A series of briefs by the Texas Medical Association’s Medical Student Section
By: Ammie Rupani and Alwyn Mathew
In 2019, 18% of Texans had no form of health insurance.1 650,000 Texans have lost their health insurance due to unemployment during the pandemic. The rate of uninsured Texans is staggering and has only been worsened by the pandemic. During this critical time, we must talk about Medicaid Expansion and the potential solutions for millions of people with no health insurance. As a medical student, I have seen patients defer life-saving medications such as insulin in order to afford rent or groceries. Consequently, these choices have brought such people to the Emergency Room in diabetic ketoacidosis, which could have been easily avoided with regular insulin treatments. Stories like this are far too common in Texas, and it is important to recognize such outcomes are easily preventable with improved access to health insurance coverage. How can we as students learn to treat people, when the system we are bound to practice in is perpetuating their very diseases?
Medicaid is a health insurance program managed through the Federal Centers for Medicare and Medicaid Services (CMS). Medicaid is currently jointly funded by the Federal and State governments with the Federal government matching each dollar the State spends. Texas Medicaid is primarily a fee-for-service model that has poor reimbursement rates and high administrative burden that discourages physicians from accepting Medicaid in their practice. Currently, Texas Medicaid coverage is only offered to children, pregnant women, seniors, and people with severe disabilities, who also fall below a certain income threshold. For example, a single mother making minimum wage at her full-time job is not eligible for Medicaid because she earns too much. However, she does not qualify for Federal subsidies covering some of the insurance cost because she does not earn enough. The Patient Protection and Affordable Care Act of 2010 would help address this woman’s dilemma since Medicaid Expansion would cover all individuals with incomes up to 138 percent of the Federal Poverty Level, amounting to $16,643 for individuals and $33,948 for a family of four. Medicaid Expansion would provide a health insurance option to an estimated 2.2 million uninsured low-wage Texas adults.2
Although the original arguments against Medicaid Expansion in Texas focused on States’ rights and limiting Federal dependence on funding, the primary opposition to this program was the Federal mandate. In 2012, the US Supreme Court ruled that the Federal government could not mandate the Expansion of Medicaid in any State, leading to Texas and several States opting out of the program. Realizing the benefits and improvement in health outcomes, several States have since adopted the Expansion program offered through CMS, including Arkansas (2014) and Louisiana (2016). Currently, Texas spends nearly $40 billion (State and Federal funds) for the Medicaid program, with a 60-40% distribution between the Federal and State Government respectively.3 Expansion would be fiscally sound for Texas as it will reduce the strain on our State budget and draw in more Federal resources. Looking past the dollar amount, it is crucial that medical students and other healthcare professionals recognize the benefits of improved access and early medical intervention that can be achieved through Medicaid Expansion.3
TMA’s Legislative Recommendations4
Develop a meaningful, statewide health care coverage initiative using federal dollars to:
Extend meaningful coverage to low-income uninsured working-age adults, and
Establish a state-administered reinsurance program to reduce premiums for people enrolled in marketplace
Provide 12-months’ comprehensive coverage for women who lose Medicaid 60 days
Establish 12-months’ continuous coverage for children enrolled in Medicaid, the same benefit given to children enrolled in the Children’s Health Insurance Program.
Accounts TCof P. Uninsured Texans. Retrieved from- https://comptroller.texas.gov/economy/fiscal-notes/2020/oct/uninsured.php
A series of briefs by the Texas Medical Association’s Medical Student Section
By: Elleana Majdinasab and Rishi Gonuguntla
Medicine has its unspoken mores, does it not? Certain specialties are notorious for their personalities, and the idea of foregoing food and sleep are deemed signs of strength and resilience. Upperclassmen advise against getting in Dr. X’s way, lest you become subject to a tailored diatribe, and you hear whispers of Dr. Y’s career-crushing evaluations. Your roommates do not bat an eye over your tears every evening, because chances are they are no stranger to such days themselves. It doesn’t require a detective to identify that the above are the direct result of mistreatment in medical school.
Per the AAMC, mistreatment occurs when there is a show of disrespect for another person that unreasonably affects the learning process. Public humiliation and belittlement by doctors are the most common forms of mistreatment in medical school.1 The practice of aggressive “pimping,” or the act of doctors disparaging students for not knowing information, potentially in front of patients or fellow classmates, is a phenomenon too many medical students needlessly experience.2 Other examples of mistreatment include the shaming of students for asking questions and being subjected to offensive names and remarks.1 According to one 2014 study, over three-fourths of third year medical students reported being mistreated by residents, with over 10% of those responses citing recurrent mistreatment.2
Given the omnipresence of these events, one may consider whether there exists a common denominator among guilty attending physicians. Indeed, mistreatment of medical students can occur secondary to a multitude of reasons. Physician burnout is still rampant as ever, and ironically, often occurs partly due to the same toxic culture attendings themselves experienced as budding residents.3 The doctors in question blissfully perpetuate the cycle, humiliating and pimping, justifying their behavior with the mentality of, “I went through it back then and turned out just fine.” Thus, the vicious cycle continues. What doesn’t kill you makes you stronger, right?
As medical students, we are quietly told by the older and wiser to improve our resilience – to grow tougher skin. We are advised to expect, or even welcome, microaggressions and impatience from our superiors while we work toward our lifelong dreams.4 We take deep breaths and smile through the jabs because we are fully aware of the consequences of speaking out against the deeply ingrained practice of mistreatment.4 Mistreatment in medical school matters because doctors eating their young further propagates the toxic reputation of the career’s culture while contributing to the development of many future doctors’ unhappiness.3 It is the accumulation of years of pressure, competition, and negative experiences that leads to feelings of burnout in students and physicians alike.5 Even worse, medical students act on these feelings, and they are three times more likely to commit suicide than their similar-aged peers in other educational settings in the general population.6 The hazing of medical students is in no way constructive or beneficial to anybody involved. Stress and toxicity in the learning environment prevents students from being themselves and asking questions, thus damaging their confidence during the formative years of their training.7
Even more alarming is that mistreatment is more commonly directed towards minority students, including female, underrepresented in medicine, Asian, multiracial, and LGBTQ+ students, than it is toward their white, cis-gendered, heterosexual, male counterparts.8 In the same vein that we encourage and recruit people from minority communities to join medicine, we must be aware of the potential mistreatment they will experience and take clear, targeted steps to protect them. If we, as a community, fail at this task, then we are complicit in perpetuating the systemic inequities and inequalities that are currently prevalent in medicine.
