Discussion
In the standard 4-year medical school curriculum, the third year marks
the transition from preclinical studies into the clinical environment
full time. Medical students at this stage typically complete one year of
core clinical rotations through a variety of fields such as internal
medicine, general surgery, and pediatrics. In particular, the summer of
third year is a crucial time to take additional electives, form
meaningful mentoring relationships, and complete research endeavors
before the residency application deadline. These several months are
invaluable and allow undecided medical students to gather data and make
an informed decision about their future specialty. A sub-internship
during this time further increases exposure and allows for full
immersion into the rigorous resident training environment. For
competitive and specialized fields like otolaryngology, the above
experiences are invaluable for the applicant to successfully match.
As a surgical subspecialty, otolaryngology electives are only pursued by
a small minority of medical students per year. Physical restraints due
to COVID-19 will further limit medical students from taking month-long
clinical electives in the field. And, while otolaryngology is an ever
evolving and growing discipline, smaller institutions or those located
in rural regions may not have a home otolaryngology program to allow for
adequate exposure to the field. Students coming from such institutions
may be disproportionately affected especially due to the travel
restraints and social distancing precautions. Furthermore, away
rotations at different institutions typically help students distinguish
and choose their residency program based on preferred geographic
location, program size, on-call responsibilities, teaching methods, and
a sense of the whether a program is a good fit for them. Given the
uncertainty and progression of the virus at the time of publication, it
is plausible that such experiences may not occur during the 2020-2021
application cycle.
As a result of the pandemic, a significant number of students may not
have the opportunity to learn more about otolaryngology. The ideal
solution to promote student engagement and interest within the
constraints of COVID-19 should include both the opportunity for
scholarship and clinical application. The rapid emergence of
telemedicine and teleteaching may hold the key to this solution. One of
the advantages to videoconferencing is widespread accessibility and
flexibility, allowing learners from distant institutions and locations
to participate. Teaching techniques such as the flipped classroom
approach or blended learning are easily applicable to videoconferencing
and have been found to be effective.3–5 Students
could potentially enroll in a structured virtual clinical elective. A
curriculum could be created that includes selected readings and surgical
videos from sources like the American Head and Neck Society,
otolaryngology journals, and YouTube. An assigned attending can then
discuss the videos and readings with the student. Students can also
participate in resident didactics, grand rounds and tumor boards
virtually. Suture materials can be distributed to allow students to
practice knot tying and techniques, which can be reviewed by the
attendings or residents. Students can also be given a research project
that they can complete even after the rotation is finished. Lastly,
opportunities for weekly mentorship meetings could be established, which
could be an ideal platform for meaningful discussion and advice.
The obvious challenge and drawback is the inability to provide genuine
patient interactions. Creating and using available virtual cases can
promote critical thinking and increase clinical exposure, but there
still remains a scarcity of opportunities for patient interaction
especially in a surgical setting.