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In the Bubble: On the Frontlines
All Podcasts How COVID Shook Up Med School (plus Zach Slavitt)

How COVID Shook Up Med School (plus Zach Slavitt)

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Description

For In the Bubble’s one-year anniversary episode, Dr. Bob catches up with the person who came up with the idea for the show: Zach Slavitt. Then, it’s a conversation about how COVID-19 disrupted the education of doctors and medical students. Bob is joined by three people in different stages of their medical careers at UCSF: medical student (and Bob’s daughter) Zoë Lyon, resident Jack Penner, and Vice Dean for Education Catherine Lucey. They discuss what changed when COVID hit San Francisco, how it affected patients, and how the experience steered Jack in a new professional direction.

 

Follow Dr. Bob on Twitter @Bob_Wachter and check out In the Bubble’s new Twitter account @inthebubblepod.

 

Find Zoë Lyon @ZoeMarkLyon, Jack Penner @jackpenner, and Catherine Lucey @CatherineRLucey on Twitter.

 

Keep up with Andy in D.C. on Twitter @ASlavitt and Instagram @andyslavitt.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at http://lemonadamedia.com/inthebubble/

 

Support the show by checking out our sponsors!

 

 

Check out these resources from today’s episode: 

 

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcript

SPEAKERS

Jack Penner, Zach Slavitt, Dr. Bob Wachter, Dr. Catherine R Lucey & Zoey Lyon

Andy Slavitt  00:00

I saw the new Mr. Rogers movie recently. You also remember what movies is that, right? And there was a sentence in it that struck me. And it’s one that I think is probably known to many of you. And he says: “when I was a boy, and I saw scary things in the news, my mother would say to me, look for the helpers, you will always find people who are helping.” And then that movie after I heard that line, it made me realize that what I want to be, all I want to be, is a helper. All of my time being an entrepreneur, a public servant, a business person, leading the healthcare.gov turned around, a founder of a major nonprofit, an investor in underserved communities. That’s my dog. I realized what I was really aspiring for. And that’s just to be a helper. I think we need that in this time. I don’t care who you are. And I want to be helped to, I want to be helped by going through all this together because there’s no monopoly on getting through tough times. So I hope that this podcast does serve that purpose in some form.

Dr. Bob Wachter

Welcome to IN THE BUBBLE. I’m your host, Dr. Bob Wachter. You just heard a voice that should be very familiar to frequent listeners of this show. Hope you haven’t forgotten. That’s Andy Slavitt. And that was Andy on the very first episode of IN THE BUBBLE, which was on April 1 2020, and yet another one-year anniversary, but one that’s pretty meaningful for all of us, here on the show. So we thought we’d start out with a little clip of Andy to remember those early days. And to mark that I’m beginning today’s episode with a brief chat with the person whose idea it was for this podcast.

Dr. Bob Wachter

That wasn’t Andy, that was Andy’s son, Zach Slavitt, who is now finishing his freshman year at the University of Pennsylvania, which happens to be Andy’s alma mater, and my alma mater. So it’s a good time to check in with Zach and see how his year has gone and reflect on the origins of the show. So we’ve got a few things we want to talk about with you. And thanks for coming on. First of all, I understand as I heard the history of this podcast that this was your idea. First of all, true or not true? And second of all, if true, what made you come up with that idea?

Zach Slavitt  02:34

Okay, well, yeah, that’s true. I don’t know. Like, I had the idea for my dad to do a podcast like a while before. And then like, I don’t know, he started, like, kind of blowing up a little bit beginning of the pandemic. And so I was just like, okay, like, you should do this, because a lot of people do this. And people your age, listen to podcasts.

Dr. Bob Wachter 

Assuming their hearing still works. That’s what they do.

Zach Slavitt 

Yeah. But I just thought it’d be a good opportunity. Like he can get good guests. Honestly, like, initially, did not intend to like, be involved at all. But I don’t know that just kind of happened as well.

Dr. Bob Wachter 

What was his reaction when you suggested it?

Zach Slavitt 

He was just kind of like, oh, like, cool idea, initially, and then like, eventually, I don’t know, I don’t know what happened. But then eventually, he was like, into it, like, send out a couple emails, and just like, learn […]

Dr. Bob Wachter 

And did it come out the way you had hoped it would?

Zach Slavitt 

Yeah, I think so. Honestly, like, I didn’t know anything about podcasts going in. And I didn’t know like, how successful or not successful would be, but I just think, like, if I could so many people liked it a lot. And there’s cool guests on. Like, I personally learned a lot. So I don’t know, I think was definitely a success.

Dr. Bob Wachter 

I think so too. I was a big fan before. Andy called me and said: “would you like to do it?” You know, a lot of listeners got to know you before you left for school. So tell us how your first year at school has been?

Zach Slavitt  04:04

First year has been, I don’t know, it’s been fun. I think other people have probably had more challenging years than me definitely. So I don’t I can’t complain about anything. Even though obviously, it’d be a lot more fun normally. And I think, I don’t know, like, academically it’s like a little challenging doing stuff online. It’s hard to stay focused and stuff. And participate in class and everything. But it’s getting better I think, too, like, I think more and more fun things are gonna start happening like the weather changing to, it’s gotten warmer out. So people have been doing stuff outside. I don’t know. It’s just gonna keep getting better, I think.