The reality is that the culture of medicine doesn’t have to be this way. It is certain that mistreatment has been inadvertently ingrained within the culture of medical training, so attempting to address this problem feels daunting. There is a current lack of literature regarding what interventions successfully reduce mistreatment, but introspective analysis yields some steps we may take in an attempt to slowly chip away at the current social infrastructure.9
First and foremost, students must realize and acknowledge the negativity they have been subjected to is not ‘all in their head,’ but instead a universal and rather unfounded experience. The next step is to seek support from classmates, friendly administration, and trusted professors and physicians who can provide guidance and vouch for students’ justice. Addressing mistreatment is at its core a collaborative effort, as we cannot expect only the bravest, most outspoken students to carry this initiative to fruition. Each and every person in medicine can enjoy a role and responsibility in this endeavor. School administrations can create interventions aimed at educating faculty and students about recognizing mistreatment and the harmful effects that public humiliation can have on student learning.10 It is only when students recognize abuse and have a strong support system that they may finally gain the confidence required to be vocal against toxic behavior and speak out for both themselves and classmates. Schools can further assist efforts by ensuring students are aware of their rights in this context, and offering guaranteed protection if mistreatment does rear its head.11 Current physicians may also positively contribute by gently and constructively pointing out questionable behavior among their colleagues to create a more effective learning environment. Finally, our generation of medical students is tenacious, progressive, and outspoken. We can weaken, and even break the cycle, by remembering our roots, exercising our rights, and manifesting the golden rule: to always treat others the way you want to be treated.
2020 GQ All Schools pdf. (n.d.).
Cook, F., Arora, V. M., Rasinski, K. A., Curlin, F. A., & Yoon, J. D. (2014). The Prevalence of Medical Student Mistreatment and Its Association with Burnout. Academic Medicine : Journal of the Association of American Medical Colleges, 89(5), 749–754. https://doi.org/10.1097/ACM.0000000000000204
Dyrbye, N., Thomas, M. R., Massie, F. S., Power, D. V., Eacker, A., Harper, W., Durning, S., Moutier, C., Szydlo, D. W., Novotny, P. J., Sloan, J. A., & Shanafelt, T. D. (2008). Burnout and suicidal ideation among U.S. medical students. Annals of Internal Medicine, 149(5), 334–341. https://doi.org/10.7326/0003-4819-149-5-200809020-00008
Markman, D., Soeprono, T. M., Combs, H. L., & Cosgrove, E. M. (2019). Medical student mistreatment: Understanding ‘public humiliation.’ Medical Education Online, 24(1), 1615367. https://doi.org/10.1080/10872981.2019.1615367
Stone, J. P., Charette, J. H., McPhalen, D. F., & Temple-Oberle, C. (2015). Under the Knife: Medical Student Perceptions of Intimidation and Journal of Surgical Education, 72(4), 749–753. https://doi.org/10.1016/j.jsurg.2015.02.003
Mazer, M., Bereknyei Merrell, S., Hasty, B. N., Stave, C., & Lau, J. N. (2018). Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees. JAMA Network Open, 1(3), e180870–e180870. https://doi.org/10.1001/jamanetworkopen.2018.0870
A series of briefs by the Texas Medical Association’s Medical Student Section
By: Shubhang Bhalla, Chelsea Nguyen, and Alejandro Joglar
There are only two possible scenarios: either the Mayans were inept seers, or they ran out of stone. In any case, the predicted end of the world missed its appointment by exactly eight years. With nearly three million deaths globally, COVID-19 has quickly assumed its standing as one of the leading communicable causes of mortality.1 Despite the novel therapeutics to combat the pandemic, recent scientific models and health information now report that masks could have prevented nearly 12% of mortality associated with SARS-CoV-2.2 Surprisingly, this simple piece of personal protective equipment has become politicized, with some opponents claiming that masks are an infringement on human liberty. In the current sociopolitical climate, we are amid two pandemics: one of SARS-CoV-2 and another of misinformation—both equally harmful. Much like the historical precedent set in 1918 with the formation of the Anti-Mask League, public health leaders of the twenty-first century must face the challenge of juggling objective science, pandering politics, and devastation left in the wake of the SARS-CoV-2 pandemic.
Public health has been consistently linked to leading political efforts of the time. From the development of environmental regulations, seatbelt laws, and smoking zones, to the contentious debate over mandatory vaccinations, efforts to improve public health sometimes impinge on various political ideologies and interests.3 Often, these debates can be broken down to the fundamental balance of individual autonomy and communal benefits. This intricate relationship between public health and politics has become increasingly strained during the current pandemic. Many critics of the pandemic response argue that by “flattening the curve,” individual autonomy has been infringed upon. Undoubtedly, the pandemic has catalyzed the transformation of established social operations: business closures, online education, and disruptive daily living. However, among what some call “liberty-depriving” mandates, the mandatory mask usage remains a significantly contentious proposal. Wearing a mask serves to fulfill two broader, complementary goals: individual responsibility and adherence to a common, public paradigm to eradicate the pandemic. Despite its complementary nature, the wearing of masks has become a catalyst for political conflict, becoming a form of divisive political symbolism for the American public.
