May 8, 2020

Psychiatry Clerkships in the Time of COVID-19

How medical students' clerkships were affected due to the pandemic

By medical student Brycin Hanslits, and David Belmonte, M.D., clinical assistant professor and director of medical student education 

Medical students at the University of Michigan Medical School (UMMS) had their clinical rotations officially put on pause in mid-March 2020 after the Association for American Medical Colleges (AAMC) issued guidance that removed medical students from any rotation that required direct patient contact, due to the COVID-19 pandemic. In the meantime, many medical students have been making productive use of their time by volunteering with the M-Response Corps, working on academic research, and completing an online course about pandemics. UMMS is tentatively planning to have medical students return to clinical rotations on June 8th, 2020.

While most students have not been able to work with patients, there have been some exceptions. A small group of students in the Oral Maxillofacial Surgery (OMFS) program still had two required clerkships to complete in order to meet their medical school graduation requirements, one of the rotations being psychiatry. Drs. David Belmonte and Dayna Leplatte developed an alternative learning experience with a condensed curriculum that included video visits in which the OMFS students were able to actively participate in patient interviews. While restricted from physical contact with patients, the students were able to interact with the patients via videoconferencing in a variety of settings including: Geriatric Psychiatry, Child Psychiatry, Psychiatric Emergency Services, Consultation-Liaison Psychiatry and Adult Ambulatory Psychiatry. Another group of students has been working with faculty in a psychiatry longitudinal clinic and was able to continue seeing patients through videoconferencing.

"While the curve of new COVID-19 cases has flattened, the threat is far from over, and innovative approaches to learning psychiatry and developing clinical skills will need to be adopted," says Dr. Belmonte.

Building off of the pilot experience in April, Drs. Belmonte and LePlatte are evaluating how to expand the use of telehealth for medical student education to a larger group of students when clinical rotations resume. The Michigan Medicine ambulatory psychiatry program quickly adapted to seeing patients using telepsychiatry and now clerkship directors are looking to use this same technology in the hospital setting. "This will be particularly useful especially if restrictions on physical contact with patients remain," says Dr. Belmonte. The clerkship directors are developing online resources including self-study modules designed to increase medical student knowledge and case-based role play modules to formatively assess a student’s psychiatric interviewing abilities.

The impact of the novel coronavirus pandemic has been devastating, permeating almost every aspect of previously normal life for students, providers, and the patients and families we care for. As experienced in previous natural disasters or times of economic instability, there will be serious mental health consequences stemming from this pandemic. Addressing these needs in a post-COVID world will require innovation and flexibility. The University of Michigan is poised to continue training students to respond to mental health needs in such a manner.

"As a non-traditional student, I often wonder if I made the right decision to attend medical school. Putting work on hold for several years of education does not feel like I am really helping accomplish anything good in the world. But during this pandemic I have been reminded why I decided to pursue medicine in the first place. Mr. Rogers, whom I admire deeply, has that quote about "looking for the helpers" when life is scary and I am proud to be part of the community of helpers in this tragedy," says Brycin. 


Brycin Hanslits also wrote this article for Psychiatric Times on how three other medical schools are responding to the pandemic.