With three classmates, Asmeron crowded anxiously around a computer monitor to watch a virtual town hall in which school leadership would reveal how their education would be impacted by COVID-19 and the growing pandemic.
In March 2020, rumors and uncertainty plagued Betial Asmeron, then a third-year student at UC San Diego School of Medicine who was, by nature, optimistic and assured.
With three classmates, Asmeron now crowded anxiously around a computer monitor to watch a virtual town hall in which school leadership would reveal how their education would be impacted by COVID-19 and the growing pandemic.
Prior to the pandemic, Asmerom’s routine was the same, day in and out: Wearing hospital scrubs and coffee in hand, she would arrive at 5 a.m. for a rotation at UC San Diego Health to check on the welfare of patients under her watch.
“As medical students, we have the gift of time in the hospital. We get to know our patients on a deeper level, which allows us to better help with their medical and emotional needs,” said Asmerom.
With consent from patients and under the supervision of resident and attending physicians, third-year medical students interview and examine patients, write notes in their electronic medical records, present findings to their team for review and are part of hands-on care, such as surgery or labor and delivery.
After a full day in the hospital, Asmerom would return home by 7 p.m. for a late night of studying for shelf exams — national standardized exams that evaluate competency over each core rotation or clerkship — before repeating the routine the next day.
— Carlos Jensen, PhD
Virtual Class Rooms
All levels of education — from elementary schools to universities
— found themselves grappling with unprecedented challenges posed by a highly contagious virus that did not discriminate by age, gender, ethnicity or even health status.
Once lively campuses emptied as schools and districts took early or extended spring breaks to plan for online instruction and to implement safety protocols to bring staff and students back, when it was safe to come back.
UC San Diego faculty, program directors, course directors and information services scoured online resources to build and shift to virtual learning on a campus-wide scale.
“For the safety of our faculty and students, and to ensure our students had a way forward through this difficult time, we made tremendous changes over a very short period of time in a highly collaborative way,” said Associate Vice Chancellor for Educational Innovation Carlos Jensen, PhD.
“The way that administration, faculty and senate came together, because it was the right thing to do, is a tremendous testament to the kind of community that we are. We’ve shown that we can really change education if we want to.”— Carlos Jensen, PhD
For example, the Division of Arts and Humanities quickly flipped its campus-based, 12-week transfer student Summer Academy to online only. The Preparing Accomplished Transfers to the Humanities partnership with the San Diego Community College District provides hands-on resources for students to succeed at the university, as well as two full academic courses.
For the class “Politics of Food: Justice, Diversity, Community,” led by Stephanie Jed, PhD, a professor in the Department of Literature, students would normally visit multiple community farms together. For the virtual class, students instead received a produce delivery from a San Diego-based Community Supported Agriculture (CSA) program, and seeds, soil and a planter box to grow their own vegetables at home. The program staff organized an online discussion about community gardens and food deserts and cook nights to help create bonds among the students.
Bioengineering students at UC San Diego Jacobs School of Engineering completed senior design projects. They used many strategies, including creative use of Zoom for collaborative brainstorming and design; a focus on regular, precise communication with project sponsors and clients; off-campus, socially distanced outdoor work meetings; and limited use of labs following safety protocols. And, in a nod to the old days, they mailed parts and prototypes to each other.
Faculty members tapped into a wealth of resources available through the Teaching + Learning Commons. It became an important source of support for faculty, instructors, graduate instructional assistants and students. The Commons created an integrated approach that ensured educators had the tools they needed to keep teaching through partnerships with Educational Technology Services, the Library, Academic Integrity Office, Campus Privacy Office and others.
A School Tested
Shelter-in-place began in March 2020. It took approximately six weeks for medical students to return to clinics and hospitals and yet seniors still needed to complete rotations in order to graduate in May.
While medical students were ready, patients were not.It took a while for hospitals to have the resources to return to regular operations, but it took patients even longer to feel comfortable resuming routine screenings and active health care, affecting some clerkships and residency programs.