Today, only twenty-five states currently mandate face masks in public;4 however, as restrictions begin to lift due to mounting public pressure, it is critical to understand that the origins of the mask resistance is the consequence of inconsistent scientific recommendations, actions of political figures, and America’s long-standing principle of liberty. The argument of wearing masks is simple: viruses are transmitted via droplets, and properly constructed masks can prevent the spread of infected droplets. According to the CDC, this is called “source control.”1 However, the delivery of this message has been muddled. In April, the World Health Organization (WHO) instructed the public not to use masks, while the CDC recommended the opposite. In June, the WHO adjusted its guidance to state that the public should wear nonmedical masks only in specific instances of high risk of infectivity. However, the CDC director touted universal mask wearing as “one of the most powerful weapons” to curb the rates of COVID-19.5 The net result of conflicting recommendations was a divided population who sought concrete guidance from political figures.
Yet, political figures further allowed for festering sentiments against masks to transform into a symbolic ideology. Initially, the conflict arose with protest against government mandates, cited by some as “extensive governmental reach into individual action,” but as the debates shifted towards masks, a new conflict—one of the “culture war”—reigned.6 In this battle, masks were described as “muzzles . . . restricting His [God’s] respiration mechanism.”6 As these views gained popularity, politicians’ action indirectly supported these protests. Top officials, such as Donald Trump and Mike Pence, sought to erroneously show strength by limiting mask usage or outright denying the need for the equipment. In Montana on September 14, 2020, former Vice President Mike Pence stood in front of a large crowd to support the state’s Republicans. However, many individuals who attended the event, including Mike Pence, were not wearing a mask despite a mask order that was in effect for the surrounding county.7 Furthermore, at the national level, Congress denied passing the Masks for All Act of 2020, an initiative to provide high-quality masks for all individuals.8 Contradictions between the scientific community, state policy, and actions of key figures downplayed the severity of the virus, influenced public’s perception, and shifted support towards the anti-mask masses.
As of May 19th, approximately 125.5 million people in the United States have been fully vaccinated, either by the two-dose series by Pfizer and Moderna or Johnson & Johnson’s single-dose vaccine.9 Per the CDC, it is predicted that 90% of the total US population will be vaccinated by July 12th.9 Despite this incredible progress, it is still important to continue following mask-wearing protocols as new research is being developed about effectiveness of the vaccine. For example, it is still unknown whether fully vaccinated individuals can transmit COVID-19 to unvaccinated individuals.10 Additionally, the rise of new variants of COVID-19 may influence the effectiveness of vaccines and the spread of COVID-19 among susceptible individuals. The uncertainty surrounding the vaccines and COVID-19 means it is essential to continue following public health mandates, including mask wearing if unvaccinated, social distancing, and following travel and local guidelines regardless of vaccination status. Dr. Anthony Fauci even mentioned during an interview with CNN that it is “possible” that Americans will be wearing masks in 2022.11
As medical students, we can play an important role by engaging with and educating our communities about the most effective methods of maintaining safety during the pandemic. It is important that we talk with our friends and family about why unvaccinated individuals should continue to wear a mask and follow certain precautions and remaining guidelines (ex: wearing masks on public transport) as well as recommending trusted resources for more information, such as the CDC. As new research develops and guidelines change, being a clear and comprehensive line of communication between science and the public is more important than ever before.
CDC and WHO offer conflicting advice on masks. An expert tells us why. Accessed May 9, 2021. https://abcnews.go.com/Health/cdc-offer-conflicting-advice-masks-expert-tells-us/story?id= 70958380
Dyson, (2020). Are they masks or muzzles? Two discussions highlight different opinions | Latest News | starexponent.com. Free Lance Star. https://starexponent.com/news/are-they-masks-or-muzzles
The Mask Hypocrisy: How COVID Memos Contradict the White House’s Public Face | Kaiser Health Accessed May 9, 2021. https://khn.org/news/mask-wearing-hypocrisy-how-covid-white-house-memos-contradict-ad ministration-coronavirus-defense-policy/
A series of briefs by the Texas Medical Association’s Medical Student Section
By: Grayson Jackson, Kate Holder, and Whitney Stuard
Vaccine hesitancy refers to when an individual refuses or delays receiving an available vaccine, primarily due to misinformation, lack of health literacy, or fear.1 This issue—especially in the setting of the COVID-19 crisis and growing misinformation about science and medicine nationwide—is of great importance for medical students as future physicians and scientific communicators. Widespread vaccine refusal may result in untold public health consequences, including outbreaks of vaccine-preventable infectious diseases and rising healthcare costs. Vaccine hesitancy is often observed by quantifying nonmedical vaccine exemptions from state-mandated immunizations. In Texas, these exemptions have tripled since the 2010–11 school year.2 Data compiled by the Centers for Disease Control show that during the 2018–19 school year (the most recent available), Texas reported 2.2% of kindergarteners with a nonmedical exemption, amounting to 390,000 exempted children second only to California.3
The ongoing health crisis caused by COVID-19 has placed tremendous hope on vaccine compliance as the most practical way to stifle the global pandemic. Scientific facts have become increasingly politicized, and vaccines represent one of the key topics in which such facts have become distorted and polarized. Some questions (i.e., whether vaccines cause autism) have persistently circulated among vaccine-hesitant groups for years, whereas the COVID-19 crisis has heightened the risk of disinformation as vaccines by Pfizer, Moderna, and others are rolled out nationwide. It is incumbent upon us as future physicians to engage in the responsible dissemination of correct information about vaccines’ safety and efficacy. However, one should also avoid rushing to condemnation or judgment of vaccine-hesitant patients and parents which may only intensify their opposition.4
The Texas Medical Association (TMA) has worked to actively combat vaccine hesitancy and problems with vaccine availability throughout the state. The TMA has been working to support vaccinations including influenza, HPV, MMR and others throughout its history. TMA’s current vaccine advocacy agenda is still working to advocate for flu shots during the ongoing COVID-19 pandemic. The TMA Medical Student Section (MSS) has also continually supported vaccine availability to all Texas residents and promoted Be Wise Immunize chapters throughout the medical school within the state. In addition to TMA’s Be Wise Immunize program, TMA has published a variety of policies supporting vaccinations to increase overall vaccination rates. Policy such as 135.012 Immunization Rates in Texas, 260.072 Conscientious Objection to Immunizations, and 135.022 Adolescent Parent Immunizations all work to increase vaccination rates within the state, promote the Texas Vaccines for Children Program and the Adult Safety Net Program, as well as combat vaccine hesitancy. In addition, during the COVID-19 pandemic TMA has encouraged the #ThisIsOurShot campaign to combat vaccine hesitancy.
