From Socialization to Isolation: MD Class of ’22 Responds Gracefully to Uncertainty, Challenges

Boston University School of Medicine’s Class of 2022: proactive, passionate, inspiring, resilient, creative, collaborative, gracious. Did we mention resilient?

During their first two years of medical school, members of this class displayed remarkable enthusiasm for collaborating with faculty and sharing their varied cultures with one another. Then the COVID-19 pandemic turned their medical education upside down, repeatedly delaying their first major licensing exam and the start of long-anticipated clerkships. When students eventually began clinical rotations, they often did so with extra layers of personal protective equipment (PPE) and the added anxiety of uncertain schedules and possible COVID exposure.

“Medical school is hard. It’s hard on a good day,” says Associate Dean for Student Affairs Angela Jackson, MD. Medical students endure intense academic pressures and deal with the extremes of human experience—suffering and death, joy and sadness, she says. “Emotionally, it’s difficult.”

For the Class of 2022, that emotional stress was compounded by constant changes in plans and protocols as the School tried to keep students learning while also keeping them safe.

“We all had to pivot on a dime to create resources and experiences for them,” Jackson says. “And they had to do the pivoting as well.” Students accepted changes and disruptions with grace, she says, “and that ability is something that’s absolutely applicable to the rest of their professional lives.”

Good doctors know how to make do with imperfect circumstances and uncertainty and how to respond gracefully in emergencies, Jackson says. “That ability to think quickly, to rework your plans and move forward—this class got a lot of practice with that.”

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First Year

Members of the Class of 2022 began medical school as most students do, focused on building study habits and social ties. At the time, they couldn’t have known how those habits would be tested or how important those ties would become.

The Medical School hosted a White Coat Ceremony for the 160 members of the class on August 2, 2018, after a summer filled with news about immigrant families separated at the US/Mexico border and Prince Harry and Meghan Markle’s royal wedding. Speakers at the ceremony noted the diversity of the class: 50 percent are women, and 22 percent are from groups underrepresented in medicine. Class members come from 36 different U.S. states and were born in 19 countries. Almost 85 percent speak more than one language, and as a group they speak 26 different languages.

During their first year, which was dominated by cycles of studying and test taking, class members made an effort to get to know one another.

“That was a highlight of first year for me—all the social gatherings with our classmates,” says Max Vaickus (’22). “And that was pre-COVID, so socializing could happen then.”

Class members held impromptu gatherings in their homes and at restaurants and bars to celebrate and unwind after exams. They organized ski trips, hiking trips and skit nights.

“Getting people engaged in the social aspects of medical school is a great way to address the isolation you can feel when you’re studying all the time,” says Jae Cho (’22), one of the social leaders of the class. “Having events where you get to form relationships is really important. You need that support structure when you’re in a really challenging environment.”

It’s especially helpful to build community early in your medical training, adds Delia Motavalli (’22). “Medical school gets progressively harder. You have less time the farther along you go,” she says. “So, the time that I really valued these relationships was when I was a third year and had so little time but was on the wards with people that I could talk to and could trust.”

Class members took time that first year to learn about classmates’ cultures. A group of dance enthusiasts, for example, started a dance interest group that met weekly to learn one another’s choreography, which ranged from Afrobeats to Indian folk dances. In January 2019, BUSM’s various cultural groups hosted the first-ever BUSM Culture Show, with the dance interest group providing the finale.

The Culture Show provided one of Maria Suarez-Gama’s favorite med-school memories. As a volunteer for the Delivery Resources, Education and Advocacy for Moms program, she spent most of the day of the show in the hospital supporting an expectant mother through labor—and nervously watching the clock. The baby was born just in time for her to hurry to Heibert Lounge to perform.

“It was such a memorable day,” Suarez-Gama (‘22) says, “to run over and change into my dance outfit and put on my makeup. The show goes on, right?” Being able to use her Spanish language skills to assist with a birth and then share her Colombian heritage all in one day confirmed that BUSM was where she belonged. “I really felt like I was in the right place, where I needed to be,” she says.

As the academic year progressed, class members got involved with existing efforts to improve BUSM’s curriculum, and several students approached BUSM deans with new ideas for enhancing medical education at the School.