Dr. Bob Wachter 

Yeah, I’m sure it will. What’s been the experience in terms of classes has been all virtual the whole year, or was it ever in person?

Zach Slavitt 

No, yeah, it’s been all virtual. A lot of them are asynchronous too. And I don’t know it’s just like, definitely easy to fall behind and stuff. Like a lot of people are falling behind. Like I’ve tried to stay on top of most things. Just like with all asynchronous lectures, and then like you miss a couple, and then they all add up, and then you’re like, way behind. Pretty easy to happen.

Dr. Bob Wachter 

And what’s been the kind of social and cultural experiences, obviously one of the big things that happens as a freshman, and obviously, it’s been different. How’s that all worked out for you?

Zach Slavitt 

Well, yeah, it hasn’t. It hasn’t been, like, impossible, like meeting people or anything, just because like, I don’t know, especially when it’s warmer out, we can do stuff. But obviously, like trying to be safe and everything and balancing all that can be a little challenging. Especially like when I hear older guys talking about, like, what they would do in a normal year, like this weekend, we would have had this big event, but we can’t this year. I don’t know. That’s a little frustrating. But it hasn’t been too bad, honestly.

Dr. Bob Wachter 

Yeah. What’s the thing that you’re missing most or looking forward to most as things get back toward normal?

Zach Slavitt 

I’m probably looking forward to go into like, big concerts like music festivals, stuff, like just like huge, massive things that like you obviously can’t do right now. Especially like, like with like, famous, like, musicians and stuff, like, stuff like that with friends and everything. A lot of fun.

Dr. Bob Wachter  06:09

Yeah, I’m a little worried that you’re going to name one of those famous musicians and I’ve never heard of that person. In fact, I’m almost 100% sure. Like you’re not talking about you know, Bruce Springsteen and Billy Joel and James Taylor.

Zach Slavitt 

No, definitely not.

Dr. Bob Wachter 

Have you heard of those people?

Zach Slavitt 

Oh, yeah, I heard of them.

Dr. Bob Wachter 

It makes me feel better. Of course not. But it might hurt your ears.

Dr. Bob Wachter 

Is that your favorites?

Dr. Bob Wachter 

Those are my yeah, I’d say Springsteen, Billy Joel, James Taylor. The problem is, I think there is nobody that I listened to that I did not listen to in college, which is really disgusting.

Zach Slavitt 

Okay, that’s probably going to be me honestly. Like, I don’t know. I don’t Yeah, I’ll probably be the same way with like the current music now.

Dr. Bob Wachter 

Yeah, it just happens. You sort of can’t believe that it would happen because it feels like your parents, but you turn it to your parents. It’s very weird. How about you looking for the sports games?

Zach Slavitt 

Oh, definitely. Yeah. I don’t know. I don’t know if those Penn sports games are too exciting. Whatever. But I don’t know. It’ll be good to go with some sports games. Maybe some sixers games?

Dr. Bob Wachter 

[…]

Zach Slavitt 

Yeah, they still are.

Dr. Bob Wachter 

It’s great. You know, even though the teams aren’t great. It’s just when it’s your team. It’s pretty cool.

Zach Slavitt 

That is true. And like, I don’t know, the fact that one team from the Ivy’s goes to the tournament every year. Kind of exciting.

Dr. Bob Wachter 

Yeah. Usually for one game. So, Zach is there anything you want to say to your dad, now that it’s been a year of COVID, he’s had these amazing roles, both during the podcast and what he’s doing in the White House?

Zach Slavitt 

Yeah, just like we’re all like, so proud of like all the work he’s done in the last year, like, so busy, like not getting any sleep, and just doing everything he can to try and make the whole situation better. So just a great job.

Dr. Bob Wachter 

That was wonderful. And he deserves I know how hard that is. I’m trying to think what my kids would have done if asked to say that about me. But he actually truly deserves that. He’s a remarkable guy. And you’re a great kid. I’m glad things are going okay for you. And yeah, next year will be better. And a more regular college experience. And I think you’ll love it.

Zach Slavitt  08:11

Thank you. And yeah, and good job on the podcast.

Dr. Bob Wachter 

Thanks. Appreciate that. See, that’s easy to say when I’m not your dad, right?

Zach Slavitt

Thank you.

Dr. Bob Wachter

Well, a special thanks to Zach not only for spending some time with us, but for coming up with the idea of this show, which I know has been so meaningful for so many people. And I’m glad things are going reasonably well for him although it’s got a hurt I think back on my freshman year and some of the very human experiences as you were breaking out of the shell of living with your family. And obviously that’s been a very different experience for Zach and all of the freshmen out there. And it sounds like it’s getting better and it will continue to get better. So I wish him and all finishing freshmen just a fantastic and exciting sophomore year.

Dr. Bob Wachter

Well, as long as we’re on the topic of education, we thought it would be interesting to look at how this year of COVID has transformed medical education. We’ve spent a lot of time talking about elementary school and middle and high school education a fair amount of time about the college’s not so much talking about medical education and medical education has been transformed perhaps more than any of those other fields because it wraps up not only education and all the issues of trying to keep people safe and moving a lot of the education to online, but also the issue of actually taking care of COVID patients and trying to figure out how to do that effectively and safely.

