Second-year Harvard Medical School student Joshua “Josh” J. Ellis ’17 thought he would be delivering babies at this time in April.
When the first few COVID-19 cases appeared at Beth Israel Deaconess Medical Center — a Medical School teaching hospital — Ellis was in the middle of a surgery rotation. The rotation was part of Ellis’s Principal Clinical Experience: a full year of learning in the hospital for second-year Medical School students.
But after all students were pulled from clinical work due to concerns over the novel coronavirus, Ellis said his experience in cardiac surgery was postponed indefinitely, along with his forthcoming April and May clinical rotations.
Now, instead of completing his OB-GYN rotation, Ellis is finishing up his second year of medical school virtually. He said that for him and his classmates, the disruption has been instructive but profound.
“As medical students, our lives are pretty planned out for a long time, so everything is so routinized for us that it’s tricky when things get a wrench thrown into it,” Ellis said. “I think what we’ve learned and what we’ve realized is that it’s important to be fluid.”
Like students across all 12 of Harvard’s degree-granting schools, Medical School students have transitioned to online courses and, in most cases, moved off campus as the coronavirus pandemic escalates.
But unlike their peers in other parts of the University, these students have spent their time at Harvard studying and practicing the very medical scenarios the nation has seen unfolding during the COVID-19 pandemic. The illness has forced them out of the classrooms and hospitals where they had been training to become healthcare workers, just like their professors and supervisors currently working on the front lines.
Ellis said he recognizes that by the time he and his classmates enter the workforce, their medical training will not be as “cookie cutter clean” as students’ in years past.
“You know, I wish things were different,” Ellis said. “At the same time, I think it’s definitely been important to keep in mind that this is an unprecedented time, and no one really has walked this path before.”
In early March, fourth-year medical student Josephine “Josie” T. C. Fisher started a clinical rotation in the emergency department of Massachusetts General Hospital — another Medical School teaching hospital — to fulfill a capstone course requirement while she prepared to graduate in May.
At the time, the healthcare staff in the MGH emergency room was trying to figure out how to manage suspected COVID-19 patients, according to Fisher, whose arrival at the hospital coincided with that of the first few suspected cases at MGH.
During those early days, MGH put out scores of new policies and procedures “basically every single day” to protect the students working in the hospital, Fisher said.
“We were told immediately in the beginning, ‘Definitely don’t see anyone who is worried about having COVID,’” she said. “It got even more restrictive as time went on, which was totally understandable in their attempt to protect us.”
Students could not see patients who had coughs. As the hospital prepared for an anticipated equipment shortage, they were also barred from entering rooms that required personal protective equipment, or PPE.
After working in the MGH emergency department for only two weeks, Fisher found out that the Medical School was pulling all students from their clinical rotations — leading to the premature end of her final clinical experience as a medical student.
“I think we as students like to be super helpful, and we can play important roles, but we are non-essential personnel,” Fisher said. “Medical care can absolutely be provided without us there.”
Then, the Medical School announced that students whose residency programs needed them to start early would be allowed to graduate early. Fisher — who is staying in Boston after matching to the MGH internal medicine and primary care program — said her program has told its matched students they are “feeling appropriately staffed” so far.
While Fisher said she wishes she could help “right now” and “the best way I can” by getting involved clinically, she also acknowledged it was comforting that MGH was not pressed for resources.
“This to me is just very reassuring that I feel like we’re really lucky here in Boston, that we have these hospitals that are so well-resourced and well-staffed,” Fisher said. “It takes a lot to get us started as new hires, and so the administrative burden of that is a big barrier that they only want to have to deal with if it’s absolutely necessary.”
Along with the disruption of being removed from rotations or having career plans delayed, Medical School students say the disruption has also led to profound shifts in how they conceive of their roles as future doctors.
LaShyra “Lash” T. Nolen — a first-year medical student and the first black woman to serve as president of the Medical School’s Student Council — said in an interview that as students’ days change, she has taken time outside of class to think “on the level of social justice and equity” by considering the many “societal wrongs” the pandemic has revealed and exacerbated.
“I think we see this in who is dying from COVID-19 at rates disproportionately compared to others. And I think we see it in the fact that cashiers and folks who are carriers for the mail, they still have to work. Yet there are other individuals who don’t have to work, and they are able to work from home,” Nolen said.
“This has just really made me think even more deeply about injustice in our society and privilege and how that will impact my patients,” she added. “The pandemic has really exposed America for the unequal space that it is for a lot of people.”
