COVID-19 vaccination clinics are being added at additional locations across Tarrant County, and officials are encouraging residents to register online for an appointment.
Tarrant County Public Health maintains an online portal that allows eligible residents to easily register for a no-cost vaccine for residents with or without health insurance. Tarrant County Public Health will determine if you qualify for a vaccination and then send an email, text message or phone message regarding upcoming appointments.
Quantities of the coronavirus vaccine are expected to increase over the coming weeks as manufacturing and distribution ramp up. Residents are encouraged to preregister on the website now so that Tarrant County and its partners can better plan for and distribute the vaccine.
Currently, anyone 50 and older, as well as school and licensed child care personnel, are eligible to receive a vaccination. Anyone more than 18 years old with chronic health conditions is also eligible. The Texas Department of State Health Services has information on the criteria used for vaccination priority on their website. You can also find a list of other vaccination locations throughout the state on their website. It is anticipated that everyone will be eligible very soon, so even if you are not currently eligible, it’s acceptable to register now.
Fort Worth Health Officer and Code Compliance Director Brandon Bennett emphasized that people should not visit one of the clinic sites without an appointment. “By registering on the Tarrant County portal, it not only gets your name in the queue for the vaccine, it also helps us plan for future locations for vaccinations,” Bennett said.
People who show up without having used the online portal to make an appointment will be turned away, he said.
Susan Rudd Bailey, MD, TMA past president and current American Medical Association president, will serve as honorary chair of the TMA Foundation’s virtual gala, Superheroes: Meeting the Challenge, which is scheduled for Friday, May 14, 2021, during TexMed 2021, TMA’s annual meeting. The gala helps make TMA’s population health, science, and quality of care programs possible.
“Clearly the COVID-19 pandemic has called on physicians like no other threat has in our lifetimes,” Dr. Bailey said. “It’s with great pleasure that I join the TMA Foundation gala to recognize and celebrate the courage physicians have shown because of their singular dedication to the health of their patients.”
Dr. Bailey is an allergist in private practice and has been with Fort Worth Allergy and Asthma Associates for more than 30 years. She has a long history of service in organized medicine, having served as TMA vice speaker and speaker and as board chair and president of the Tarrant County Medical Society.
“Please join me, the gala-co-chairs, and the TMAF board by attending this virtual gala, which comes at a time when we need to remain strong and follow where the science leads us. The continued strength and resolve of our physician heroes is needed to see us to the very end of this pandemic,” Dr. Bailey added.
TMAF’s gala will take place as a virtual event from 7 to 8:15 pm (CT) Friday, May 14, with a preshow from 6:30 to 7 pm. It will feature a silent auction, special messages to the health care superheroes in Texas, entertainment from Austin musicians, a party Box for guests and more.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Thursday, March 18, 2021.Find more COVID-19 information from TCPH here.
*These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
Originally published in the January 2021 issue of the Dallas Medical Journal. Reprinted with permission.
There is a prospective optimism that a new year brings allowing a “start over” positivity that helps our collective need to shed and renew. Yet, before we burst out the Champagne, we should process how we got here as 2020 may well have been the most challenging year of our lives, with enough despair, wounds, and wisdom, such that we are Turning 2021, metaphorically speaking, of course.
We have been in the grips of a worldwide pandemic that has upended our personal and professional lives. Our nation’s soul lays bare amidst a fight for racial equality. As the pandemic rages on, our mental health has continued to take a hit. The chronic exposure to stress is causing a variety of issues. The uncertainty, lack of sense of control, and alteration in our values and routines have given way to anxiety. The successive, unexpected changes brought on by the pandemic have also been underscored by a series of losses—our jobs, how we work, our children’s routines, travel, finances, gathering with family and friends, and simple pleasures like eating out and entertainment. This sense of loss over life as we knew it has been a chief driver of depression. When attempting to suppress severe wildfire, there is a possibility for firefighting crews to be overrun by wildfire, known as entrapment and burnover. There are many metaphors that come to mind when we consider the toll of 2020 on our mental fitness. Move over burnout. We are suffering from burnover.