Dr. Bob Wachter

So we decided to look at medical education and its transformation through the eyes of three different people get three different perspectives. A one that of a medical student just entering her clinical rotations the way medical school works is first year so the classroom. And after about a year and a half, you begin going into the hospital in the clinic seeing real patients. We also looked at it through the eyes of a resident, who was making a transition from the intern year, which is mostly about getting the work done to this very special role of being a second-year resident, where you take on much, much greater responsibility not only for delivering the care and supervising the care of some very sick patients, but also for teaching and supervising interns and medical students.

Dr. Bob Wachter  10:30

And finally, we thought it’d be useful having the perspective of a leader in medical education, someone who has had to reorganize her educational programs on a dime, and also to make sure the trainees were safe, and that the institutions that depend on them to deliver clinical care could continue to do so for both COVID and non-COVID patients. To find these three people, I decided to look pretty close to home at my own institution, UCSF, in one case, I chose to look very close to home. And that was with the medical student who is my daughter, Zoe Lyon, who in March of 2020, was just beginning the third year of medical school at UCSF, and I can tell you for the past 10 years or so she’s been really looking forward to going to medical school, but particularly to that moment where you leave the classroom and actually begin taking care of real-life patients.

Dr. Bob Wachter 

So she was about a month into that when COVID hit, and this incredibly formative year was transformed. We’ll also hear from Jack Penner, Jack was a second-year resident at UCSF, again, this extraordinarily formative year. And jack will talk about how this changed the nature of residency training. And for a leader in medical education, I didn’t have to look far for that either. Catherine Lucey is our Dean for medical education at UCSF, and she is truly a national leader in thinking about innovation in the training of physicians and as has been a leader of multiple institutions and a national leader in that. And so I really wanted to hear her perspective on how the year has gone. So we will begin with a conversation with Zoe and Jack, and then bring on Catherine toward the end. Let us start with Zoe, and Jack.

Dr. Bob Wachter  12:18

So Zoe, I’m not sure everybody understands how medical school works. So tell us about where you were in your studies when COVID first hit.

Zoey Lyon 

So when COVID first hit, I was in the first third of my clerkship year. So I was on clinical rotations, which happens for UCSF students after their first year and a half in school. So we’ve technically only been in school for a year and a half, but then we become third year students, and we leave the classroom and enter the hospital and start rotating. So when COVID hit, I had finished one and a half full rotations.

Dr. Bob Wachter 

So the first year and a half really is being in classrooms not that different than what it might have been in college. So you’re learning new stuff. And then it really toggles into something very different, where you’re going into hospitals and going to clinic and seeing real patients.

Zoey Lyon 

Yeah, so it’s basically you go from learning in a classroom to essentially working every day, and really kind of doing the thing that you thought you were going to come to med school to do.

Dr. Bob Wachter 

So you’ve been waiting for however many years you wanted to be a doctor, and here you are, and you’re about to start doing the real patient care thing, get out of the books, get out of the Internet, and really take care of patients. And maybe it sounds like a month or two into that this hits. When you heard about it, did you kind of have a sense of how disrupted your education would be? Or did you think it was kind of going to be a month or two of, of maybe it’ll be a little different than I’ll get back to normal.

Zoey Lyon 

Definitely the latter, I could not have imagined how disruptive it was going to be, not disruptive necessarily, in a bad way, just disruptive in a change way. I thought maybe things would be a little bit different for two weeks, maybe a week or so because that’s what the school initially told us. And then 16 weeks later, we had a plan. Yeah. So no, I don’t think I could have imagined at the beginning how different it would be. It was not the year that I was expecting. But there were some wonderful meaningful surprises that came out of it.

Dr. Bob Wachter  14:21

So let’s just talk for a second about what you did. So okay, you’re supposed to be going into the hospital and taking care of real patients and talking to them and examining them and being on a team and let’s say after the first week of to have everybody not having any idea what to do. They figure out a plan. And I know they did because I kept paying tuition. What was the plan that you had? What did you actually do for your education, given that you’re no longer going to be doing the clinical rotations you’re expected to do?

Zoey Lyon 

Yeah, so basically, so I left the hospital on a Friday afternoon and then San Francisco shut down essentially and that Sunday, we got an email from the school saying no third year students should return to clerkships on Monday. We had a series of meetings with all the education deans, I think that week. And then they basically said, sit tight, we’re coming up with a plan rapidly. And we’ll let you know. And essentially, what ended up happening is that we stayed out of the hospital, I guess, for 16 full weeks. And what we did was we did all of the didactic components of our clerkship year so UCSF kind of interweaves classroom didactics, with the clinical learning in the clerkship year. And so we did all of that up front, we took all of our shelf exams in a 16-week period, which was a really..

Dr. Bob Wachter 

What’s a shelf exam?

Zoey Lyon 

A shelf exam is a comprehensive examination that you take at the end of each clerkship that tests your medical knowledge for the clerkship. So like you do them for psychiatry, surgery, internal medicine, ob-gyn, pediatrics, neurology, and then we did one for family medicine as well. So we essentially had three-week blocks of learning for each of those different rotations.

