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The Calm Before the Storm: The Impact of COVID-19 on Dermatology’s Next Leaders

The Calm Before the Storm: The Impact of COVID-19 on Dermatology’s Next Leaders

On Friday, March 20, Jocelyn Mendes, a fourth-year medical student at the University of South Carolina School of Medicine in Columbia, waited for good news. It was Match Day, the day in which graduating medical students across the country discover where they would begin their medical careers as residents. Mendes had been waiting eagerly for this moment for a long time. In fact, she had watched her school’s Match Day through a livestream for the previous 3 years in anticipation of her own. If she matched into dermatology, her chosen specialty, she would be the first person from her medical school to ever match into the field. 

Photo courtesy of Jocelyn MendesUnlike how she had envisioned, Mendes waited at home for her result. Precautions against the quickly spreading coronavirus disease (COVID-19) had caused her school’s Match Day festivities to be canceled. Instead of envelopes to rip open, she, her classmates, and peers around the country clicked on an email with their match results. Still, Mendes celebrated. She matched with the dermatology department at the University of North Carolina in Chapel Hill and was ecstatic. But before moving to North Carolina, she would complete a preliminary internal medicine year at Mount Sinai in the Morningside Heights neighborhood of New York City, NY, the American epicenter of the COVID-19 pandemic.

“I’m extremely nervous,” she said, thinking about her intern year. “But I also consider it a privilege to have firsthand contribution to care for patients in this historic time. Very few people are able to say that.” 

Although the novel coronavirus first touched the United States in late January, the second half of March brought forth a turning point for many students like Mendes across the country, who faced a dizzying array of changes. Besides Match Day, graduation plans and celebrations were canceled amid efforts to slow the spread. The Association of American Medical Colleges recommended all medical students be pulled out of in-person rotations.1 To help their mentors and future colleagues, students began to volunteer their time, donate blood, collect personal protective equipment (PPE), and provide childcare and run errands for health care workers.2-4 Photo courtesy of Yoo Jung KimMedical schools debated early graduations, and some asked graduating students to start residency early.5 However, residents are not immune to COVID-19; the first resident physician has died of COVID-19 in Michigan,6 and statistically, more deaths will follow.

In a matter of weeks, graduating medical students were faced with a looming new reality, both terrifying and exciting: being a brand-new doctor in the middle of the pandemic.

For certain medical students, knowledge that the virus would have an enormous impact came long before Match Day cancellations. Yoo Jung Kim, a fourth-year medical student at Stanford University School of Medicine in California who matched into dermatology at the Feinberg School of Medicine at Northwestern University in Chicago, IL, said news from her family, who live in Washington and South Korea, helped her anticipate the virus’s impact. Kim’s parents live in Snohomish County, WA, the county in which the first US case of COVID-19 was confirmed.7 In March, when Kim decided to fly home, only 10 people were on her flight.

Other students on emergency medicine rotations say they also began to notice changes earlier than their peers. Taylor Erikson, a medical student at Loyola University Chicago in Illinois who also matched at Northwestern, rotated in her hospital’s emergency department throughout March. Erikson said it quickly became apparent that there were not enough tests kits. She recalled seeing patients suspected of having COVID-19 that were not tested due to stringent testing criteria. As medical students were barred from seeing patients with upper respiratory symptoms and attendings began to talk about rotating schedules so that they would be less exposed, Erikson realized that something major was happening. 

Rachel Fayne, a student at the University of Miami Miller School of Medicine in Florida who matched in dermatology at the University of Michigan Medical School in Ann Arbor, echoed Erikson’s statements about testing. While working in the emergency department, a patient from Italy tested positive for the coronavirus family of viruses but did not meet standards for testing of the specific COVID-19 strain. Fayne recalled the team getting out a binder to review hospital policies for testing. No one knew what to do. Photo courtesy of Ashley RiddleAround her, attendings began looking nervous, an ominous sight for her because emergency medicine physicians rarely looked nervous before this moment. 

“It’s coming,” Fayne remembers thinking at the time. “People don’t think it’s real, but it’s coming.”

Since then, the medical field, and world, has changed. Now no longer working in the hospital, fourth-year medical students in self-isolation reflect on their fears, worries, and the moments that were taken away. 

