Medical Students Chart a New Course
Fourth-year medical student Alyssa Mangino sat casually in front of her laptop, the faint radiance of the Zoom video feed illuminating her face. Behind her, brown blinds obscured the nocturnal world outside. Her eyes gleamed as she spoke, and occasionally she gestured with her hands. Mangino’s dark blonde hair curled along the side of her head, barely touching her shoulders.
“As medical students, we were pulled out of our clinical duties when the pandemic hit,” she said. “So it was like the only thing we were allowed to do that would allow us to be part of the pandemic and help people.”
Her desire to continue helping people led her to Stony Brook University’s COVID-19 Service Learning course. “I wanted to get involved,” she said.
Video by Kraig Klein
Crafted by Stony Brook’s Renaissance School of Medicine, the course aims to prepare medical students for tackling the coronavirus on the front lines. It consists of 15 to 20 projects, depending on how many students enroll. The projects offer glimpses into different aspects of hospital routines. It was partially meant to help students graduate on time since other medical courses had been suspended. But its primary mission is to educate as many students as possible about working in a medical environment as COVID-19 rages around them.
Dr. Lisa Strano-Paul, the school’s assistant dean for clinical education, explained how the course works.
“Students chose a project and completed the associated readings or attended educational sessions to learn the background information,” she said. Students then “explored the diseases or problems the activity was designed to help, completed the service learning activity and submitted a reflection about what they learned from their experience.”
Dr. Andrew Wackett, vice dean of undergraduate medical education, offered more details. “Students received credit depending upon the number of hours they dedicated to service learning. Twenty hours of work was equivalent to one week of credit. The course counted towards fourth-year credit, so first- through third-year students could only apply up to four credit hours towards their fourth-year elective time.”
Wackett also explained the basic methodology of the course. Students were required to review written and recorded training materials at the start of the course. “These materials taught the epidemiology, pathophysiology, treatment and prevention of the disease and trained students on the proper use of PPE,” he said, referring to personal protective equipment. Students then applied their newly learned knowledge in a series of hands-on projects.
Strano-Paul and Wackett said at least 100 students took the course when it was first offered in the fall 2020 semester. They were subdivided based on the project they signed up for, with each project overseen by medical staff. Wackett added that the course was designed so students in any year of medical education could take it.
“Even first-year students had been trained to obtain a history physical exam from a patient at this point, so they were able to assist with setting up telephone calls and following up with patients,” he explained. “Only third- and fourth-year students were allowed to participate in giving vaccinations, as New York State requires CPR training and extensive clinical experience.”
Students could sign up for multiple projects. Mangino, for example, worked for a month on a project that collected data on COVID-19 patients who were treated in the hospital’s emergency room. Then she signed up for a different project that involved personal protective equipment.
“I helped make gowns and some of the PPE the hospital was short on,” she said. The PPE included items in high demand such as face shields.
The desire to help out at the hospital following the university’s shutdown in March 2020 was a major motivation for medical students signing up for the course.
“We had been kicked off rotations at the time since there wasn’t enough PPE for us to actually help out at the hospital,” fourth-year medical student Kyle Albagli of upstate Clifton Park, explained. The 26-year-old said he “wanted to try to find a way to help out, and this was a great way to do it.”
His classmates echoed the sentiment. “I felt I had to do something to help patients and the medical community during such tumultuous times early in the pandemic,” explained oncology student Naveen Mallangada of Mineola.
“Students were not allowed to work from March to June, but we wanted to contribute, and the best way was to do it virtually or in non-clinical settings,” Victoria Yuan, a fourth-year medical student from Brooklyn, said.
Many students worked on the PPE management and production initiatives, keeping track of the supply or assembling new gear for use in the hospital.
“At that point we weren’t sure how long the supply would last, and if we would have to start, for example, recycling N95 masks,” Albagli explained. “We had a whole system in place where we would monitor people taking masks, and when they came back and they needed new ones, they would drop off the old ones so that they could be re-sterilized and saved to be used if we ever ran out.”