The TMA Medical Student Section supports widespread vaccine availability in a prompt and timely manner to all Texas residents. The MSS supports incorporation of the COVID-19 vaccine into the mandatory vaccine category once it is federally authorized beyond emergency use. This may become increasingly important as we see young people and college students, who deny the vaccine due to not fearing the less negative COVID-19 health outcomes, become the population disproportionately responsible for COVID-19 spread.
As a medical student, you have probably heard countless friends and family members discuss their hesitancy to receive the COVID-19 vaccine. Many people have vehemently opposed the COVID-19 vaccination simply because they have fallen victim to false information. As medical students and advocates, we should commit to broadcasting truth and combating misinformation in our local communities. We have the wherewithal and the voice to endorse the COVID-19 vaccine.
1 MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4164. doi:10.1016/j.vaccine.2015.04.036
The future of education will play a key role in the future of the world as we know it. What learners are taught and how they are taught will help them assimilate into society after school. Over the years, education has changed in different ways but it is going to keep changing with time. Right now, one of the key factors that will shape the future of education is technology. Contrary to popular opinion, technology isn’t the only factor that will revolutionize education. Many other factors are already trending in today’s education industry. Some of them are listed below:
1. Project-based Learning
This learning method allows students to gain knowledge by participating in real-world projects. The projects could either be assigned to groups or individuals and teachers check their progress over time. Depending on the complexity of the project, the timeline could be days, weeks, or the entire semester. The goal is to keep the students engaged and teach them meaningful life skills. It allows students to tap into their creativity, collaboration, and communication skills, among others
2. Video-based Learning
Video-based learning is a popular teaching approach in learning and cognition that relies on videos in the designation of knowledge. However, it is now becoming a more mainstream method of teaching that uses visual and auditory cues. While the videos are the primary source of information, audio is used for elaboration. Video-based learning is more effective when classes are divided into short videos rather than incredibly long sections.
3. Tech-based Learning
Tech-based learning is a combination of different electronic technologies like audio, satellite broadcasts, intranets, webcasts, video conferencing, CD-ROM, and the Internet in general. In this Covid-19 era, tech-based learning became even more popular. Students could not attend in-person classes during the lockdown. So, they had to rely on technology to get the education they need. Older students have also been taking online tech courses on Bootcamprankings.com and Computersciencehero.com.
4. Teaching Data Interpretation
As technology advances, the manual aspects of literacy become less relevant. Students will still be taught the three major literacy courses but they will focus more on data interpretation. Computers will be handling every form of mathematical and statistical data analysis but humans will still be needed to interpret this data. Students are now being taught how to predict trends from the data they interpret. They are taught how to apply numbers to theoretical knowledge but they also need human reasoning.
5. Diversification of Interests
When you ask children below age 10 what they want to do with their lives, they typically pick any one of the most popular occupations. One would say he wants to be a doctor, another wants to be a lawyer, and one wants to be a nurse. Even if some of these children change their minds when they become more mature learners, some hold on to their early dreams for too long and it shapes their career path. In the future, teachers will promote the diversification of interests among students. They will consciously and unconsciously shape the future career of their students allowing them to develop interests in other fields.
6. Real-world Skill Training
In the future, schools will focus less on theories and more on real-world skill training. Proponents of this form of education believe that it is a more efficient method of teaching and it prepares learners for life after school. Since the beginning of the Covid-19 pandemic, many schools have had difficulty providing in-person practicals for their students to experience real-world training. Some of these schools have turned to virtual reality for a solution to their problems. Using virtual reality allows students to immerse themselves in the virtual world in a more realistic way than any other technology. It might not be the same as face to face skills training but it’s the next best thing.
The future of education will be shaped by several factors but the ones listed above will have the most significant impact. All these variables have a few things in common. First of all, they are all directed toward making the learning process more engaging. The more engaged students are, the more attentive they will be in the classroom. This will aid in the retention of knowledge as well.
Covid-19 completely changed the education sector. It made all institutions undergo an abrupt transition from in-person to online modalities. Most governments implemented lockdown from one day to another, and the sector had to come up with a solution fast. Even now, eight months later, things haven’t gone back to normal. Here is how the virus has disrupted the education industry. The stats on this article are from the OECD’s The Impact of Covid-19 on Education.
The Covid-19 pandemic has increased the demand for the healthcare sector. The industry is already at its full capacity in most countries in a normal situation. But with the virus, the massive amount of new cases and people that needed medical attention reached numbers higher than ever before.
To try and meet the needs of citizens, governments started giving more funding to the healthcare sector, and the education industry was given less priority. So now, the education sector is in need of more tools like online platforms, computers, and digital devices so students can learn from home. The sector needs to prepare for when they reopen again with all safety measures like cleaning, temperature readers, face masks, and so on.
But it is a real possibility that education will have the same or a smaller budget than before the pandemic. Eleven percent of global public expenditure was directed to education on average worldwide. We will have to wait and see what happens next year while the pandemic is still raging and if the efforts to continue education with the virus are applied long-term.