“We worked to find the right spots for students who still had requirements that needed to be met so that they could meet their graduation requirements. This necessitated adaptability and a lot of individual work with students. For example, surgeons who could not be in the operating room instead helped in the intensive care units putting in central lines to help their overworked colleagues,” said Savoia.
In the end, all students passed their tests and met the requirements to move on to the next stage in their medical education or career.
“Given the situation and how many unknowns there were, I think we adequately prepared students to be able to have the clinical information that they needed to move forward to their fourth year and to their future careers. Their test scores reflected that readiness,” said Cormano.
Charley Coffey, MD, associate professor in the Department of Surgery, who published three papers on student perspectives of remote learning during the pandemic, said that although first- and second-year students spend minimal time in clinics, they too felt the loss of clinical interactions.
“For many students, working with patients is one of the most gratifying things that they do. It is one of the things that keeps them motivated through sitting in lecture halls for hours and years on end,” said Coffey, co-director of the Third Year Surgery Clerkship.
“There were very creative and innovative things done to involve students in telemedicine and to rounding remotely on the surgical floor and labor and delivery floor. Those were things that students responded well to, ways to reconnect with those aspects of patient care that were so easily lost when we shifted to remote learning modalities.”
Students did appreciate the flexibility of learning at their own pace and working virtually in smaller groups, said Coffey. However, digital fatigue set in after one hour.
“It is nearly as easy for a professor to stand up in front of a lecture hall of students as it is to stand in front of a computer and similarly for students to be able to just sit in front of their computer.
”On the other hand, when it came to anatomic dissections, it is impossible to do that without being in person. It is nearly impossible to replicate during an overnight transition to remote learning and it is among the things that preclinical students missed most,” said Coffey.
Fellows are physicians who have already completed their residency and are now in specialty training. Because fellowships are entirely dependent on caring for patients, fellows were dramatically impacted during the pandemic. Thankfully, by this point in their training most fellows had met the required number of surgeries.
“The concern that many trainees had at that time was how they would transition into the working world. A lot of the hiring, or the interviewing process, or both, were put on hold due to the pandemic,” said Coffey.
Prior to the pandemic, some lectures were available virtually. COVID-19 forced the entire campus, from dance instruction to chemistry labs, to find alternative instruction options.
“We have learned a lot about how diverse our student population is, and their diverse needs, and how some of the small changes that we make in the classroom have a tremendous impact on student well-being, success and retention. We have learned to become comfortable with remote and hybrid teaching in a way that we were not before and it has made us think differently about classes,” said Jensen.
“This post-pandemic period is going to be an exciting time when we start thinking about what are the right pedagogical tools. It forced faculty to challenge their assumptions and learn new skills.
“I wish we could have learned these skills under better circumstances, but I think we need to take the good that has come out of this and take that forward. They are valuable skills.”
For the School of Medicine, small groups for hands-on learning has been one of the most touted changes by students and faculty alike. Cormano recognizes that less time in the labor and delivery ward may actually be a more productive and immersive experience if it allows for individualized teaching.
“I think one of the real take-homes for educators is to be critical in determining the modalities and the resources that are going to be most useful to students. How do we make those accessible, digestible and useful for student learning without just throwing a lot of information at them?
“Part of that comes with experience and listening to what students said worked and what did not.”
For Asmerom, who will start her fourth year of medical school in the fall after taking a year to pursue a master’s degree in public health as part of the UC San Diego School of Medicine Program in Medical Education – Health Equity program, remote learning was an effective experience. Still, she is not advocating to make medical school virtual.
“Remote learning is not how you learn to be a doctor. It’s really like an apprenticeship model where you have to go there in person, work with patients, residents and attendings, review labs, and develop your differentials. You have to do it over and over again in order to cultivate your clinical decision-making skills. You can’t do that very well from home,” said Asmerom.
“And I really missed seeing and interacting with patients, meeting their families and being able to bear witness to some of their hardest moments or laugh with them. Relationships are the heart of medicine and I really craved and missed that when we switched to remote learning. And, of course, I missed morning burritos from the Hillcrest cafeteria.”