Turning 2021 might not feel like a moment to see the glass as half full, but a critical step towards restoring mental fitness, and a favorite tool in the psychiatrist’s toolbox, is perspective taking. This is not meant to minimize the harsh reality of an incredibly difficult 2020 with Pollyannaish optimism. Many of us have lost loved ones, friends, and colleagues. We are sad, frustrated, and exhausted. But as we reflect on 2020, taking stock of the losses and triumphs, there were unmissable silver linings:
Creativity Amidst the suffering, we witnessed heights of human spirit and ingenuity. Rising to the clinical and logistical challenges, we put on our problem-solving caps to make the most of a limited supply of Personal Protective Equipment (PPE), ventilators, and medications. When our hospitals reached capacity, we built makeshift hospitals and converted concert centers into giant negative-pressure rooms. We served our patients to the best of our abilities, embracing the steep learning curve and ever-changing guidelines and information on COVID-19. We held our patients’ hands to give them a dignified sendoff when their loved ones could not be there in their last moments. Our creativity wasn’t just limited to our professional lives; In addition to doctor, we added teacher, caregiver, coach, and other roles to our credit.
Technology We went virtual. Sure, we went from one online meeting to the next and had to scramble for a bathroom break, but we found a great way to safely connect with our patients, parents, friends, and each other. When we ached for culture, we brought Hamilton, the Metropolitan Opera, and concerts streaming home. We virtually toured cities and world class museums, studying art masterpieces, closely zooming in and out.
We flexed our tech muscles and found other convenient ways to bring the comfort of nourishment and shopping for essentials to our doorsteps. It took a few months to get the hang of it, but we joined online gyms and live workout classes from home.
Our internet bandwidth made it possible to meet the combined needs of work from home, telemedicine, online school, and a dozen devices streaming online platforms simultaneously. We concurrently admired and doom-scrolled the Institutional and governmental COVID-19 data repositories. Most importantly, we had real time information about this pandemic on our fingertips, (at times—perhaps too much information).
Community We learned that gratitude and grief can coexist. Our circles got smaller by necessity and we became intentional about our connections, out of which came bonus time with family and pets (and plants). Without our usual external outlets and distractions, we turned inwards and made time for introspection. We came upon unexpected opportunities for nourishment—we took up new (and old) hobbies, games, books, podcasts, yoga. We made a commitment to support struggling local and small businesses. Even if the presidential election of 2020 delivered a powerful referendum on how divided we stand, we found ways to unite over popular fads and shows. We developed new coping skills, and when these were not sufficient, we leaned on our colleagues, family, and friends for support. Meanwhile, our scientific community also embraced the challenge of 2020 with a promise of a vaccine, which has been developed in record time.
Priorities There’s nothing quite like a pandemic to make us reevaluate our priorities. As physicians, we (finally) learned to say no as self-care became more critical than ever. We watched a third of the country burn in wildfires and came to appreciate the profound impact of our choices on our environment. A discussion about Turning 2021 would be entirely remiss without acknowledging the pandemic of racial oppression thrust into the forefront in 2020. The intersectionality of COVID-19 pandemic and social determinants of health has been underscored by the disproportionate and devastating impact of the pandemic on black, latinx, and indigenous people of our nation. So, we committed ourselves to the task of self-examination and intentional antiracism. Out of activism came a commitment to change for the better with more progress on equity and justice.
If 2020 was the ultimate exercise in improv, we gave a performance worthy of cheers and ovation. Even so, 2020 was especially stressful for doctors as we were stretched beyond our capacities in all spheres of our life, all at once, and for far too long. Published research on the impact of the pandemic on health care workers in the U.S. is limited at this point, but the data from China, Italy, France, and other countries impacted by COVID-19 earlier on in 2020 are telling. As a volunteer psychiatrist for the Physician Support Line, a free and confidential peer phone support helpline for struggling physicians and medical students, I have heard countless stories of physicians and medical students, I have heard countless stories of physicians who endured a risky, exhausting, and demoralizing milieu for much longer than the human body and mind were meant to tolerate—all the elements of not just burnout, but anxiety, depression, post-traumatic stress disorder (PTSD), substance use, and much more.