Reduction of International Students
International students are part of the education industry and create an environment of diversity and inclusion. In some cases, like tertiary education, they become essential to educational institutions. In most countries, international students pay higher tuition fees than national ones. The lack of them will result in a great hit for most universities. And this is even more true for doctoral programs where international students represent 22 percent of the class.
With distance learning, things change for international students. They lose the main benefits of being in another country to meet new people and cultures. Plus, they probably have expensive living costs that they could save by moving back to their home countries. The point of going abroad to study is to go to a better university that will provide better opportunities for their careers. And if they, from now on, have to study online, they may have other options like more affordable online courses.
Also, in many countries, international students are a source of development. Countries like Australia and Canada facilitate the immigration process to highly qualified students that will improve the country’s chances of development. This could be hindered by the reduced number of people that decide to study abroad.
More Online Platforms
What immediately changed when the pandemic started back in March was an increase in online learning platforms. Every institution in the education sector, either private or public and from pre-K to tertiary education, had to move to online platforms to continue their operations. By May, 94 percent of learners worldwide were affected. Many of them already had online platforms that they only need to adapt to the new needs.
But most schools didn’t have any idea where to begin, and they created learning platforms that weren’t that effective. So, they will probably go back to traditional in-person methods when the governments allow it. Other learning institutions, like coding bootcamps, were already offering interactive and user-friendly online platforms. So those will probably continue with this methodology for a while.
Another thing that changed with the pandemic, especially in primary and secondary education, is that the learning process became a shared responsibility. We are in a society where most families have two working parents, so education was the responsibility of the schools.
Now, with the pandemic and most kids back at home and parents working remotely, they have at least some of the responsibility in the learning process. Online learning is hard for younger kids. It is difficult for them to concentrate and keep themselves engaged. That is why parents had to step up and become the teachers for a few hours each day.
The Covid-19 pandemic generated an economic crisis in many countries, and this will probably have an impact on education funding in the future. With all the distancing and safety measures, the number of international students will decrease, which is a huge hit for the sector. Plus, many online platforms were created and will probably stay as a new way of learning.
Beyond borders, beyond languages, and beyond our differences students across the world have united with a common purpose to serve and create a positive impact. With over 1000 students comprising more than 90+ countries, #Students_Against_COVID, a grassroots movement has served as the cornerstone for creation, purpose, fulfillment and fostered collaborations throughout the world allowing students to join forces in the fight against the COVID-19 pandemic.
The Power of Technology
The Spanish Flu or the 1918 pandemic over 100 years ago, vastly differs from the COVID-19 pandemic due to the availability of technology. Since then, there have been many advancements with new medical equipment and instruments to care for patients. Many cures for diseases or drugs that were impossible decades ago are now a reality due to the hard work and diligence of researchers in finding answers to the centuries’ old medical mysteries. During the Spanish flu pandemic, scientists could hardly imagine elucidating the nucleotide makeup of the virus, but with the advent of polymerase chain reaction (PCR) half a century later, in today’s technological landscape, within 2 weeks of a global emergency scientists were able to determine the sequence of the coronavirus genome. Within seconds, a text message from South Africa is transferred via the internet to Canada, and as such the spread of information and misinformation has appeared to be an added pandemic, namely the infodemic of the century.
Objectives of SAC, the Grassroots Movement
One of the core objectives of SAC in tackling the infodemic and the pandemic, has been to disseminate trustworthy information as quickly as possible and in as many languages to reach minorities, villages and people far away. From Pashto in Afghanistan, Turkish in Turkey, German in Austria, Hausa in West Africa, Yoruba in Nigeria to Lugada, the most prestigious language in Uganda, “the Pearl of Africa”, students have translated different COVID-19 campaigns.
The objective of the Global Health & Social Media Team has been to echo public health guidelines to stop the transmission of the infectious disease and to encourage those with symptoms of COVID-19 to seek medical assistance. Despite the socio-economic challenges for many without access to the internet, the major global health challenges the international community face will require an integrated, interdisciplinary approach addressing the political, cultural, legal, biological, and medical issues. Therefore acknowledging the role of technology in tackling the ongoing pandemic the team aims to eliminate avoidable disease, disability and death, while serving as an avenue of health promotion and disease prevention.
As such, important values, such as altruism, service in times of crisis, and solidarity with people around the world offered the chance, or opportunity of a lifetime to participate in the fight of this historic pandemic. Stemming from leadership’s most fundamental element to create a difference in the lives of others SAC therefore provided students with a platform to unleash their creativity and innovation necessary to navigate a crisis and to emerge from it healthy.” by Leah Sarah Peer
Additionally, with increased reliance on virtual platforms for connection and socializing, telehealth technologies for consultations, counseling sessions and physical examinations, physicians have been able to continue providing care while maintaining social distance. Similarly, educational institutions have transitioned to online remote learning where students and professors meet over interactive technologies such as Zoom and Google Meets for lectures. Medical students especially have had their clerk-ships suspended without direct patient contact while others have graduated early to serve as front-line clinicians. In this manner, technology has defied space and time, as it has not only exposed the fragility of humanity but also proved that technology is an integral part of our future evolution.
A Spark of Creativity & Innovation
With more free time for students, as the usual commutes to school, scheduling of classes and extracurricular in person activities were all cancelled they were able to invest in themselves and even develop new hobbies. Within SAC, it was evident that despite the negative impacts on medical education, these exceptional times represented opportunities for change. Such an example is that of the Clinical Resources Team, that curated a database of clinical resources for health professionals to access COVID-19 & medical information. This volunteer experience among many highlighted the value of non-graded elective courses in furthering student’s knowledge while allowing them to participate in a movement greater than themselves. As such, important values, such as altruism, service in times of crisis, and solidarity with people around the world offered the chance, or opportunity of a lifetime to participate in the fight of this historic pandemic. Stemming from leadership’s most fundamental element to create a difference in the lives of others SAC therefore provided students with a platform to unleash their creativity and innovation necessary to navigate a crisis and to emerge from it healthy.