Zoey Lyon  16:12

And then we had like self-directed study time, I think, actually Jack was, he was like a small group leader for me when I was doing my, my internal medicine didactic component, which was great. And so we did all this upfront kind of classroom learning that we would have done in a longitudinal fashion, had the year not been disrupted by COVID. And then we did these, these shelf exams, the kind of clinical knowledge learning portion, in a very compressed time period.

Dr. Bob Wachter

What was your sense about the degradation of learning? In other words, how important is it to actually see real patients, I assume what you did with Jack and others was read about cases, hear about scenarios of patient comes in in a shorter breath and has a fever. So how important is it to actually see real people?

Zoey Lyon

I would say vitally, vitally important. I think that it was really such a mindset shift going from being in the hospital one day and kind of flexing those muscles and interviewing real patients and seeing things in your life to then going back to the classroom, I had to really like, honestly dig very deep to find a lot of meaning in that, just because the clinical having gone from the clinical experience, and then being taken out of it, it was really sad. There’s really no substitute for seeing patients in person, you know, I can do a million questions about hyponatremia.

Zoey Lyon 

But then actually seeing a patient who’s actually manifesting those symptoms, like that’s what really sticks with you, I think you and Jack can probably both speak to that experience. So it was, it was a really big shift, I think. And then going back to the hospital after we had done this, this kind of very compressed didactic learning. While they were figuring out how to restructure our year, I was then just reminded that there again, there is no substitute for seeing patients in person and really doing the daily work and understanding what it means to be a physician.

Dr. Bob Wachter  18:13

Yeah, I think people probably have a hard time understanding. It’s not just seeing an actual person and examining actual person, there’s a rhythm to the way that the hospital and a clinic work and what everybody does, and who does what they can’t get out of textbook, right?

Zoey Lyon 

Yeah, absolutely. I mean, even you know, being a clerkship student, like a third-year medical student is hard at baseline, it’s oftentimes like, okay, like, where am I going to put my body in this situation? Like, am I standing in the way of the resident? Or, you know, am I like taking up too much space here? Or I like how do I do this in the EHR, and like, the learning curve for those things is so steep and so I think, and that’s the stuff that just takes time. And so losing all of that time, or having that time restructured, I think that was what was hardest was then jumping back in and then having to kind of restart that learning curve again.

Dr. Bob Wachter 

Got it. So I’m gonna do a little translation. So hyponatremia, earlier was a low sodium level and EHR is the electronic health record. That’s a computer that we use it. One of the things that happens that when someone goes from layperson to being a doctors, they start speaking a different language. It’s hard to remember kind of what the normal language was. You mentioned that there were parts of it that were really hard and, and challenging and depressing. And then there were parts of it that somehow were positive, what were the positives?

Zoey Lyon

So I had a really cool opportunity to take on essentially a COVID related project while we were figuring out how the year was going to proceed. And so I was really involved with this project at San Francisco General, setting up like iPad visits for patients who couldn’t have visitors to the hospital. Due to the visitor restrictions, and I was actually in the hospital multiple times per week, essentially running this service where we would take iPads into patient’s room and then visit with the families over Zoom. And it was extremely gratifying to be able to connect with patients in that way.

Zoey Lyon  20:11

And just be back in the clinical environment and also build something from the ground up that seemed really meaningful for patients and for providers, because I think there was a lot of strain on doctors and nurses and everybody who couldn’t say yes, your family can come to the bedside. And so people were really grateful for our service, I think, San Francisco General themselves, they were really grateful. It was cool to kind of like redeploy ourselves in that way, since we couldn’t actually participate and care for patients, we could contribute in this way.

Dr. Bob Wachter 

Any particular scenarios or stories that you recall from that it was really meaningful […]

Zoey Lyon 

Yeah. And so there are a few Zoom calls, where we actually facilitated basically, end of life goodbyes for patients whose families couldn’t come because it was this was even before you could have one person come for end of life. And so without going into like, kind of too much emotion about it, it was very, it was extremely poignant, and profound and difficult to have to see that happen over Zoom. I think at one point, my therapist told me that I was acting as a death doula, which I thought was odd. But appropriate. But those were the most meaningful things I think we’re being able to have people say goodbye to their loved ones.

Dr. Bob Wachter 

Yeah, it’s hard for, if you haven’t had a family member, or someone who’s been in the hospital and very sick, and particularly this issue, that they’re heading toward the end of life. And the idea of trying to do that without your family member being allowed to be at your bedside, it’s just brutal. And the idea that you were able to ease that somewhat through the iPads is really, that’s pretty profound.

Dr. Bob Wachter  22:12

Let us turn to Jack. So Zoey kind of described the life course of a medical student, Jack already went through that. And then you became this thing called an intern and then a resident. And so describe what that is, and then what stage you were at when COVID hit?

Jack Penner 

Yeah, so I was in the second half of my second year of Internal Medicine Residency. So I had gone from being a fourth-year medical student to then being able to sort of move from this middle phase where you’re both a student and a worker on the different services in the hospital, to being primarily a worker where my training was also a part of my work itself. And so in the intern year, you move from being a fourth-year medical student to a first-year resident. And during that time, you’re really sort of learning via immersive work in the practice of a physician. And so for me, as an Internal Medicine physician, it was a mixture of working on inpatient hospital services, as well as working in the clinic.

