Medical student dermatology rotations in the context of COVID-19

Dear Dr Dermatoethicist: We frequently have medical students rotate through our department but, because of the COVID-19 pandemic, we are hesitant to accept rotating students at this time. Although we want to optimize the educational opportunities these students receive, we do not want to endanger trainees, staff, and our patients. Additionally, we are concerned about the impact that this may have on students interested in applying to dermatology. What should we do?

—Worried Program Director

Dear Worried Program Director: Deciding whether to accept medical students in your department is challenging. Beneficence is at play because rotating through dermatology benefits medical students, and it is an excellent way for students to learn more about the field and help them determine if dermatology is in fact the specialty they would like to pursue. Additionally, rotations help students obtain letters of recommendation from academic dermatologists. Since the start of the pandemic, medical students rotating in dermatology have been temporarily sidelined as clinics have closed and are seeing only patients with emergencies. As we reopen, far fewer in-person patient visits are being scheduled, and many appointments are now virutal.¹ As a result, students may not benefit significantly from in-person rotations, and creative solutions are needed.

Nonmaleficence, or the avoidance of intentional harm, must also be considered. With the COVID-19 pandemic, there is a risk that medical students may become infected themselves and subsequently infect their patients and fellow health care workers if allowed to participate in clinical rotations.² Because medical students are learners and are not considered essential personnel, limiting their exposure to infectious patients is paramount.

Regarding the ethical principle of justice, limiting student rotations will harm certain groups of students more than others. Dermatology is a competitive specialty, and rotations and specialty-specific letters of recommendation have been cited as important factors in resident selection.³ Limiting rotations may thus disproportionately affect those with limited or no prior experience in the field. Similarly, students without home dermatology departments, who typically rely on away rotations to secure letters of recommendation, are likely to be disadvantaged as well.

Follow the guidance of your medical school and institution when deciding whether to allow medical students to rotate in person and ensure that they have access to appropriate personal protective equipment during in-person encounters if allowed. Prioritize safety while optimizing medical student education. Creative options include 1) sitting in on virtual lectures and grand rounds sessions, 2) participating in teledermatology care, 3) engaging in case-based learning, and 4) performing scholarly activities. Organizations such as the Association of Program Directors are devising novel ways to involve students in learning experiences at different institutions.

Because many students will not have the opportunity to rotate at various dermatology programs or obtain dermatology letters of recommendation before applying, this is an opportune time to endeavor to evaluate the applicants based more upon intrinsic values beyond their academic achievements and credentials, including their backgrounds and challenges overcome, whether their school has fewer dermatology opportunities, ties to a particular region, unique skills or interests, and aspirations.

—Dr Dermatoethicist