Mallangada coordinated medical student volunteers in assembling 3D-printed face shields from SBU iCREATE – a department within the university’s Division of Information Technology that provides tools and resources for faculty, staff and students to work collaboratively on projects that can benefit from advanced technologies. The 25-year-old also helped gather non-sterile gowns for the hospital to keep up with the demand.
“I felt I had to do something to help patients and the medical community during such tumultuous times early in the pandemic.”– Naveen Mallangada, oncology student from Mineola
Most students who collected PPE also worked on other projects. “I delivered food to in-patient teams, brought groceries to elderly neighbors, and mentored underclassmen,” said Ariel Yang, a fourth-year medical student.
One of the more complicated initiatives focused on the hospital’s telehealth programs, which connect health care workers and patients remotely, usually by phone.
Brecken Esper, an anesthesiology student from upstate New York, explained his role: “I was mainly involved in helping educate and set up patients so that they would be able to have successful telehealth appointments with their various Stony Brook Medicine physicians and other practitioners across the Stony Brook network, in order to reduce the exposure for having patients going to the office or hospital setting. This included giving patients’ tips and tricks on how to make their telehealth appointments successful. Lastly, it involved assisting with the actual telehealth process, helping patients set up their devices and their various software applications.”
The telehealth initiative was further divided into concentrations based on patient demographics. One such sub-group focused on aiding elderly patients. Yang and fourth-year internal medicine student Alexandra Coritsidis from the central New York village of Newport were part of the team that called older patients who might be isolated.
“I worked with geriatric patients to mitigate any loneliness caused by social distancing,” Yang said.
“I called to see if they needed help getting groceries or medications,” Coritsidis said. “And if they did, there was another separate service where medical students ran errands and brought that stuff to them.” She also called patients who had been hospitalized with COVID and had been discharged.
“I had some difficult conversations where I had to tell a patient she had to deliver a baby alone. I had to tell some people who were really concerned about the risks of their baby—about their newborn baby—getting sick.…”– Cristina Young of Albuquerque, NM, fourth-year obstetrics and gynecology student
Cristina Young of Albuquerque, NM, another fourth-year obstetrics and gynecology student, worked the pregnancy hotline.
“It was very emotional and difficult for a lot of the patients,” the 25-year-old recalled. “I had some difficult conversations where I had to tell a patient she had to deliver a baby alone. I had to tell some people who were really concerned about the risks of their baby – about their newborn baby – getting sick, so those two parts were really hard. But overall, they were very rewarding.”
The course offered a variety of challenges. With the pandemic raging around them, students needed to observe social distancing protocols at all times. Organizing such a large-scale effort in a restricted environment proved to be trying.
Coritsidis listed just a few of the challenges the emergency department faced – “getting the volunteers together, creating the Google sign-up sheet, just figuring out an efficient way to make sure someone was there consistently.”
Esper explained the demands of ramping up the telehealth program. “Most of our patients had never used the application we used, Microsoft Teams, before, so even things such as who calls the patient to set up the appointment, who’s going to troubleshoot when they’re having issues, what sort of device are they going to be using – these were all questions we had to figure out with the patients. Keep in mind, a lot of our patients may not have had the same access to technology or the same experience with technology that many of us in school can take for granted.”
Young took on a unique role – educating doctors, nurses and other medical personnel in the appropriate use of PPE. “That was difficult, going from a situation where you’re used to these people evaluating you, to having to evaluate them, and having to educate them and tell them what the new policies were.”
Safety restrictions prevented students from working where they wished they could be – in the hospital. In pre-pandemic days, students could freely go wherever they wanted in the hospital as they fulfilled tasks as part of their rotations. But once the pandemic hit, large segments of the hospital were off limits. Students had a choice of working in specific areas in the hospital, where they would have to observe social distancing and refrain from leaving their assigned area, or working remotely. Either way, they were prohibited from direct contact with patients – a fact that pained several students.
“That was challenging, knowing people were in the hospital helping and I couldn’t help,” Mangino said.