Jack Penner 

And then after your intern year, where you’re really learning by primarily being the person who’s doing the work, you get to transition into the second year of resident, where you take on a new role of still doing the work itself, but then also supervising other learners who are also doing the work. And so as a second-year resident, I was supervising interns, I was also supervising medical students, but at the same time being supervised by an attending physician who was shorter, I would say, ushering me through this next phase of training throughout the second two years of Internal Medicine Residency, so I was about halfway through residency training overall. And maybe 8 months or so into that second year of residency.

Dr. Bob Wachter

Okay, and so you hear about these cases happening in China and Italy. And it’s clear that it’s coming and you’re in San Francisco, and it’s probably going to come in a big way. For Zoey, it transformed it as in, you know, she’s changed from real, second or third year to Zoom University. For you, I assume we did not boot you out of the hospital, you stayed at work. So what was that, like?

Jack Penner  24:14

So much of learning in residency and practicing and residency is driven by the structure of the services that you’re on, but also this sort of informal passive learning and practice that happens just by means of being in the hospital. And I think because that environment changed so much in terms of what types of social interactions you’re able to have in the hospital, the opportunities to get to interact with your colleagues and your supervisors, just like in the hallways of hospitals and in the work rooms, I think that felt like a tangible shift right away. And then of course, there was also the fact that many of the hospital services were restructured in a way where there was now the ICU team and a COVID ICU team.

Jack Penner 

There was the inpatient medical service and then the inpatient medical service that was taking care of COVID patients because we were trying to cohort them together. For me early on, that meant that some of our clinic time changed a lot, because all of a sudden, we weren’t necessarily going into the clinic itself, but doing virtual clinic, and then also having had the opportunity to be a part of caring for patients in the intensive care unit with COVID during the early parts of the pandemic, I think those were both really rich and new opportunities. And also the changes I think, made being a resident feel a lot different, and I think in in ways that are ultimately hard to quantify. But a lot of that sort of social fabric of training really felt like it degraded, necessarily to keep us all safe.

Dr. Bob Wachter 

You’re young, I assume that you know, the data would say, even if you got COVID, you’re probably going to do okay, but nevertheless, you’re being exposed to a whole lot of patients with COVID. How scared were you?

Jack Penner 

It varied from low level anxiety to moments of feeling true fear. And I think as time went on the anxiety predominated over the fear, but I can remember in March, having potential exposures to patients who had upper respiratory symptoms, and we just didn’t know and some of the testing algorithms weren’t in place yet to get answers right away. And so it was taking days. And I think, you know, our whole I was, it was a bit surprising, because I feel like our whole job in some ways is learning how to manage and navigate uncertainty. And when that uncertainty feels like it’s directly impacting you, it felt a lot different.

Jack Penner  26:22

And so there was definitely moments early on a feeling fear at what might happen to me or God forbid, I live with a partner who doesn’t work in medicine, and God forbid, I exposed her unnecessarily or potentially got someone close to me sick who wouldn’t otherwise have been exposed. And so I think they, it slowly settled into a low-level anxiety about it. But even that anxiety, I definitely has felt what tangible in different ways throughout the better part of the last year.

Dr. Bob Wachter 

Had any of your colleagues get sick from work exposures?

Jack Penner 

I have had one close co-resident who did contract COVID while we were working together in the COVID-ICU.

Dr. Bob Wachter 

Zoey, you one of the sort of life stages you were at was needing to figure out what you wanted to do for a living. People think, well, I’ve decided that I’m going to be a doctor. But that’s usually about 500 choices you need to make once you’ve decided you wanted to be a doctor. So has this experience influenced that at all?

Zoey Lyon 

Yes, and no, I mean, I think it was hard. It was hard having kind of such an abrupt stop after doing one and a half rotations, because I had done my entire surgery, rotation and half of my psychiatry rotation. And so for a while I was I kind of thought I wanted to be a general surgeon, because that’s all that I knew, really, in terms of the day to day other than my exposures to other parts of medicine, prior to my third year, but I, I went on kind of like a windy road coming back into the hospital, after we were out and circled back to Internal Medicine, which is what I came into med school thinking that I wanted to do.

Zoey Lyon  28:00

And I was also interested in critical care before COVID. And then COVID only made me more interested in critical care. So I’m grateful for that it allowed me to have a lot of exposure to how dynamic of a field it is. And I’ve been able to work on some COVID research and connect with people who are very, who are working in the space really closely. And I think that those are opportunities that might not have opened up otherwise. But there are also things that I feel like you know, I spent like eight days on a neurology service total. And so I just I kind of have no idea like maybe I was supposed to be a neurologist, it just like wasn’t enough time.

Dr. Bob Wachter 

And Jack, people are gonna find this really weird. So you think, alright, I’ve chosen to be a doctor. Now I’ve got to make a choice. And the choice is Internal Medicine versus surgery versus Neurology. You chose internal medicine; you still have a ton of choices ahead of you. So how did, how did this experience influence your choice, because you could then do all the sub specialties of Internal Medicine, cardiology, oncology, etc, primary care, hospital medicine, administration, epidemiology, sort of, you know, it’s still pretty wide-open field. So how did you think about that change?