In his seminal book on trauma and its effects, The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma, Dr. Bessel van der Kolk discusses how trauma and chronic stress rearrange the brain’s wiring— specifically areas dedicated to pleasure, engagement, control, and trust—in a process known as neuroplasticity. The human response to psychological stress is one of the most important public health problems, and doctors are especially susceptible to it because of the nature of our work and the long hours, only compounded by the pandemic. Many of us are Turning 2021 psychologically wounded, exhausted, and mentally exhausted.
Taking stock of 2020, Turning 2021 mentally fit might seem like a lofty goal. Fortunately, there are evidence-based strategies that can help us ameliorate the impact of chronic stress as we pursue our goal of mental fitness in 2021.
Recalibrate “normal” We have endured a collective trauma in 2020 that has given way to a crisis of meaning. The chronic stress might make you feel irritated, impatient, angry, sad, and you might experience feelings of disconnection, difficulty concentrating, and a range of other cognitive effects. You might also be navigating anxiety, depression, or fatigue. These are all perfectly human, adaptive responses during such a difficult time.
● Welcome and honor the full spectrum of emotions that make you human, because they are here to teach you important lessons about your triggers, coping skills, and current emotional state.
● Practice Self-compassion – as physicians, we have several personality traits that lead us to pursue careers in medicine, including perfectionism and self-denial. While these traits can serve us well in doing our clinical work, they also give way to unrealistic personal and professional expectations, including denial of personal vulnerability. Some days your best IS enough. You are a doctor, but you’re also human. Acknowledge and accept your vulnerability.
● Seek Help – part of recalibrating normal is to also normalize seeking help. Extraordinary stresses cannot be overcome with ordinary measures. Although we all have the ability within us to heal, we sometimes need support in the journey to self-realization and optimal mental fitness.
Reflect and release Unprocessed traumatic memories and stress can become sticking points that cause our mental and physical processes to suffer. As such, it is imperative that we reflect inwards and take intentional steps towards improving our mental fitness. The journey to recovery can be slow, intentional, and at times, uncomfortable, yet, immeasurably rewarding. As with any form of recovery, the first step is acceptance. ● Give yourself the permission to grieve the many losses of 2020, including loved ones, colleagues, and even your routines. This isn’t always at our forefront, but in addition to attachments to other people, we also develop powerful attachments to our work, things, and places.
We know that neuroplasticity and trauma go hand in hand. Just as traumatic events can forge neural pathways, so can positive and effective therapeutic experiences that help us cope and heal. The psychiatrist’s toolbox is equipped with evidence-based strategies to help you navigate this journey.
● Psychotherapy – if anxiety is the worst use of the imagination, psychotherapy helps us reestablish psychological safety and dial down the trauma response. There are numerous evidence-based therapies to help address anxiety, depression, and burnover, such as Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, psychodynamic psychotherapy, and Mindfulness-Based Stress Reduction. The undertaking of knowing oneself might be the most challenging yet rewarding experience of one’s life, with lasting results. In fact, suffering often brings with it the opportunity that drives emotional growth for a more mentally fit self. As with anything worthwhile, this process requires time and commitment.
● Medications and more – we enter the medical profession with many underlying vulnerabilities, including personal and family medical and psychiatric history, chronic stress from childhood, personality factors, social determinants of health, and much more. Moreover, the stress from medical training is associated with systemic inflammation, telomere shortening, and oxidative stress, findings which have often also been reported in major depression. Antidepressant medications, in particular, are associated with not just mood recovery but also recovery from oxidative stress on a cellular level. There are also several medication and non-medication augmentation strategies that can help you with your mental recovery. Most importantly, a good psychiatrist can blend psychiatric medication management and psychotherapy while empowering you with skills for self-management over time.
If the body keeps the score of chronic stress, then the symbiotic relationship between the mind and body becomes a critical target for recovery.