Kim, who is the first to graduate from college and medical school in her family, said it would have been an amazing experience for her parents to see her “in her full regalia and floppy hat.” Ashley Riddle, a medical student at the University of North Carolina who matched with the dermatology department of Dell Medical School at University of Texas Austin, was planning on throwing a formal goodbye party. She will be moving away from her home state for the first time and does not know when she will see her family next. Maureen Ezekor, a student of University of Texas Medical Branch at Galveston who matched with dermatology at Howard University College of Medicine in Washington, DC, had originally planned for family from Dallas, Houston, and New York to come for her graduation. All of these plans have been canceled.Photo courtesy of Maureen Ezekor

When thinking about the future, a combination of fear, nerves, and excitement come to light. Ezekor says she does not know if she will be asked to begin early and wonders if the people training her and her peers may themselves be burnt out. Riddle says she fears contracting the virus and spreading it to other people. Kim said she even has resident physician friends treating COVID-19 patients who are currently writing personal advanced directives and updating their own last will and testaments.  

Charlie Katzmann, a medical student at the University of Michigan who matched with dermatology at the University of Iowa in Iowa City, will complete a transitional intern year in Chicago. He has a history of asthma that has not always been well controlled and wonders how this may impact his susceptibility to the virus. 

Erikson, an only child, worries about spending her intern year in Michigan away from her parents. 

“There is such a feeling of uncertainty each and every day…Hearing the news stories, the lack of protective equipment, it’s frustrating and scary,” Erikson said. “There are already so many anxieties about being autonomous for the first time. Now, this adds a new layer.”

Despite these fears, medical students are doing what they can to stay positive at home. Katzmann, who says he has always had a love of working on small projects, has been Photo courtesy of Charlie Katzmannbaking bread and started an indoor garden full of lettuce mixes, arugula, spinach, beets, zucchini, bok choy, and two types of radishes.

Ezkor, who currently lives with her grandmother, said she is enjoying spending more time on cooking and daily devotions. Kim has been able to help her parents, who do not speak English, apply for a small business grant for their restaurant Teriyaki Express. Riddle said she has been having Zoom meetings with friends, catching up on Netflix shows like Tiger King, and working on art projects. Mendes has enjoyed being able to spend time with her husband after years of doing long distance. And Fayne has started puzzles and is finishing up an online neurology clerkship. 

“It’s weird when friends ask me what I’m doing and I say ‘I’m at home with my family just like you,’” said Fayne, who will be staying in Miami for her intern year. “Soon I’ll be thrown into an acute stressful situation where I don’t know where things are, how to place orders, and so many other logistical things. But I’m anxious to get in there and get started.” 


Neelam is a medical student at the University of Michigan in Ann Arbor and a graduate student at the Columbia Journalism School in New York, NY.


References
1. Whelan A, Prescott J, Young G, Catanese VM, McKinney R. Interim guidance on medical students’ participation in direct patient contact activities: principles and guidelines. Association of American Medical Colleges. March 30, 2020. Accessed April 7, 2020. https://www.aamc.org/system/files/2020-03/meded-March-30-Interim-Guidance-on-Medical-Students-Clinical-Participation_0.pdf

2. Columbia medical students start COVID-19 virtual volunteer group. March 24, 2020. Accessed April 7, 2020. https://www.cuimc.columbia.edu/news/columbia-medical-students-start-covid-19-virtual-volunteer-group

3. Erickson M. Not yet able to treat patients, Stanford medical students help caregivers. Stanford Medicine News Center. April 3, 2020. Accessed April 7, 2020. http://med.stanford.edu/news/all-news/2020/04/medical-students-lend-a-hand.html

4. Langer J. Medical students babysit for health care workers aiding COVID-19 victims. The Lantern. April 1, 2020. Accessed April 7, 2020. https://www.thelantern.com/2020/04/medical-students-babysit-for-health-care-workers-aiding-covid-19-victims/

5. Dwyer J. One final step for 52 medical students, eager to join the fight. New York Times. April 6, 2020. Accessed April 7, 2020. https://www.nytimes.com/2020/04/06/nyregion/coronavirus-medical-students-early-oath.html

6. Neporent L. Coronavirus social: mourning colleagues lost to COVID-19. Medscape. April 7, 2020. Accessed April 7, 2020. https://www.medscape.com/viewarticle/928240

7. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. New Engl J Med. 2020;382(10):929-936. doi:10.1056/NEJMoa2001191

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