Jack Penner

Early on when COVID was happening. And there was lots of changes happening to the residency structure, there was a chunk of time where I had clinic, but I didn’t really have that many patients to see, I wasn’t working in the hospital during sort of that phase of residency training so I assume we had a lot of time to kind of sit and reflect and do some self-directed learning and some and a lot of reflection. And I think for me, I think that time in the spring retrospectively was really important to kind of have the space in residency to ask myself, what are the things that I really enjoy about my own training? What are the things that I really want to continue to do and I think getting to be on the frontlines throughout the pandemic has reinforced a desire to really be a primary provider, and a primary provider within the hospital setting.

Jack Penner 

And so for me, I kind of started the pandemic thinking about a career in infectious diseases and have come out the other side as much as we are now wanting to pursue a career as in general inpatient medicine, specifically in the hospital setting. I know that for many people, infectious disease clinicians really became superheroes. And it’s probably one of the things that is going to be incredibly popular for the specialty. But for me, it did create a bit of a pause, and if some really valuable time to reflect during residency training, which we really didn’t get to have, and or I should say, which we don’t oftentimes get to have. And I think that space and time to reflect helped me realize where a lot of joy for me came clinically. And I think hospital medicine has ended up being the space that I set up on there.

Dr. Bob Wachter  30:33

Great. Yeah, we did a show last week about the lessons from HIV AIDS for COVID. And those were my formative years, basically the same stage that you guys are at. and Carlos Del Rio from Emory was on and he talked about how he was sure he wanted to be a cardiologist, and then AIDS hit. And that’s how we decided to do infectious disease. So whether it’s gravitating toward the specialty itself, or just giving you a chance to think about it in a slightly different way. You know, a lot of people make different choices. I understand medical school applications are up. Are you surprised by that? Either one of you? Zoey, are you surprised by that? No, I

Zoey Lyon 

No, I don’t think so. I mean, this is the best job ever. No, I don’t think that’s surprising. I think, you know, if there’s any, there’s still so much like romance in this profession, I think. And it was only further that was further amplified, I think throughout the pandemic.

Dr. Bob Wachter 

Jack, are you surprised that just made the field apparently more attractive for now?

Jack Penner

I don’t think so. I think you know, I’m really happy to see that I actually, that’s a new stat to me. And I think, you know, one of the things that I’ve noticed from sort of consuming a tremendous amount of popular culture content over the course of the pandemic is that I think, for a long time, a lot of what was what I feel like was talked about medical school was, you’re going to go to medical school, you’re going to be in a ton of debt, you’re going to work really hard and a lot of physicians burnout. And I think there was because of physician voices becoming more and more prominent throughout the pandemic, it did I think expose the general public to a lot of the pain and tragedy and hardship that physician saw during the pandemic.

Jack Penner  32:09

And that families of patients who had COVID also sigh and I think the opportunity for those stories to be shared. And my hope is that it added a new layer of meaning to the type of work that we get to do meaning that I know that I have felt throughout medical school and residency training. But that was always hard to communicate, you know, there’s perspective pieces in medical journals. And those aren’t always read by people who might be considering a career in medicine. I think so much of the humanity of this practice, it seems like has been able to be disseminated to the general public now.

Jack Penner

And I and yes, like it has been really hard and really emotionally challenging throughout the last year to sit with grieving families and to see patients dying alone. And there has been a huge opportunity to infuse meaning into that. And I hope that people who are considering a career in medicine are able to see that because it has been really hard and an unforgettable time and training for me so far. And so yeah.

Dr. Bob Wachter 

Yeah, I think that’s right, I’d add that it’s also the most interesting thing you can imagine. I’ve always felt now 40 years later, that’s the privilege and having lived through the early years of HIV and AIDS, you know, it’s hard and it’s disruptive. But you will look back on this, I’m not sure fondly, but you will realize how profoundly it’s changed you in the many things that you’ve learned, learned from it. So thank you for taking the time to talk to us today. It’s been fascinating. And thanks for all the great work you’ve done over the past year.

Jack Penner 

Thank you so much, Bob, I really appreciate the opportunity.

Zoey Lyon

I didn’t do any great work. But thank you.

Dr. Bob Wachter 

I saw you on Zoom, I saw you doing some really great Zoom work.

Dr. Bob Wachter 

Special thanks to Zoe Lyon and Jack Penner, really interesting. And in many cases quite moving, I had a chance to watch Zoe up close in person go through the year, and the challenges of trying to learn online and realize what you’re missing. But also, I was extremely impressed by the medical students at UCSF and how they really felt the need to contribute in different ways. If they couldn’t be there taking care of patients. The residents did an amazing job. Just rolling up their sleeves and learning to do this work is incredibly important work in very, very new ways. And I’m on clinical service now. And I come into the hospital and as Jack talks about this, the change in kind of the sociology and the culture of the place that’s very real.

Dr. Bob Wachter  34:47

My team is in one conference room with four people and they sit there all day they go out and see the patients and then come back and it’s this room and in the next room is another group of four or five residents and students attendings, and we have about 10 of them scattered around the hospital. Whereas in normal times, they would all be sitting in one big communal room, a lot of sharing, a lot of learning a lot of laughing, a lot of commiserating. And that has really been broken up for obviously, for really, really good reasons. But I think was useful hearing from them and looking forward to things getting back to normal for them as well. So now let’s get the perspective of a medical educator and medical school Dean and administrator and bring on Catherine Lucey.