● Mind-Body strategies – we all know the benefits of exercise as a healthy coping skill to build our mental and physical fitness. However, when we are exhausted, the last thing we might want to do is run laps around the neighborhood with a mask on. Fortunately, recovery from stress does not require us to train like an athlete. In fact, routine, less intense activities, such as walking a pet, doing the laundry and dishes, gardening, and washing your car can be just as effective and give you a sense of accomplishment. One of the best strategies to facilitate traumatic release from the body is to engage in an intentional, slow, and mindful activity like yoga, which you can easily access over the internet from the comfort of your living room.
If you’re suffering from burnover from another discussion about mindfulness, you’re not alone. I had similar skepticism about mindfulness when I first took the eight-week Mindfulness Based Stress Reduction (MBSR) course. In fact, around the third week, I recall being quite frustrated with the process of completing the same body-scan meditation every day for an hour or more, but I stuck with it. Around week six, a sense of calmness came over me. My movements and actions became more intentional and I felt less exhausted, without any change in the rigor of my clinical schedule. My relationship with nourishment also changed as I learned to chew my food instead of my thoughts, which saved me precious mental energy to devote to other aspects of my life. When I wavered from this intentionality, I returned back non-judgmentally to the task at hand. One of the greatest misconceptions about mindfulness is that it helps us fight distressing thoughts. Quite the contrary, mindfulness allows us to change our relationship to the distressing thoughts that are a part of living.
Reimagine “Work” As physicians, our careers have been shaped by the expectation of conformity married to the assumption that resilience and professionalism are in endless supply, particularly during a pandemic. Fittingly then, 2020 has been the ultimate test of our professional status quo. While the long hours and medical culture might make it seem that your personal identity is inextricable from your professional one, this is a perfect recipe for burnover. Along with recalibrating normal, Turning 2021 mentally fit requires that we reimagine work as an extension of what we do, rather than us as an extension of who we are. You are a person with many gifts, values, dreams, and talents, and one of them just happens to be being a hard-working doctor. This could be a variety of things, including spirituality, advocacy, mentorship, leadership, and other activities outside of your profession. Also, as much as possible, release yourself from the myth and burden of multitasking. Focusing on one task at a time and being mindful of the task at hand will improve your concentration and help you to be more mentally fit. Spreading ourselves thin depletes our battery faster than working on tasks individually. Like any of your devices, the more programs you have running simultaneously, the harder it is on the system. It is the same for our body and mind.
Reclaim Joy Mental fitness is not merely the capacity to endure, but also the capacity to recharge. Most of us forget the latter. Take the time to slow down and explore other aspects of life that fill your bucket and keep you mentally fit. Recreation, humor, daydreaming, connection with nature, your partner’s touch, and the simple act of doing absolutely nothing at all can all be ways to recharge your mind. Rather than spending your time on passive activities like binge watching shows, find a book or a podcast that teaches you something new. Monitor your screen time and disconnect digitally to give your mind a digital holiday. Be it while on a walk around the neighborhood or on your walk from the parking lot to your office—put down your phone, pull down your mask and stop to smell the roses. New experiences and new ways of doing old things can also set you on the path to mental fitness.
Most of all, remember that mental fitness is not a checkbox, it’s a moving goalpost practiced over time with intentionality. If at first you fail, get up and try again. And again. And again. Join me in the commitment to turn 2021 happy, healthy, and mentally fit!
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Tuesday, March 16, 2021.Find more COVID-19 information from TCPH here.
*These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Tuesday, March 9, 2021.Find more COVID-19 information from TCPH here.
*These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
The vast majority of Texas physicians agree that the prior authorization process is burdening your practices and hurting your patients. Now is the time to tell your story.
TMA is lobbying on your behalf this legislative sessions. Equip them with your nightmare prior authorization stories so they can tell legislators the real, serious complaints of their constituents.
Please submit your stories via TMA’s secure email portal as soon as possible.
“Physicians already know all too well the burdens and harm that can occur when insurance company impose prior authorization requirements,” TMA President Diana L. Fite, MD, said. “Our lawmakers need to do more to make sure our patients get the medicines, tests, and treatments that they need, when they need it.”
