P3D385: "What's My Responsibility?" Self-perceptions of Students' Role on the Pediatric Clerkship Before and During the Pandemic

Background: Each year, 170 medical students from the Uniformed Services University complete their clerkship rotations across the United States at military treatment facilities (MTFs) where they directly interact with patients and health care teams. The COVID-19 pandemic led to changes in the pre-clinical experience for medical students entering their clerkship year with an increase in virtual learning and less clinical exposure. We sought to identify how medical students perceived their pediatric clerkship responsibilities pre-pandemic and during the pandemic.

Methods: Prior to starting their pediatric clerkship, students complete a mandatory survey, including the free response question: “What do you feel are your responsibilities as a student?” A third party de-identified and randomly chose 30 clerkship students’ responses from 2019 (pre-pandemic) and 30 from 2021 (pandemic). Qualitative thematic analysis was performed by two different teams, blinded to the individual groups’ relation to the pandemic’s time course. An inductive, recursive analysis was performed on all responses by 2 independent coders per team, who compared codes iteratively to ensure consistency in coding. Collective themes were identified. Themes were compared between the two groups and a deductive lens was used to identify similarities and differences between the groups. The groups were then unblinded. Designated by the IRB as non-human subjects research.

Results: Three major themes were observed: medical student responsibilities as a 1) developing professional, 2) member of a healthcare team, and 3) learner of academic knowledge, procedures and clinical skills.

As a developing professional, students felt their responsibility was to exhibit characteristics of respect, timeliness, and preparedness. Students discussed the importance of appreciation as well as a proactive and positive attitude.

Student responsibilities as a member of the healthcare team varied between pre pandemic and pandemic. Perspectives of being a passive “visitor” who should avoid “inhibiting the [healthcare] team” during the pandemic were compared to an active participant, or even advocate, in patient care that was described in pre-pandemic answers.

As a learner, students expressed the need to “learn the most pertinent aspects of a specialty” while also “satisfy[ing] the clerkship curriculum.” Pandemic answers noted the need to study for the “NBME” whereas pre-pandemic answers did not specifically mention the NBME.
The subtheme of a growth mindset was also described as they reflected on their responsibility to “understand my limitations,” “seek feedback,” and “learn from mistakes.”

Themes overall were very similar among all respondents; however, there were subtle differences in the way students viewed their roles on the team and their learning responsibilities between pre-pandemic and pandemic.

Conclusion: An increased virtual learning experience and decreased clinical care exposure in the preclinical years, due to COVID, may be associated with a shift in how students view their responsibilities to the clinical team and their learning responsibilities.