Dr. Bob Wachter

For this episode, I spoke to medical students Zoe Lyon and resident in medicine, Jack Penner, we talked about their experiences over the past year, why don’t you tell us about your experiences over the past year? Tell us about the early days when you heard about China? Or maybe Italy? Or maybe the cruise ship kind of you had a sense this was going to change things in some ways. Did you have any sense it would change things as much as it did and that it would last as long as it did?

Dr. Catherine R Lucey  36:08

Yeah, it’s a great question. You know, people keep using the word unprecedented in terms of the COVID pandemic, and certainly it was unprecedented in terms of scale, and scope, and disruption in every sort of organization you can imagine. But it really isn’t unpredictable. I mean, Bob, you and I were physicians in the HIV pandemic. And there have been lots of other pandemics and crises that have impacted medical education in the time that I’ve been a physician. And so when we started seeing things, particularly Italy, I think what’s really what began to make us very anxious, because we realized that if the United States was going to be subject to as much disruption as Italy did, we would really have to fundamentally change the way we conduct medical education.

Dr. Catherine R Lucey

For a lot of different reasons, for scarcity of PPE, and scarcity of faculty, all the way to concerns about risk and inappropriate risk, perhaps for early learners in medical education. So we began to sort of mobilize and think about what were we how are we going to make decisions in a very dynamic environment? But I don’t think we were really as creative or as, as we might have been in imagining what type of disruptions were going to be in store for us.

Dr. Bob Wachter 

In the clinical environment, Telemedicine felt like the biggest pivot, you know, we went from 1 or 2% telemedicine to 70% telemedicine and probably did 10 years of innovation and transformation in a month. How important was that in the educational environment? And how does that change your thinking about the environment as COVID recedes, hopefully into the rear-view mirror.

Dr. Catherine R Lucey

Yeah, I was very impressed with that. And that’s another sort of COVID I think benefit from COVID. You know, I laugh a little bit, because I think maybe a full decade ago, the state of California invested in telehealth opportunities and they just didn’t catch on with the exception of our colleagues in neurology and pediatrics, I think have been kind of leaders in telehealth. It was helpful in education wasn’t a predominant strategy in education because honestly, the faculty needed some time themselves to get used to what telehealth looked like before they had to simultaneously engage in telehealth and teach a medical student how to do telehealth.

Dr. Catherine R Lucey  38:23

So we were really conscious of faculty bandwidth and wanted to give them a little bit of time for that. But eventually, students were actively participating in telehealth, and many of the early students helped, for example, seniors who were not technology comfortable by preparing them. So they found different opportunities to serve the community. For example, by helping seniors set up their telehealth appointments and preparing them to work with doctors that way. It certainly is affecting medical education going forward, because we have to prepare the students to be able to deliver care in person and online.

Dr. Catherine R Lucey 

And I think that there are some really wonderful Patient Centered philosophies we can do is you know, you can really meet the patients where they are and minimize their burden of getting to the doctor. And I think that’d be really positive. At the same time, we have to teach students to recognize and resonance to recognize, when does an individual need to come in for an exam? What can you do in terms of an exam over the teleconference, those are pretty advanced skills, but I think beginning to introduce them into the medical education environment is going to be an important part of subsequent work. Starting now and following the pandemic.

Dr. Bob Wachter 

We’ve talked a lot about how COVID changed the past year in terms of medical education and how it may lead to some changes in the future. But the year was also characterized by all of the issues around racial justice. How did the layering of that on top of COVID influence your approach this year and how do you think it changes things going forward?

Dr. Catherine R Lucey

I think that the issues, you know, the health consequences of structural racism and our responsibility to prepare not only physicians who use their professional competencies in the office, but use their cognitive abilities and backgrounds to be really effective citizens that write social wrongs. And some of them will do that as advocates and some just by voting in the elections and advocating for particular political approaches is really going to be pivotal to our success going forward, if we want to meet the needs of our communities, we’ve been working on issues of equity and education and teaching students about health care disparities for several years now.

Dr. Catherine R Lucey  40:38

But I do think this last year, kind of put the pedal to the gas. And I think appropriately so you know, institutions, academic healthcare institutions, medical schools, colleges, they’re built for inertia in many ways. And I think the COVID pandemic and the racial justice reckoning really have catalyzed work that has been proceeding but proceeding at a pace that’s inappropriately slow. When we think about the lessons of COVID, in the year 2020, and the year 2020, preparing our learners to not only be pandemic ready, but to be able to identify, address and prevent healthcare disparities in the future, are going to be guiding principles that we use going forward, in many ways, major disruption allows you the freedom to innovate in a lot of areas, not just ones that seem to be obvious for the pandemic has been the case for that.

Dr. Catherine R Lucey

So I’m excited about this. I think our learners are farther ahead than many of our faculty. But together, I’m confident that we can build a better workforce that not only is better prepared for the next pandemic, but hopefully, has already addressed the issues of structural racism that are embedded within our institutions and interfere with us providing the right care for all the patients that we serve.