Megan Alexander (’22) asked about better integrating lifestyle medicine—nutrition, exercise, stress management, healthy sleep habits—into BUSM courses and was thrilled to find the administration receptive. Alexander’s work has already resulted in changes to the way BUSM teaches medical interviewing and patient counseling, and she’s working with faculty to update instruction about hypertension, diabetes, and other conditions so that lifestyle changes are presented alongside pharmaceutical interventions.

“That’s the really important idea,” she says—that lifestyle medicine be incorporated into standard curriculum rather than being separated into its own module or elective.”

A group of social-justice-minded students suggested examining systemic racism’s impact on BUSM and its curriculum. Administrators helped the students form a Racism in Medicine Vertical Integration Group (VIG), which later published an exhaustive 139-page report that includes numerous recommendations for removing racist beliefs and stereotypes from medical education. Their work also resulted in the publication of a paper, authored by multiple members of this class and faculty, “Deconstructing Racism, Hierarchy, and Power in Medical Education: Guiding Principles on Inclusive Curriculum Design,” in Academic Medicine in November 2021.

Second Year

Members of the Class of 2022 began their second year of medical school with the increasing confidence of experienced medical students and ended their year facing many unknowns.

Members of the Racism in Medicine VIG knew their curriculum-development project would take time but wanted to begin making immediate impact, so they spent the summer before their second year creating an enrichment series, which they named Creating Leadership in Education to Address Racism (CLEAR).

“It was a six-series course that we rolled out over the next semester for students who are interested in learning more about racism in medicine—the history of it, how to identify it, how to combat it, how we even talk about race in medical education,” says Sabreea Parnell (’22). “We had about 40 students sign up for the course, which was incredible.”

Many class members used their free time to lead student groups and to volunteer in the community, riding the Outreach Van to take hot meals and basic medical care to immigrant communities in East Boston, providing comfort to newborns suffering through opioid withdrawals, and offering tax-filing help to low-income families visiting the medical center’s pediatrics wing.

Rachel Rockers (’22), who was balancing schoolwork with family responsibilities during her second year, didn’t have time to join her classmates in such activities, but was awed by their energy and passion.

“I am shocked and inspired by how proactive my younger classmates are in trying to make the world a better place,” she says. “That my classmates have this type of conviction and aren’t afraid to show it, I think it’s very inspiring for the future of medicine.”

Classes were winding down and students were beginning the intensive study period before their crucial Step 1 licensing exam when the COVID-19 pandemic began, sending everyone into lockdown.

At first, says Vaickus, the COVID quarantine didn’t disrupt student’s lives all that much, as they were already planning to shut themselves inside to study. But then their tests got canceled and rescheduled and rescheduled again.

“It’s such a finely orchestrated study plan that we put together,” Vaickus says. “Everything was laid out and structured, and then COVID threw a wrench into all of that.”

When Boston-area testing centers closed their doors, Paige Curran, assistant dean for student affairs, worked around the clock to help students regroup.

“Several of these students were canceled, not once, not twice, but on average five times to sit for this exam,” she says. “Many showed up at their testing site under the impression that they were scheduled to take the exam, and the testing center was locked.”

Many students managed to take their Step 1 that spring, either at a typical testing center or at temporary testing campuses that area medical schools worked together to set up at BUSM and at Brown University. Others ended up waiting months to take the eight-hour exam, severely testing their ability to retain knowledge and maintain intense study.

Rockers chose to delay her exam to the fall, which she says was both a blessing and a curse. During spring 2020, Rockers was caring for her ailing mother, mourning the loss of her father-in-law, and without childcare for her newborn and toddler. While she’d have liked to tick the Step 1 off her list earlier, she says, she appreciated the opportunity to care for her family during quarantine, knowing she had the flexibility to test later.

Curran was impressed by the grace with which students accepted such a major disruption to their academic schedule and with their willingness to collaborate with faculty and staff to make new testing plans.

“The fact that they did not lay down and stay down is just remarkable,” she says.

Third Year

COVID influenced nearly every aspect of the Class of 2022’s third year of medical school, just as it affected nearly every aspect of American life at that time.

Third-year clerkships, a highlight of the medical school experience, were set to begin in May 2020. Boston Medical Center and affiliated sites and practices, however, were so overwhelmed with COVID patients that it didn’t make sense to begin clerkships then, increasing the density of healthcare workers in limited spaces and putting students at risk of exposure. Assuming hospitals and practices would be in better shape come fall, BUSM administrators quickly reworked the third-year curriculum so the Class of 2022 could delay its clinical start but still graduate on time. Clerkships are typically a mix of classroom and hands-on learning; for this class, all classroom lectures took place virtually over the summer. When students later entered the hospital for clinical experience, most of their rotations were shortened by two weeks but were entirely focused on hands-on learning. Faculty worked hard to make the virtual learning period as productive as possible, says Associate Dean for Medical Education Priya Garg, MD, walking students through virtual cases and even mailing them sewing kits for suturing practice.