Share your stories to defend your patients and your profession.
A reminder as you submit your story: It is important for you to ensure that your submission complies with state and federal laws, including, as applicable, the HIPAA privacy rule. HIPAA’s safe harbor list of 18 de-identification requirements is available here.
This piece was originally published in the January/February issue of the Tarrant County Physician. You can read find the full magazine here.
Dr. Bailey presented this speech at the AMA’s House of Delegates on November 13, 2020.
In my inaugural address to the AMA House of Delegates in June, I talked about how a hero’s journey is symbolic of the journey we walk as physicians.
Our journey starts with a moment of inspiration to pursue Medicine. We find a mentor to show us the way. We encounter struggles and hardships before emerging stronger and more resilient . . . forever changed by the experience.
Few times in history have we embodied the hero’s journey like we have in this past year. In June I talked about Harry Potter, Star Wars, and The Wizard of Oz . . . but much of the last few months have felt more like the dystopian world of The Hunger Games.
COVID-19 has brought immense challenges and pain for so many—including our physician community. We have struggled mightily at times. Many of us know a colleague who lost their life to COVID-19. Many of us have fallen ill, or we have watched a family member or loved one battle the virus.
We have done things in 2020 that we could not have imagined . . . shining a spotlight in an uncomfortable place—on ourselves—as we repeatedly cried out for more protective equipment to keep us and our patients safe.
For the financial aid to keep our struggling practices afloat.
For the information and resources to make sense of it all. To provide counsel for our patients. To better understand what we were up against.
As we greet the new year 2021, the pandemic feels a little different now.
We don’t know if it is the end of the beginning . . . or the beginning of the end. But we are a bit wiser and a bit tougher than before.
“As with every hero’s story, we must learn from the trying times we have experienced. We must grow and move forward because that is what a hero is asked to do. “
We don’t know everything about the journey ahead, but there is plenty we do know.
This year has shown us the best in physicians and our health care community—the nurses, assistants and staff personnel who are always by our side.
Who are in the trenches with us even in the most difficult of times . . . and that understand the importance of physician-led teams.
But this year also has revealed how politics can be corrosive . . . how misinformation and anti-science rhetoric can impede our ability to respond in a health emergency and can magnify the cracks and inequities in our health system.
Nine months into our fight against COVID-19, the pandemic is as dangerous as ever. We have reached record highs and surges continue across the country.
We have learned in this most difficult year that no person and no community is safe from this virus. It reaches everyone . . . no matter their background, their income, or their politics.
And yet, in face of this pandemic—perhaps the greatest threat to public health in our lifetimes—physicians have heroically answered the call.
Time and again, through surges and plateaus, working under intense pressure and at great personal risk, our physician community has risen to the challenge of this moment.
We have done this with courage and with selflessness because of our singular dedication to our patients’ health.
And now, with a new year ahead and possible vaccines on the horizon . . . we are about to make a fresh start. Change is in the air.
Never again can we allow the politics of division to undermine our ability to deliver the very best care to our patients.
Never again can we allow anti-science bias and rhetoric to undermine our public health institutions . . . and discredit the work of physicians, scientists, and researchers.
Never again can we allow a campaign of misinformation and disinformation to co-opt conversations around public health . . . and sow divisions that only serve to prolong the suffering of so many.
Never again can we allow public health officials to feel the pressure of threats and intimidation simply for doing their jobs.
And especially when lives are at stake, never again should physicians have to fight a war on two fronts—caring for severely ill patients in a raging pandemic . . . while at the same time battling a public relations war that questions the legitimacy of our work and our motives.
This is unacceptable . . . and we will not and cannot continue to work in this atmosphere.
While we have seen the best of physicians in 2020 . . . we were reminded again of the power of the AMA, the TMA, the TCMS, and of the entire Federation community working on our behalf and being our voice when it mattered most.
Our organizations created tools and resources—all grounded in credible science and evidence—to help us respond to this historic crisis.
We pushed the administration to accelerate production for testing and PPE. TMA and TCMS kept our practices supplied with life-saving equipment.