“It’s not every day you get to feel you’re making a difference, and the course was nice in that I felt I was making a difference,” Pando said. “But I would sit there and wish I could help out more, wish I had a few more years of knowledge, to be able to help out in a different way.”
Albagli fought off paranoia about the possibility of getting infected.
“At that point, no one was sure what was happening with this virus. Was it airborne? Was it just droplets? There were so many unanswered questions, and I think people wanted to keep themselves and their patients and everyone around them as safe as possible,” he said. “Even though we weren’t having direct patient contact, it was a little nerve-wracking going into the hospital. We would pretty much wipe down every single surface we touched. We’d always make sure we had masks on at all times and keep a good distance from other people. That was probably the biggest challenge.”
“At the same time that I was volunteering at the hospital, anti-Asian sentiment was at an all-time high. I was reading in the news and on social media news accounts of hate crimes against Asian people every day.”– Ariel Yang, fourth-year medical student
Yang faced a different kind of emotional obstacle. Family pressures weighed on her mind. “My parents and my sister, a labor and delivery nurse, strongly opposed any volunteer work that would bring me into the hospital,” she explained. “Amidst sensationalist news stories of young people hospitalized and suffering strokes, they were unwilling for me to take any risk that wasn’t absolutely necessary. We also sparred over the idea of donating our spare masks to the hospital. My father said, ‘If the hospital runs out of masks, it will find funding and get masks. Our donation of masks would supply the emergency room for less than a day. But what will we do if we have no masks and this pandemic lasts for a year? Who will donate to us?’”
The looming threat of racism didn’t help.
“At the same time that I was volunteering at the hospital, anti-Asian sentiment was at an all-time high,” Yang said. “I was reading in the news and on social media new accounts of hate crimes against Asian people every day. My family discussed, for the first time, the possibility of buying a gun to protect ourselves. I remember feeling hyper-alert while running around the neighborhood. Any time a car slowed down near me, I got anxious. Even in the hospital itself, I heard staff joking outside the office about how they don’t want to eat Chinese food because of the pandemic. On a Stony Brook forum, where I hoped to volunteer, I read countless posts calling Chinese people dirty and blaming them for the pandemic, even while posting articles about China donating ventilators to New York City.”
Despite the physical and emotional challenges they faced, the medical students gave the COVID-19 Service Learning course high marks.
“It was really helpful to see people working together as a team, seeing how you can get something done very quickly,” Coritsidis said.
“The course itself was a good way to incentivize volunteerism and give medical students a better view of all the services required to keep a hospital running in the face of crisis,” Ariel Yang said.
“I think it’s a really good chance for people to get involved in a way that they’re passionate about, learn in a way they’re passionate about, and get more comfortable with self-learning and self-teaching,” Mangino added.
“One of the key aspects I took away from the course was adaptability and ingenuity in terms of coming up with different ways and solutions in order to solve some of the problems that we’ve faced,” Esper said. For example, students learned to use Microsoft Teams to organize telehealth appointments and in the process learned lessons about the value of communication. “It required imagining yourself in the patient’s shoes and looking at it from their perspective,” she said, “trying to walk someone through steps of a complicated procedure, sometimes without actually being there.”
Cristina Young agreed. “I learned a lot about patient communication, and communication in general. … The pregnancy hotline was my introduction to using telehealth and discussing things with patients over the phone, and that also included evaluating any patients that had been exposed. It was my first time conducting a physical exam when I couldn’t see the person that I was talking to,” she said.
“It was a great way to make us feel we were able to continue our education at a time we were so unsure what the next year was going to look like,” Pando said.
Strano-Paul said the School of Medicine is planning to expand the course to “address other community health needs” and other illnesses. Wackett added that the course will be a “longstanding elective,” with the hope that it can be customized in the future to focus less on COVID-19 and more on other developing medical issues. Most of the students hope that future generations of medical students will be able to experience the course and reap the same benefits and lessons they did.
“In a microcosm, we learned what the whole country learned in 2020,” Yang said. “That all services are essential, and that in a war, every person has a part to play.”