Besides making a difference, SAC provided a sense of community where friends soon became family. In isolation many were reminded of our collective values and collective history, emphasizing society at large rather than individual self-interest.
The Mental Health Team sparked the beginning of students inspiring one another, of sharing their own stories as well as becoming listeners as a crisis naturally triggers a range of physiological and psychological responses that are heightened under lock-down. The earlier trauma and abuse students faced often resurfaced as the lost sense of normalcy triggered grief with feelings of denial, anger and depression.
Bearing the consequences in mind, the Women’s Health Team of SAC drafted up a list of domestic violence hotlines per country for individuals afflicted by domestic violence. To them, having access to these resources during quarantine was vital and therefore have further created campaigns on sexual health, reproductive rights, maternal health and “The Period Project”, all aiming to raise awareness for the challenges girls and young women are faced with. Passionate about women’s health, to commemorate international breastfeeding week, educational material was prepared celebrating womanhood while promoting access to skilled breastfeeding counseling.
Advocating for Vulnerable Populations
Nonetheless, the #Students_Against_COVID community rarely sleeps and while students are taking care of themselves, and those around them, they are also actively advocating for vulnerable populations.
The Asylum Seeker’s & Refugees initiative within SAC aims to raise awareness about the predicament of minorities by creating infographics, and posters. Furthermore, underway is the curation of a database of World Organizations & Charities for donations so that donors have access to places where their funds are needed and may be used wisely. In a catastrophe such as that presently in Lebanon, the database gathers recognized Lebanese Non-Governmental Organizations (NGOs) providing humanitarian aid and emergency relief.
Additionally, bearing in mind the challenges of the COVID-19 pandemic, the team recognizes the plight of refugees suffering from human rights violations. Whether forced to leave their homes, their communities and their families, to find safety in another country, the Asylum Seekers & Refugees Team within SAC abides by the Universal Declaration of Human Rights (UDHR) to assure all human beings are treated with respect and dignity. Since, by definition, refugees are not protected by their governments, the international community steps in to ensure the individual’s rights and physical safety while monitoring and promoting respect for refugee rights. Although the newest edition to #Students_Against_COVID family, the team’s aim is to strengthen and broaden public information, education and involve members of the civil society in refugee, asylum seekers and migrants protection.
Reflecting on the Past Year & Moving Forward
Recognized for it’s positive contributions internationally, #Students_Against_COVID was awarded the Pollination Project grant, won 1st place in the DICE Foundation COVID-19 Innovation Challenge, as well as the 2021 CUGH Pulitzer Prize for Highest Impact Project, Video Submission.
Besides these accomplishments, currently in the works and set to launch late spring to early summer 2021, is the creation of a unique, Global Health Program: An interdisciplinary Overview. It’s aim is to cultivate a better understanding of Global Health amidst the COVID-19 pandemic and the program hopes to connect global health enthusiasts from around the globe, introducing students and young professionals to critical global health issues and ways to address or solve them.
As the crisis evolves, compassionate leadership entails the unified efforts of changemakers championing science in both local and international theaters. Although words may not adequately serve to express the work and dedication of this virtual agora, pushing boundaries to inspire, help and motivate people is at the centre of the #Students_Against_COVID movement!
Leah Sarah Peer is a medical student at Saint James School of Medicine in Chicago and a graduate of Concordia University, Specialization in Biology, Minor in Human Rights in Montreal, Quebec, Canada.As a Core-Facilitator within Students_Against_COVID, Leah aims to foster belonging and inclusion to unify the movement and compassionately strives to empower others to make a difference.
Societies across the world have been disrupted by the Covid-19 pandemic, with millions of people being forced to stay indoors and many losing their jobs. But this very disruption has ushered us into what could be the new future of work. Remote work itself has been around for years but, traditionally, companies prefer their employees to work at their physical headquarters. That’s all beginning to change as a result of the pandemic.
With no choice for companies, entire industries and employees alike were forced to embrace remote work—yet this may just be the beginning. In fact, Business Insider recently discussed 12 different companies that were extending remote work, with some end dates as far away as the summer of 2021.
For other industries, however, there may not even be a return to the office on the horizon.
Technology has made remote work possible but, ironically, has also been a disruptive force that has uprooted traditional jobs. This trend has only been accelerated by remote work—employers have realized just how many jobs can be done from the comfort of their homes.
Over the past few years, the medical field has been slowly merging with technology. Every aspect of the healthcare system, from entire hospitals to physicians, is being influenced by new technological trends, including remote work. The future of the field has never been more unclear.
Flexibility with Administrative Tasks and Employees
In the coronavirus era, medical professionals are in high demand for obvious reasons. Many medical facilities have transitioned to working remotely. In fact, the automation of administrative tasks has been a major byproduct of the Covid-19 pandemic.
Offices around the country report feeling positive overall about these changes. Medical Economics recently examined Lugo Surgical Group, based out of Texas, who have been operating remotely for two years, showing that this is viable.
Each week, the owner of this clinic, Rafael Lugo, reserves a day and a half to meet with patients. Every other aspect of the surgical process—including billing, scheduling, and follow-ups—are done remotely.
While doctors and nurses still need to meet with patients in person, it is clear that this is not the case for administration. This new hybrid business model has altered the jobs available in the medical field. In fact, the Bureau of Labor Statistics projects a 9% decline in secretarial or administrative assistant jobs over the next decade. Nonetheless, Covid-19 has highlighted the need for in-person physicians but has demonstrated that administrative workers are not essential for the office.