Our medical organizations helped establish a financial lifeline for struggling physician practices, securing tens of billions of dollars in financial support, grants, and interest-free loans to infuse practices with much-needed capital to survive this pandemic.
Organized medicine was a leading national voice in support of science, evidence, and data as the surest path through this pandemic, launching a major public health campaign to encourage everyone, everywhere to “Mask Up.”
All of us should be proud of how organized medicine has stood up for physicians this year.
As with every hero’s story, we must learn from the trying times we have experienced. We must grow and move forward because that is what a hero is asked to do.
That is what physicians are expected to do.
That is what we expect of ourselves.
All of us are eager to see an end to this pandemic. And with encouraging new reports about vaccines nearing approval, there is tremendous excitement about what the new year will bring.
But we are not there yet. All of us need to continue to do our parts. We need to constantly remind everyone to wear masks, wash hands, and physically distance. We need to remain steadfast and focused until the very end.
We should not underestimate the fight in our opponent. Every time we feel like we have COVID-19 on the ropes, here and abroad, we see it roaring back.
We have to remain strong and follow where the science leads us.
The next few months will be buzzing with anticipation about the post-COVID world that will emerge.
Regardless of when that day arrives . . . and when normalcy returns, whatever that will look like . . . our AMA, specialty, state, and county societies will play a critical role in shaping the health system of the future.
A system that ensures that everyone has access to the affordable and meaningful coverage they need.
A system that relies on science, evidence, and data to guide our approach to public health and prevention.
A system free of the historic barriers to care . . . and ensures that all patients stand on equal footing.
A system that supports and integrates a revitalized public health infrastructure.
A system that protects the patient-physician relationship from outside influence at all costs.
And a system that prioritizes physician health and wellness . . . and eases administrative burdens that take us away from what we do best . . . caring for our patients.
Despite the challenges of this past year, and they have been extraordinary, I continue to believe in the power of organized medicine to fix the persistent problems in our health system.
I believe in science and evidence to light our way.
And I believe in the strength and resolve of physicians to take on any challenge . . . and rise to any moment.
The hero’s journey is our journey. And we are exactly where we are meant to be.
This piece was originally published in the January/February issue of the Tarrant County Physician. You can read find the full magazine here.
I can brag on myself as I have been involved with medical education for over 40 years now. Thirty-seven of those years were spent working as an assistant and then an associate professor of medicine at the Texas College of Osteopathic Medicine (TCOM) within the University of North Texas Health Science Center. I was the first full-time gastroenterologist there. I left private practice in Dayton, Ohio, where I was adjunct faculty at the Ohio University College of Osteopathic Medicine. I wanted to be more involved in medical education than that position offered. So why am I telling you all this? So you know that I have been around a long time and have seen a lot of changes, including monumental ones in medical education, from the classroom to clinical bedside clerkships.
UNTHSC developed an Academy of Medical Educators where physicians, other health care providers, and basic scientists at TCOM have learned and discussed the theories and principles of medical education including Bloom’s educational approach and Miller’s framework for assessing clinical competence.
After we learned the fundamentals, we now concentrate on other aspects of medical education. One of the of most significant changes that has transformed how we educate is that we no longer “lecture.” Indeed, it is now considered a four-letter word—lecturing is seen as passive learning. Also gone are reading assignments from textbooks. Other forms of education now rule the roost. This includes online education and interactive forms of learning.
So, what is so wrong with textbooks? About 10 years ago, I read a letter to the editor in the New England Journal of Medicine, where two second-year UCLA medical students calculated the total number of pages assigned by instructors for one semester. A staggering 10,000 pages were assigned and were fair game when testing occurred at the end of the semester. Too much? Yes!
A recent Google search stated the doubling of medical technology in 1950 was 50 years, in 1980 seven years, in 2010 three and a half years, and in 2019 one and a half years. Now in 2020 it is 73 days; not even three months. I recently told this to a fourth-year medical student on my service and as his eyes widened, he exclaimed, “That’s scary!” So, to revisit what is wrong with textbooks, here it is: The editors work with other experts to write a designated chapter, all work is edited and corrected, it is then published, printed, distributed, and purchased, etc., etc. This whole process takes years. So how many times has medical technology doubled in that time frame? Educators still refer to textbooks, but as references, not as primary education material.
