By Douglas R. Hegstad ’80-A
COVID-19 came to the School of Medicine on March 17. Internal Medicine Clerkship Director Andrew Wright, MD, was in his 43rd day as clerkship director when he read these words in an email: “Clinical duties are hereby suspended for medical students.” Though new to the oversight of the student internal medicine course, Dr. Wright knew that those words spelled trouble. Without the curriculum built into clinical rotations, students might not be able to complete requirements needed for graduation.
In his second year with the LLUSM faculty, Dr. Wright had hoped to become an innovative educator, but he hadn’t planned it this way. During medical school at the University of Michigan, he’d participated in research and publication, graduating Alpha Omega Alpha and earning the Dean’s Commendation for Excellence in Clinical Skills. He went on to Massachusetts General Hospital before returning for a GI fellowship at the University of Michigan. He received an NIH T-32 award for training in basic and translational digestive sciences and the Outstanding Fellow Clinical Award. His work resulted in more than a dozen peer-reviewed publications, six as first author. “I’ve been blessed,” he reflects. “I am good at a few things, but education is the thing I love. I am an educator at heart. That’s where I experience my greatest satisfaction.”
When Dr. Wright became the internal medicine clerkship director on February 3, 2020, things seemed routine, but after receiving that email, he sat in front of his computer wondering what to do next. The clock on the mantle nearby seemed to tick louder. Patients were off limits. Student education faced disruption.
Within two days, Dr. Wright devised a plan that would require broad faculty engagement. On March 19, the following email was sent to the department of medicine faculty:
“To graduate, LLUSM students need your help. Here’s the ask: From anywhere, facilitate Zoom video conference case-based didactics for students on 3/23/20 (four days from now). Email Dr. Andy Wright with this message: ‘I will help.’ It’s ok if you’re thinking, ‘I haven’t done this before.’ None of us have.”
In just four days, with lots of phone calls and more emails, a diverse faculty educator team came together. Pulmonologist David K. Bland, MD, joined from Australia, where he had recently retired. Alumni Association President Debra L. Stottlemyer ’86, retired gastroenterologist and Professor of Medicine Michael H. Walter ’73-B, Associate Professor of Medicine and Nephrology Program Director James I. McMillan ’86, Michael J. Matus ’11, Timothy D. Lee ’13, Madalitso N. Chundu ’15, and Amy C. Hayton ’04 joined the team. Reflecting the strength of a diverse faculty, 20 of the physicians volunteering to take part in this new curriculum are graduates of other schools and represent a diversity of talent, education, culture, gender, and specialty training.
Putting together and delivering a new curriculum required focused effort, content development, innovation, planning, and connecting. Dr. Wright reflects on the days following the curriculum change: “I don’t think I got to bed before 3 a.m. in two weeks, but this has been one of the most satisfying times in my career.”
Faculty members and students dove into the technical and operational aspects of interaction via video on a Zoom platform, delivering the following material to students over the next six weeks:
- 17 case-based didactic sessions with four faculty members per session
- 18 traditional lectures
- 2 interactive EKG sessions
- 1 one-on-one ICU case simulation with 17 fourth-year students
- 3 student-led journal clubs
- 10 students participating in telehealth at LLVAH
- >150 student write-ups reviewed with feedback
- 1 workshop on clinical reasoning in internal medicine
- 1 workshop on procedural learning in internal medicine
Dr. Wright reflects on the changes: “Our faculty — and volunteer faculty like Dr. Stottlemyer — stepped up to a big challenge. They connected to student education needs. In some cases, mentoring connections have begun. During a crisis, it’s easy to get focused on our troubles. Other educators in other disciplines did similar work across campus. Some faculty physicians stepped across department boundaries to assure student experience. Sigrid Burruss, MD, surgeon and intensivist, developed critical care portions of the internal medicine curriculum.
Developing hands-on clinical skills is crucial for medical students, but some changes we made will have a permanent place in education. Someday with the pandemic behind us, we will not go back to our old ways of doing things. There will be a place for Zoom conversations between faculty and learners. Our best lectures will be accessible online for review. Our graduates will always need bedside clinical skills, but they will learn to provide good experiences for select patients through video encounters. We’ve leapt 5-10 years forward in a matter of weeks. It may take us a while to process what we have done.”
Dr. Hegstad worked for 25 years at Riverside General Hospital and Riverside County Regional Medical Center before coming to Loma Linda University in 2009 to serve as chair of the Department of Medicine.