Dr. Bob Wachter 

Great. Maybe last question, as you mentioned, you and I trained during the early years of HIV. And now as we look back on that training experience, it probably changed us in ways that we didn’t understand at the time, as you reflect back on that, and you know, how maybe 10 years ago, how long ago was that 10-15 years ago? What do you think today’s trainees will think as they look back on this year of COVID?

Dr. Catherine R Lucey  42:28

I think they’re going to look back. And first of all, they’re going to be the types of individuals who understand that legacy practices or legacy practices. And if there’s a reason to change something, we should change it. And I think we found that in the HIV pandemic, you know, when sometimes you deliver care in a specific way, because it’s always been that way. And oftentimes, it’s a pandemic that disrupts that and requires you to think differently about it. So I think they’ll be empowered to think about changing legacy practices.

Dr. Catherine R Lucey

Secondly, I think they will look back on this the same way we did in the HIV pandemic, about how critical it is to work across the medical professions and across disciplines to solve complex problems on behalf of society. You know, physicians can’t work effectively without pharmacists, and nurses and techs and respiratory therapists and environmental services people. And we can’t solve problems with just science that’s done in a under a hood. We need community advocates, we need sociologists, psychologists, epidemiologists. And so the need for broad expertise in multiple disciplines, I think will be embedded in these students forever.

Dr. Catherine R Lucey

And I think the third thing, you know, much as we learn to advocate for marginalized populations that were, you know, disproportionately impacted by HIV, I think that students will see this as a real reckoning and the responsibility of looking deeply into working with communities of color, and people who have been historically marginalized by medicine, and responding to their needs, and with their expertise, changing the system so that we better serve those communities. So that came out of the HIV pandemic, I think, and mark your career, my career. And, you know, that epidemic spawned a lot of leaders of American medicine, and I hope this pandemic will be similarly impactful in that way.

Dr. Bob Wachter  44:19

Yeah, I almost no doubt that it will. It’s inevitable. And as I’ve told, you know, students and residents, this is changing in ways that are hard to understand in real time, and no one will wish this on anyone. But in the end, it has some positive effects and certainly sensitizes people to the plight of patients and the needs of the system to work in very different ways. So, Catherine, thanks so much. I really enjoyed it.

Dr. Catherine R Lucey

Thank you, Bob. It’s great. I appreciate your invitation.

Dr. Bob Wachter 

The great big thing to Catherine, Zoe and Jack, I think you now have a good picture of what it was like to be in the medical educational system this year and some of the hardships, some of the poignancy some of the tragedy. But also some of the innovation, as Catherine said, institutions like this, and I think medical education is probably no different than any other professional education and maybe not all that different than, than colleges and universities, but they don’t innovate that easily. They’re big battleships, they’re kind of hard to turn around.

Dr. Bob Wachter 

And sometimes crises like this, provide the opportunity to rethink things that you probably should have been rethinking all along, but you just don’t. And I think some of the changes that will come out of COVID will turn out to be quite positive. I am very much looking forward to seeing that. Well, we have some more great episodes coming up here on IN THE BUBBLE, another UCSF colleague, Monica Gandhi, who’s an infectious disease and HIV specialist, who’s become very well known nationally, in some of her writing and her social media and the regular media, for advocating for a bit more optimism and a bit less glumness in our approach to COVID.

Dr. Bob Wachter  46:15

Particularly as it comes to vaccine she thinks that we have been over emphasizing the downside, the variance, all of the bummer stuff, and not celebrating enough what miracles these vaccines are and some of the things that people she believes can and should begin doing safely in. The day we spoke was a particularly interesting day because it was the day that CDC director Rochelle Walensky described her feeling of quote, “impending doom”. So interesting talk with Monica about that, and how to sort of where the needle should go between optimism and pessimism, particularly in this time where vaccines are rolling out very fast.

Dr. Bob Wachter

Cases are coming down in many parts of the country. In San Francisco, there’s just a handful of cases a day, in London as Monica will point out, there was not a single death today, and yet we see upticks in cases in parts of Europe, and in some states in the United States. So it’s a little head spinning to try to figure out where one should land in terms of optimism and pessimism. But I think Monica has become really an interesting and useful spokesperson. As we try to calibrate our own mood. We’ll also talk to Rhea Boyd. Rhea has been a national leader in thinking about the impact of COVID on communities of color, particularly the black community and spokesperson for some of those really important issues, particularly with the layering of COVID and issues of racial justice.

Dr. Bob Wachter

And the issue of what to do about the kids remains as resonant as ever and it’s not only about the schools, but now it’s about summer camps. It’s about travel, and if I’m vaccinated, can I bring the kids as usual 100 complicated issues around the kids. So we will bring back Paul Offit who’s very well known as a vaccine expert, but he’s also a pediatrician at the Children’s Hospital of Philadelphia. And he’ll be joined by a to be named a child psychologist. And that will be a ToolKit. So we’ll look forward to fielding your questions about what about the kids. So until then, stay safe, get vaccinated as soon as you can, and I look forward to talking with you soon.

CREDITS

We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced our show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produced the show. Our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @InTheBubblePod. Until next time, stay safe and stay sane. Thanks so much for listening.

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