A man walks into a bar in New Orleans and asks for a Corona and three hurricanes. The bartender hands him the bill—$20.20. Yes, the COVID-19 pandemic has changed things, possibly permanently. Virtual medical education is the current modus operandi. Zoom, WebEx, Skype, and Join.me, to name a few, are the classrooms today. Right now, learning clinical skills is generally virtual. Inconceivable but true—not hands on but virtual patients. Not entirely new, just brought to the forefront due to the pandemic.
Over the past several years, the lecture (that four-letter word again) hall has been sparsely filled unless attendance is mandatory, as some medical schools still do require, or if an in-person quiz is on the schedule. Before attendance began to drop, medical educators made the classroom an interactive session and the iClicker was used to respond to questions. However, with Power Point presentations now online before the lecture is given, and voice over with the Power Point, why go to the lecture hall? Pull up the Power Point whenever you want, play it at 1.5 to 1.8 speed, and listen to it twice. The thought is that the classroom is wasted time, and you avoid being called on in class.
There is still in-person training. I teach in the second year, which includes small group sessions called Clinical Reasoning Modules (CRMs). In the CRMs, about eight to 10 students are presented with clinical cases by a moderator who leads the discussion on history, physical, labs, imaging, etc. The model used is a version of clinical reasoning called a “mind map,” and it stresses differentials and necessary testing and imaging. Grading is based on participation. As the “clinical expert,” I rotate to all the small groups and answer questions. This is where I get to meet students I have never seen before.
So, if there are no textbooks or lectures, what do the students do to prepare or to learn? Good question! Instead of scheduled lecture time, regular time is scheduled during their day to “study.” Faculty prepares Directed Student Activities (DSAs). The DSAs include society guidelines, videos, online sites like Up To Date and more. Here textbooks are listed, usually as reference rather than test material. As you can imagine, the students are very resourceful and tell me about sites they find on their own that support their learning process. The list I have been informed about and use to refine my DSAs are Baby Robbins, Pathoma, First Aide, Sketchy Medicine, Get Body Smart, Picnomics, and Hardin MD. As you can imagine, the time spent by faculty to screen all these sites is overwhelming. Since our curriculum is problem-based, symptoms or problems are the topics of our DSAs. Since I am a gastroenterologist, my topics are abnormal liver chemistries (not called LFTs anymore), nausea and vomiting, dysphagia, GI bleeding, constipation, diarrhea, and so forth. Can you imagine the time needed to condense these topics into DSAs that are current and learnable using this format?
I have been around a long time and seen a lot of changes, including monumental ones in medical education, from the classroom to clinical bedside clerkships.
To worsen the situation, clinical clerkships have been adversely affected by the pandemic. Many institutions banned medical students from direct patient contact, and in some instances, from entry into hospitals or surgery centers. Virtual patients were used to teach clinical skills devoid of in-person contact or interviewing. When will they get to see patients in person and learn bedside and in-office clinical skills? Who knows with the recent COVID-19 surge. Some have learned telehealth clinical care, which in some cases may be here to stay. Recent legal issues about student participation in clinical care have also started to cloud the problem. How will all this impact future clinical skills?
So, all these issues in medical education will indeed have an impact on health care. Medical educators have their work cut out for them in the new learning environment compounded by a seemingly never-ending pandemic. Not only are medical students educated to pass boards and clinical competencies, but to become lifelong learners. They must learn without DSAs and with doubling of medical technology every several months. When do they learn cost restraints, physical exam, and other competencies?
I know that this essay is called the Last Word, but this is hardly the last word on this topic. Hold on to your hats—this is a new world. Who knows what the new normal will be? As for me, the Last Word is that knowledge can be communicated, but not wisdom.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Tuesday, March 2, 2021.Find more COVID-19 information from TCPH here.
*These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
Tarrant County Physician Online 