While creating the two-week virtual modules from scratch on such short notice was an amazing amount of work, says Assistant Professor of Pediatrics Rachel Thompson, MD, who directs pediatric clerkships, BUSM faculty didn’t face the challenge alone.

“So many people across the country were going through something similar,” she says. “There was an incredible amount of knowledge sharing and sharing of resources on the medical educators’ listservs. Places were offering cases they had done, models they had used.” It was heartening, she says, to see such a spirit of sharing of volunteerism in the medical education community.

BUSM solicited feedback on its initial virtual modules and then did its best to incorporate students’ suggestions into later modules.

“One of the things we learned,” says Thompson, “was that students really wanted more small-group opportunities.” With more than 150 students enrolled in a module at the same time, however, trying to find enough faculty to supervise small groups was mindboggling, she says. Then a colleague at Boston Children’s Hospital mentioned that COVID shutdowns had left fellows at Children’s with little to do. “So, I staffed a huge number of our small-group sessions with fellows from Boston Children’s who just volunteered their time.”

The virtual modules were a challenge for students as well as for faculty, especially given the intensity of summer 2020.

“Some of us were doing virtual rotations on Zoom while trying to juggle studying for Step 1, so that was definitely a chaotic time,” says Motavalli.

Following news coverage of that summer’s Black Lives Matter protests made focusing on academics difficult for many students, especially students of color. Parnell remembers how exhausting it felt to be Black in America at that time, and yet still needing to find the energy for hours of online class sessions each day.

Even the logistics of taking online courses became a challenge for some students. When lockdown was looming in the spring, Meshelle Hirashima (’22) booked a flight home to Hawaii.

“There was no way I was going to quarantine in Boston,” she says.

She chose to stay safely in Hawaii through the summer, which meant logging in to virtual learning modules at 3 a.m.

Students were thrilled to finally begin in-person clerkships in late August. Despite their shortened rotations, students had the formative experiences typical of the third year of medical school: interviewing patients face-to-face, assisting in the delivery of their first babies, witnessing death for the first time.

The presence of COVID-19 affected some clerkships more than others. Cho says his rotation through minimally invasive surgery (MIS) was drastically impacted by the cancelling of elective surgeries.

“Despite spending a month on MIS, I did not see a single bariatric surgery, which was crazy because that’s 90 percent of what they normally do,” he says.

Initially, students weren’t allowed to treat COVID patients or even see patients presenting with COVID symptoms because faculty felt they should first be familiar with the hospital and with clinical care and be well prepared for the experience.

“I did two weeks of outpatient pediatrics,” says Vaickus, “and they didn’t let us see any person who had a runny nose or an ear infection or a slightly suspicious cough, which is, you know, all kids.”

Parnell says her most trying third-year experience was her time in the medical ICU.

“In the beginning, there were almost no patients that I could actually see because everyone had COVID,” she says. “I still had patients that I was rounding on in the morning, but I couldn’t go into their rooms, so I’d have to stand outside the door looking through the windows to see how my patients were doing.”

COVID especially complicated rotations for students forced to quarantine after catching the virus or being exposed, leaving them to make up lost time during vacation breaks.

“Accidental exposures happened,” says Motavalli, “but overall, I felt very protected.”

Stephanie Vaughn (’22) agrees that BUSM struck the right balance between education and safety. She appreciated being shielded from COVID exposure.

“There truly isn’t that much educational value in taking care of COVID patients,” she says, “because you just follow an algorithm, and the cases are usually quite straightforward. So, the residents would say, ‘This is COVID. It’s just risky and not interesting. You should not take that patient.’”

Vaughn adds that COVID had much less impact on her clerkships than she initially feared. “I think there’s a sense among doctors that we need to keep prioritizing education even in a pandemic, because if we don’t make time and space for that, we’re going have a generation of doctors who are unprepared.”

Even while busy with clerkships, members of the Class of 2022 found ways to help with pandemic relief. To pay tribute to his grandmother, who died of COVID early in the pandemic, Tyler Kalajian (’22) spearheaded a fundraiser to buy masks for the homeless community in Boston’s South End.