Specifically, Nolen said the way the virus has impacted people of color is “absolutely unacceptable.” She believes working towards degrees in medicine and public policy will give her the tools to address this concern.
“I think that it’s important for me to be able to inform policy and change the rules of our society so that when something like this happens again, these communities have the power to to fight against it and to make sure that they have the tools and the resources to protect themselves,” Nolen said. “As of now, they are completely bare, and they haven’t gotten that support that they deserve and need.”
More broadly, Nolen said that as she continues her training as a medical doctor, the knowledge that doctors are not getting the protection they need during the pandemic will remain “heavy” on her heart and mind as hospitals across the country continue to report protective gear shortages.
“I think the fact that I have professors who are wearing the same PPE all day is absolutely unacceptable,” Nolen said.
“If this happens again, who is going to protect me? And who is going to protect the cafeteria workers and the janitorial staff and all of those individuals who are working alongside me when something like this happens?” she added.
National projects such as #GetUsPPE, a movement started by emergency medicine physicians, have sought to bring awareness to the need for more protective equipment in hospitals.
Third-year medical student Adam L. Beckman joined #GetUsPPE in mid-March, helping to turn the social media hashtag into a petition. That petition “snowballed” into a broader project to document the need for PPE and match groups that have PPE to those that still need it, Beckman said in an interview.
Beckman said he is also involved in covid19bill.org, a policy working group that has published recommendations for national legislation related to coronavirus.
“The recommendations did have, as we understand it, some meaningful impact in terms of what certain congressional offices advocated for, for the first and subsequent stimulus packages,” he said.
Inspired by these nationwide movements, Medical School students founded COVID-19 Student Response, a task force created to coordinate aid between Medical School students and hospitals, on March 15.
The team now has chapters throughout the country, according to its website. Its goals include supporting vulnerable populations and essential health staff, providing educational materials on COVID-19 for fellow medical students and the broader public, and aiding the clinical needs of hospitals through a student workforce.
Medical School Dean for Students Fidencio Saldaña said the “completely student run and directed” efforts have impressed and heartened him.
“This is really outside of the curriculum, outside of any faculty mandate or direction,” Saldaña said. “They’ve really taken it upon themselves to organize students to be able to contribute to the community.”
According to Medical School student Suhas Gondi, virtual efforts like #GetUsPPE, covid19bill.org, and the COVID-19 Student Response task force have inspired many students during a “scary time.”
But as a student who has completed nearly three of his four years at the Medical School, Gondi said he and many of his classmates believe they have enough experience with patient care to be helpful on the front lines. But the inability to join their mentors and colleagues in the hospitals can leave them feeling powerless.
“To be a medical student right now is to be simultaneously energized about the many things that you might be able to do to help out, but also frustrated and helpless about the ways in which we can actually materially contribute,” Gondi said.
Gondi said he has found a way to utilize skills from his clinical training by performing volunteer telemedicine for the Crimson Care Collaborative, a student-faculty collaborative clinic that provides primary care for greater Boston with several in-person clinics.
Though the clinics are now closed for in-person services due to COVID-19, many of the hospitals involved, including MGH and Beth Israel Deaconess Medical Center, are relying on medical and nursing students to reach out to patients who may potentially be infected with the virus.
Under the supervision of an attending physician at BIDMC, Gondi said he called a number of patients who had suggestive symptoms but whose cases could not be confirmed due to limited testing, checking up on them to see how they were handling the illness.
Gondi said the calls revealed to him the bitter reality of what the patients were experiencing. One patient he spoke with had been having symptoms for nearly a month and was still “feeling terrible,” mentally and physically, but had not been able to get tested.
“She was telling me about the progression of her symptoms, but what was so clear was the anxiety in her voice, and the feeling that she understood that tests were limited, and she understood that this is a pandemic that no one had prepared for,” Gondi said. “Even though she’s on the tail end of her illness, she really just felt like she needed an answer whether or not she had COVID.”
It was a “really tough” phone call for both him and the patient, Gondi said.
“It gives you a window into the anxiety and the toll that this pandemic is having on patients, even those who are not hospitalized, are not in ICU, but are safely in their homes,” Gondi said.
Correction: April 20, 2020
A previous version of this article incorrectly stated that medical student Adam L. Beckman referred to "congressional officers." In fact, he referred to "congressional offices."
—Staff writer Virginia L. Ma can be reached at email@example.com.