Table 1.

Key Challenges Faced in Medical Education During COVID-19 and Relevant Mitigation Strategies

Aspect of Medical Education	Key Challenges	Strategies to Mitigate Impact
The economic repercussions	1.Loss of income for institutions and training programs 2.Decreased funding for GME and CME activities	1.CARES Act provided relief to trainees participating in the Public Service Loan Forgiveness Program 2.Offer financial guidance to trainees and educators 3.Budget allowances for technological adaptation of education
Impact on equity, diversity, and inclusion	1.Amplification of cognitive stressors linked to implicit bias 2.Women trainees more likely to be affected 3.Students from disadvantaged background may be more affected by lack of away opportunities and direct faculty interactions	1.Use institutional resources or other open-access resources such as by the AMA to become more aware about implicit bias 2.Provide resources to address potential stressors (eg, child care or elder care facilities) 3.Implement strategies for factoring in impact of disruptions from unduly affecting application or interview process
Impact on mental health and wellness	1.Increased vulnerability to emotional suppression 2.Exposure to stigma and resultant loneliness 3.Development of mood and sleep disorders	1.Establish and promote a culture of safety, well-being, and empathy 2.Rotate trainees off high-intensity rotations regularly 3.Provide accessible mental health resources 4.Provide resources to stay in touch with family and friends digitally 5.Institute surveillance and address programs for burnout
Education delivery	1.Cancellation of in-person classes and training	1.Digitalize and encourage innovation in education delivery in the digital format
Medical students on the frontline	1.Prevent coercion into service 2.Development of feelings of guilt, shame, or moral injury by students not involved in direct patient care	1.Institute strict guardrails to ensure that student participation in direct patient contact activities is voluntary 2.Encourage involvement in nondirect care and nonclinical activities, including research and community service
Alteration of training for residents and fellows	1.Deployment of noncritical care specialty trainees to critical care areas 2.Development of deficiencies in native specialty training	1.Provide adequate clinical and on-ground guidance to redeployed trainees 2.Monitor progress and assess competence of trainees individually
Hidden curriculum	1.Redeployed trainees pressured to practice outside comfort zone 2.Fear about speaking up about redeployment	1.Ensure adequate supervision and support for trainees, especially those redeployed from noncritically trained specialties 2.Create opportunity to discuss redeployment with program and institutional leadership
Challenges with interviewing	1.Exacerbation of existing biases, especially against underrepresented minorities	1.Creation of structured interview process to avoid biases during interviews
Challenges with testing	1.Uncertainty about testing dates, testing sites, and deferral of testing	1.Ensure flexibility and open lines of communication regarding frequent changes in testing schedules 2.Acknowledge the uncertainty and provide plans in case testing needs to be deferred or cancelled
Impact on international medical graduates	1.Significant delays in visa processing and start times 2.Difficulty in finding waiver jobs 3.Inability to deploy to hotspot hospitals due to immigration limitations	1.Plan for late start and allow adaption time and resources 2.Assist graduating trainees in job placements according to their immigration needs 3.Deploy international graduates within native systems where immigration rules would not be challenged
Impact on medical literature and dissemination of information	1.Need for rapid dissemination of information to be balanced with accuracy of peer review 2.Rapid spread of misinformation	1.Maintain integrity of peer review process despite the pressure to publish the deluge of data 2.Create well-appraised literature banks that can be reliably used by clinicians and educators
Social media	1.Compromise of patient privacy 2.Creation and dissemination of insensitive content	1.Review the purview of the HIPAA regulations and ensure patient privacy even when sharing anecdotes 2.Careful creation of content keeping societal, social, professional, and personal responsibilities in mind

AMA = American Medical Association; CARES = Coronavirus Aid, Relief, and Economic Security; CME = Continuing Medical Education; COVID-19 = coronavirus disease 2019; GME = Graduate Medical Education; HIPAA = Health Insurance Portability and Accountability Act of 1996.