“We thought we’d be able to donate 1,000 or so masks,” Kalajian says, “but we got such an outpouring of support from both the South End community and the Boston University community that we were able to give seven to eight times as many as we expected. It was so humbling to see a community come together and help a very vulnerable population in our neighborhood.”

Fourth Year

With proper PPE, vaccines and treatments available to blunt the impact of COVID-19, the Class of 2022 saw a near return to normalcy in its fourth year of medical school. Students were allowed to see patients with COVID symptoms and schedule “away” rotations in outside hospital systems. Elective surgeries returned.

The geriatric rotations required of all fourth-year BUSM students remained impacted by COVID. When students made home visits, they wore gowns, N-95 masks and eye protection.

“The biggest barrier with PPE is that we’re communicating with a lot of patients who have sensory and cognitive impairment,” says Assistant Professor of Medicine Megan Young, MD, who directs the geriatric clerkships. Knowing their patients may struggle to hear and understand them, she says, pushed students to improve their communication skills.

“We’ve gotten a lot better emoting with our eyes, since nobody can see the rest of our face anymore,” says Cho, only half-jokingly.

Rockers, who plans to specialize in pediatrics, says many of her fourth-year patient appointments have been telemedicine visits, at least partially because the Omicron variant of SARS-CoV2 caused a spike in virus cases and a temporary return to cautiousness.

“I think they’re also trying to train us in telemedicine because they realize it’s more convenient for a lot of the patients to do telemedicine,” she says, “so it’s a skill they want us to have.” And despite the initial awkwardness of trying to conduct a child’s neurological exam over a computer screen, she says, she’s become adept at it over time.

Garg says these students’ ability to master telemedicine is evidence of their exceptional clinical skills. Because clinicians can’t examine patients during a telemedicine visit, she says, they must rely more on asking patients the right questions. “That takes a lot of clinical acumen, to know what’s the right question to ask,” she says. And phrasing questions in a way that patients will understand takes impressive communication skills.

With COVID restrictions easing, members of the Class of 2022 have generously used their time to help underclassmen organize the social and professional events they badly need.

“When the current second-year class came in, all group events were canceled, all indoor gatherings were canceled,” says Cho. “The feedback I’m getting from them is they really feel they suffered in their social connections and in their connectedness to the community as a whole.”

Class members have also volunteered at COVID vaccine clinics. Members of the Latino Medical Student Association spent time in Chelsea, a primarily Spanish-speaking Boston suburb, helping with patient recruitment, education and registration.

“I didn’t directly give out the vaccine,” says Suarez-Gama, “but it was still very rewarding to volunteer there, as I was usually one of maybe two Spanish-speaking volunteers in the clinic, and it was very much needed to have bilingual staff.”

Members of the Class of 2022 completed their fourth year as all medical students do—balancing their final clerkships with residency interviews. But theirs were not typical interviews.

“You’re sitting there in your suit top and your blouse,” says Rockers, “but then you have pajama bottoms on.”

All interviews happened virtually this year, so instead of booking flights and hotel rooms, students fussed with their lighting, hoped their internet service wouldn’t drop, and tried not to appear fidgety on camera. To help students prepare for virtual interviews, BUSM Student Affairs developed a range of resources, including mock interviews for each student with specific feedback.

“I was really disappointed that the interviews were virtual again this year,” says Vaughn. “I’m going to be moving with my partner, and I don’t want to move him somewhere we’ve never been.” On the other hand, she says, virtual interviews saved time and money, valuable commodities for most medical students.

Despite their awkwardness and other downsides, virtual interviews may be here to stay. Students say they appreciate that virtual interviews reduced their carbon footprint, made scheduling easier, eliminated the stress of flight delays, and—perhaps most importantly—helped level the playing field for students of lower socioeconomic status.

This group of students has always focused on advocacy and equity, says Garg, so she’s not surprised they’ve spent time thinking of ways to make residency interviews more fair.

This class’s passion for helping improve medical education also remains strong, she says. Even as fourth-year students in their final weeks of medical school, members of this class keep coming to her with ideas for curricular improvement.

“I’m just so impressed,” Garg says.  “Many students would have been so fatigued and burnt out by the experiences of COVID and medical school in general, but they just keep going. It gives you a lot of confidence and hope for the future of medicine.”