What is HAPPENING?! Advising in the Pandemic

Image by snd63 from Pixabay

The medical school academic year has come to an unusual and uneven conclusion—some of us had early graduations (15 of 72 respondents on a recent ASC-EM survey, with the early graduating institutions evenly split between the Eastern/Central/Western US) and most of us had to say goodbye to our students virtually.  

Now, facing the 2020-21 academic year, advisors—beset with the increasingly strained clamor for information from their advisees—are turning to present their own pleas for guidance to administrators and national leadership groups.  At each level, every question holds within it a snarled nest of deeper questions, and each answer is inter-dependent on the unraveling of multiple other issues.  As we all surf atop tectonic shifts in our practices, home lives, and even professional identity, many of us have converted what used to be monthly conferences to weekly meetings, and what used to be weekly meetings to daily check-ins.  Therefore, we  wanted to present some of today’s announcements with their recent background, with a plan to update next week (rather than on our usual monthly schedule) if needed.  

On March 13, as it became clear that the SARS-CoV2 crisis was going to inevitably affect the 2020-21 application cycle, ASC-EM released a consensus statement calling for flexibility on SLOE requirements and clear uniform language used at the institutional level to express local limitations on students’ capacity to enroll in away rotations.

On April 14, the AAMC released its most recent Guidance on Medical Students’ Participation in Direct Patient Contact Activities, which divided schools into two categories based on their levels of COVID community spread and PPE availability.  They acknowledged that at the time of that document’s release, most American medical schools fell under Section 1: “locales with significant, active current or anticipated COVID-19 community spread and/or limited availability of PPE and/or limited availability of COVID-19 testing,” and went on to recommend that those schools not involve students in any patient-care activities, except in voluntary efforts as emergency healthcare workers if the need for such workers was high.  Definitions of what would be considered significant community spread, or what levels of PPE availability would be acceptable were not provided, and the guidance was clear that individual decisions would be left up to schools.  Based on informal data collected from the CDEM discussion board, it appears that some schools are re-opening already with students in clinical roles, some have a plan for an on-time opening in late May/June, while others have already committed to a delayed opening with the exact date to be determined. 

The Visiting Student Application Service (VSAS), used by students and schools to schedule most away rotations in the ERAS application season, was closed on April 15, 2020, with a plan to re-visit and potentially re-open it on May 11–the opening is now formally planned for May 19.

The NRMP and ERAS initially stated that they planned to continue on the usual application schedule but acknowledged that the cancellation of tests and certain decisions by medical schools and other organizations might require them to make changes.

Active conversation continued on both the Council of Residency Directors (CORD) and Clerkship Directors in Emergency Medicine (CDEM) discussion boards regarding reasonable expectations for away rotations and SLOES for EM-bound MS4’s.  As this post was being written, the creation of a CORD e-SLOE committee was announced, with plans, per an email communication from one of the co-chairs, to create a SLOE-like format for non-EM letter writers to use for this application cycle, and to update and edit the current eSLOE format and system to reflect changes in light of the COVID pandemic. 

And finally, on May 11 the Coalition for Physician Accountability, a group that includes the AAMC, the ACGME, AACOM, the LCME and the NBME among others, released a statement that included the following guidance:

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Recommendation 1 ― Away Rotations for Medical Students 

The WG recommends that for the 2020-2021 academic year, away rotations be discouraged, except under the following circumstances: 

• Learners who have a specialty interest and do not have access to a clinical experience with a residency program in that specialty in their school’s system.

• Learners for whom an away rotation is required for graduation or accreditation requirements. 

Individuals meeting these exceptions should limit the number of away rotations as much as possible. Students should consider geographically proximate programs, when appropriate, to meet learning needs. 

Recommendation 2 ― Virtual Interviews 

The WG recommends that all programs commit to online interviews and virtual visits for all applicants, including local students, rather than in-person interviews for the entire cycle and that the medical education community commit to creating a robust digital environment and set of tools to yield the best experiences for programs and applicants. 

Recommendation 3 ― The ERAS Opening for Programs and the Overall Residency Timeline 

The WG recommends a delayed opening of ERAS for residency programs and a delayed release of the medical student performance evaluation (MSPE) and that the opening and release happen on the same day. 

Recommendation 4 ― General Communications 

Implementation of these recommendations will require transparency and regular, clear communications among all stakeholders. The WG encourages the medical education community to work together to provide consistency and equity for applicants across the country.

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It is impossible to predict in detail how individual programs will interpret and utilize these revised advising recommendations, and how they will incorporate them into their review of applications, although conversation and attempts to achieve consensus in order to provide a consistent platform for individual advice to students continue.

These efforts and all discussions at this time are complicated by the current lack of clarity on which institutions will be able to provide safe clinical experiences for students, and what the range of clinical cases available on those rotations will be.  

One thing is for sure—students right now need us to give them information, even if we are sharing our own ambiguity.  This is a good time to cement your relationship with your school’s advising deans, the registrar’s office, and any local/regional advisors or site directors, so that we can all be on the same page when more information is available or circumstances acutely change.  

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Shannon Moffett MD @BrickCityEM and Mark Olaf DO @LearnMedER in conjunction with CORD ASC-EM (advising students committee in emergency medicine)

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