The Emergence of Artificial Intelligence Systems
While admin roles may be on an accelerated decline due to Covid-19, their replacement is coming far quicker. Artificial intelligence systems are impacting every field of business and its impact on medical practices is profound. Handling administrative tasks is just the tip of the iceberg for these advanced systems; however, there is a downfall. The trust medical offices have placed on these systems during the pandemic may result in them relying on AI to handle more intricate jobs.
As such, AI is changing medical practices, particularly when it comes to patient care. Surgeries powered by robotic instruments that are controlled by a surgeon are becoming extremely popular, and some systems are now able to diagnose patients quickly based on information inputted in the system. As these systems continue to develop, new jobs will open in the field of medicine based on regulating this technology and developing it.
Entire companies may form, focused on developing and then producing these AI and robotic systems. DaVinci Systems is a modern example, as the company produces surgical robots that are controlled via a human surgeon at a desk. These devices have already been approved for urological procedures, radical tonsillectomy, and even tongue base resections. Remote work has shown a new way in which these systems can be helpful. In truth, this pandemic could very well result in a future where there isn’t even a human surgeon behind the robot.
Altering Career Paths and Customer Expectations
Before the pandemic, a common headache for patients was the annoying wait times and variability in the quality of service provided by the doctor. During the pandemic, though, wait times have become non-existent, with medical professionals able to conduct their job over a Zoom call. Additionally, the advancements of artificial intelligence systems could result in more accurate diagnosing in the future. Having access to medical professionals wherever and whenever, however, may have its drawbacks—patients may become disgruntled if medical practices return to normal after the pandemic settles.
As for doctors and other medical practitioners themselves, Covid-19 isn’t just changing the way they work, but also how they progress in their career. Online nursing programs, offered by accredited schools such as Johns Hopkins University and Rutgers University, have become more popular during this pandemic. With the number of people earning their degrees online increasing, remote learning practices may ease the transition to remote work. This could also contribute to the industry-wide switch over to automation powered by artificial intelligence.
Covid-19 has changed the way entire industries operate and the medical field is no exception. From artificial intelligence replacing administrative jobs to the way budding practitioners are learning the ropes, reliance on technology has increased as a byproduct of the pandemic. This is likely to lead to a future where medical practices are largely automated and in-person visits to the doctor are disrupted by robotics.
Based on current trends, these changes were inevitable, but the pandemic may have accelerated them. While the future of the coronavirus is unclear, its effects on the workforce and jobs may be permanent—the way work is handled could be disrupted forever.
Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.” – Voltaire
The covid-19 pandemic has claimed millions of lives, shut down economies, restricted movement and stretched our healthcare systems to the edge; but despite this time of destruction, Peer Med, a podcast dedicated to serving humanity was born! Established as a platform for creation, innovation and above all a platform for unity.
A student-led initiative of the Peer Medical Foundation, the Peer Med podcast intertwines medicine, an ever changing science of diagnosis and treatment, with conversations about issues in healthcare where lives are on the line. Due to the fashionable focus of medical education on biology, pathology and disease there has been a reduced emphasis on the social determinants of health. As such physicians lack an empathetic character understanding the human aspect of medicine and in this, fail to communicate effectively rendering patients dissatisfied with care.
Seeing the need for more fruitful discussions, the Peer Med Podcast provides listeners with a more nuanced interpretation encouraging health professionals to look beyond medicine and into the experiences, values and beliefs of patients to assure a successful therapeutic relationship. It serves as a reminder of the importance of self-determination, beneficence, non-maleficence and justice as medicine naturally exposes health professionals to the darker side of human existence. The podcast explores these themes by delving into the underbelly of life where homelessness, drug addiction, abuse, trauma, and death are brought to the surface of conversations. It takes the already prevalent cases of strokes, pneumonia, heart attacks, fractures, and miscarriages from the everyday scenarios in emergency rooms plaguing our species and encourages a more humane outlook amidst all conflict and chaos.
“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”
Founded on March 24th at the start of the COVID-19 pandemic, Peer Med is dedicated to humanity and the millions of people worldwide without access to education, health and water, sanitation and hygiene (WASH) services. The podcast aims to inspire, engage and promote action to solve challenges in global health, human rights and medicine. Acknowledging that the delivery of healthcare requires a team effort, the podcast invites everyone from clinicians, advocates, economists and even comedians to delve into the subjects of medicine. While peer-reviewed information is important, not all valuable work belongs in an academic journal. In order to strengthen health systems a multidisciplinary set of perspectives is required to teach and inspire people. Therefore, Peer Med encourages dialogue so that all listeners may raise their voices advocating for humanity.
Ensuring Peer Med is truly a global podcast is the goal but despite the best intentions to ensure inclusivity, barriers in terms of gender, language, and access prevent this from happening. To tackle the problem, Peer Med aspires to invite speakers from all corners of the world, not only to assure equitable representation but to also gain advice on how to empower those in low-and-middle-income-countries (LMIC) so that their voices may be heard. In serving humanity, Peer Med is completely free and available on a variety of platforms aiming to leave listeners refreshed, empowered and motivated to effect change. These can be heard from a mobile phone, shared via social media, or played for a friend. The conversations will leave listeners burning with a flame in their hearts to do their utmost on life’s quest to serve humanity.
It serves as a reminder of the importance of self-determination, beneficence, non-maleficence and justice as medicine naturally exposes health professionals to the darker side of human existence. The podcast explores these themes by delving into the underbelly of life where homelessness, drug addiction, abuse, trauma, and death are brought to the surface of conversations. It takes the already prevalent cases of strokes, pneumonia, heart attacks, fractures, and miscarriages from the everyday scenarios in emergency rooms plaguing our species and encourages a more humane outlook amidst all conflict and chaos.
