "introducing greater systematic change onto the familiar match/M4 timeline would take too much work, let's just try to force a square peg into a round hole and if anyone suffers the consequences it's the students that can't really do much to complain in an efficacious manner anyways."

because we all know how easy it is to just stay away from COVID+ individuals.

 

[efle]

To be honest, to me this also screams "introducing greater systematic change onto the familiar match/M4 timeline would take too much work, let's just try to force a square peg into a round hole and if anyone suffers the consequences it's the students that can't really do much to complain in an efficacious manner anyways."

because we all know how easy it is to just stay away from COVID+ individuals.

Yeah, and they're sending very mixed messages. Our critical care and ED rotations are cancelled indefinitely right now for example, and the hospital is closed to audition rotations until at least October.

So apparently it's too dangerous for me to fly in for an audition sub-I, but safe to fly in for a real sub-I, and while it's too dangerous for me to be in the ED or ICU, it's safe for me to manage floor patients coming to/from the ED and ICU.

I expect my AI to be a miserable, boring experience where I can't be involved in the care of most patients. Probably lots of long, long nights waiting for an appropriate admission to show up while watching several with coughs/fevers/PPE get admitted that I'm not allowed to H&P.

Ugh.

 

[ace_inhibitor111]

My school is sending back sub-I's first and resuming other clerkships in July (makes no sense to me, you'd think subI would be more dangerous than other cores).

We apparently do not need any quarantine after flying into the city, we can just go straight onto the wards. Policy will be that we don't see any patients on PPE precautions, both to save PPE and avoid COVID exposure.

So I guess we're just going to have an "acting intern" experience where we stand outside the rooms for 50% of rounds and can only be responsible for any admissions that are unlikely to need any PPE precautions.

Franky their behavior screams "we need to resume sub-I's ASAP to make sure all MS3s have one under their belt by ERAS, and the fact that we're a hotspot in the middle of our peak be damned"

I prefer that to what my school is doing, which is finishing the core rotations first at all costs no matter how long it takes. They’ve already wiped out two months of sub-Is and I’m hoping they don’t make it three months. I’d rather have a neutered AI experience with at least a few specialty specific letters than use up all my time on completely unrelated specialties.

 

[ciestar]

While I absolutely agree that with a lack of adequate PPE that students shouldn’t be using that valuable equipment... what is the solution? Postpone it for a while, then what? The rising M4’s do what instead? What about the M3’s?

That’s the problem. I was absolutely okay with doing my last rotation online, but it was my last rotation.

 

[efle]

While I absolutely agree that with a lack of adequate PPE that students shouldn’t be using that valuable equipment... what is the solution? Postpone it for a while, then what? The rising M4’s do what instead? What about the M3’s?

That’s the problem. I was absolutely okay with doing my last rotation online, but it was my last rotation.

I see no good options, really. There's also the elephant in the room of a second wave that hasn't been addressed whatsoever at our dean's town halls. In 1918 it was the second wave in flu season that killed an order of magnitude more people. If we get another crazy COVID spike where much of the East Coast looks like NYC in April...I have absolutely no idea what they could do besides letting us complete online versions of our rotations.

I assume this is being discussed a lot at every SOM behind the scenes. Is there an LCME requirement written in stone that we train in the hospital or can we technically just do Aquifer + NBME shelf and be cleared to graduate? I have no idea myself