Leah Sarah Peer
The support for the podcast has been humbling as love has poured in from around the globe. So many are keen on sharing their stories and this speaks volumes to the passion of the podcasts’ guests, their enthusiasm and commitment to mankind. Some have included a world renowned speaker and human rights champion, a Brooklyn-based singer, songwriter, teacher and PhD candidate in Comparative Literature, a range of student initiatives – Meet the Need Montreal, Helping Hands, to Non-profit Organizations such as Med Supply Drive and so many more.
If there is something the COVID-19 pandemic has taught us, it’s the power of community and compassionate care’s strength in uniting us across the world. Peer Med hopes to serve as a medium for inspiration, for reflection, and invites people from across the healthcare spectrum to come together committed and dedicated to serve humanity.
With the rapid advancement of knowledge and technology in medicine, physicians alienate themselves from the core purpose of their profession. A grounding in the humanities as well as a strong foundational basis understanding the medical sciences is required to establish well-rounded physicians. Art inspires medical students and physicians to observe detail they otherwise wouldn’t. With patients in the emergency room, before any physician-patient interaction can occur, the sounds of bilateral crackles, the sight of neck muscles contracting and of the nostrils flaring indicate a patient in respiratory distress. This very detail in observation is needed for split-second decisions of utmost importance in the emergency theatre.
Art is the projection of our experiences, memories and has the power to record reality and fantasy. These altogether add to the artistic memory of an artist and allow them to add adaptations based on their life’s observations. Artists have captured the human body through the pursuit of conveying human experience, of the human’s appearances, shapes, and sounds all reflecting their state of health. Artists must see the details of a picture and reproduce it, and only once they’ve mastered observational art can they move on to more abstract forms conveying emotions of the real world.
When dissections were forbidden centuries ago, artists together with doctors snuck out to examine human corpses for a closer look. This was important for them to accurately reproduce representations as they not only had to know the inner workings of the human body just as physicians did but they needed the eye for their artistic creation. Unfortunately, today the acquisition of life-drawing skills has lost its traditional importance due to increased demands for the more conceptual art forms.
In medicine, observational skills provide insight into a patient’s problem. From observing, not only do we see it as is but we recognize patterns, are able to analyze context and make connections. Despite knowing everything about a disease or illness, learning how to see pathologies, and diagnostic criteria is important to avoid missing all the signs. The four steps of physical examination are inspection, percussion, auscultation and palpation. Inspection or observation is often overlooked but is so crucial to patient care and treatment as is to the creation of art.
The artwork of Piero di Cosimo, A Satyr Mourning over a Nymph (1495) depicts a young woman killed accidentally during a deer hunt by a spear. Upon analysis of the painting and deep observation, evident is that there is no spear wound but instead the women’s arms are covered with long cuts as if acting in self defense from her assailant. Her left hand additionally is placed in position with her wrist flexed and fingers curling inwards known as “waiter’s tip”. Fundamentally at large, di Cosimo used the girl’s corpse as a model and because as an artist he had no understanding of medicine and injury, he portrayed exactly what he saw. Unintentionally, he captured the girl’s true injuries dictating to a medical practitioner the likely theory of the young woman’s actual cause of death.
Appreciation for paintings by physicians even reveal medical diagnoses given the structural facial characteristic changes that occur in different diseases. The Old Woman by Quinten Massys depicted an exaggerated ugliness due to the pattern of facial deformations; bossing forehead, prominent cheekbones, enlarged maxilla and increased distance between the mouth and nose all consistent with leonine faces of Paget’s disease stemming from accelerated bone remodeling. Another example is that of Peter Paul Rubens, The Three Graces, displaying symptoms of benign hyper-mobility syndrome, an autosomal dominant disease. Scoliosis of the spine, a positive Trendelenburg sign and double jointedness as well as lax upper eyelids is evident in the artists painting.
Fascinating nonetheless is that the medical diagnoses in both paintings were unknown to doctors at that time. Paget’s Disease and benign hyper-mobility syndrome were discovered just a couple years ago while these paintings existed long before them.
Compared to artists however, doctors have stopped putting their skill of inspection into practice and with all the expensive tests available to help doctors make diagnoses, the necessity of individual, physician observation has decreased. Thus raises a question, will the dependence on tests rather than investigation through the senses define the future of medicine?
As medical students, this urges us to hold true to the art of observation. Technological advances were directed to improve patient care and not impede the physician-patient relationship. The personal touch of a doctor and the direct communication through movement, and language has been lost. Remembering the feelings of our patients allows us as future physicians to be mindful that no patient manifests the same way despite presenting with the same disease. Neither are patients aware of the manifestations of disease and overtime naturally adapt to the abnormal posture, gait, and lifestyle changes often overlooking the skin changes, mood or weight fluctuations.
When doctors are trained to “see”, observe and infer from signs alone a basic diagnosis, will they understand the whole human being. Therefore, arts education in medicine helps humanize science and connect medical theory into the patient’s journey. In analyzing art pieces, students are able to connect clinical skills and improve their ability to reason with the physiology and pathophysiology of the human body from visual clues alone causing them to become more emotionally attuned to their patients and aware of their own biases as physicians.
The skills of observation requires improvement and practice from physicians to both diagnose and understand the underlying concerns of a patient. Only when doctors have mastered the art of observation and trained their eyes to truly see, will they ultimately return to a world of greater human connection in medical practice.
References McKie R. The fine art of medical diagnosis. The Observer. 2011 September 11;Culture. Berger L. By Observing Art, Med Students Learn Art of Observation. NY Times. 2001 January 2;Health Christopher Cook. A Grotesque Old Woman. BMJ 2009;339:b2940 Dequeker J. Benign familial hypermobility syndrome and Trendelenburg sign in a painting “The Three Graces” by Peter Paul Rubens (1577–1640). Annals of the Rheumatic Diseases 2001 September 01;60(9):894-‐895. Pecoskie T. Improving patient care with art. The Spec. 2010 December 2;Local. https://www.mcgill.ca/library/files/library/susan_ge_art__medicine.pdf