fbpx

Medical School During a Pandemic: A Retrospective Study on U.S. Medical School Reopening Policies

By Andrea L. Klein; Daniel J. Muller, MPhil; Zach Silverstein, MHS

Share on facebook
Facebook
Share on twitter
Twitter
Share on linkedin
LinkedIn

Citation

Klein A, Muller D, Silverstein Z. Medical school during a pandemic: a retrospective study on U.S. medical school reopening policies. HPHR. 2021;48.  

Medical School During a Pandemic: A Retrospective Study on U.S. Medical School Reopening Policies​

Abstract

Background

The COVID-19 pandemic has resulted in innumerable unprecedented challenges in the medical education system. Among other factors, personal protective equipment restrictions, contact limitations, and social distancing measures have all significantly altered the structure of undergraduate medical education and have required rapid adaptation to an ever-changing environment. For the majority of institutions, in-person courses and clerkships were halted abruptly in mid-March as schools were forced to transition to a completely virtual learning environment for the remainder of the 2019-2020 academic year. Heading into the 2020-2021 academic year with the knowledge that the COVID-19 pandemic would affect the fall semester at the very least, many medical schools developed plans to reopen in some capacity.

Methods

The publicly available reopening plans of U.S. MD programs were evaluated at the start of fall semester and at the end of fall semester.

Results

All schools adopted a version of hybrid medical education, and mask use, social distancing of more than 6 feet at all times, and enhanced disinfection of common areas were universally implemented. 23 of 25 medical schools continued to require that students attend activities like anatomy lab and clinical skills simulations in-person. Every school prohibited clinical students from taking care of patients with a confirmed or suspected diagnosis of COVID-19.

Discussion

As the pandemic surpasses one year in duration and the undergraduate medical education system concludes its first full pandemic year, this paper focuses on how medical schools have responded thus far to this crisis, where the current data stands in relation to safety of school reopening, and how the structure of undergraduate medical education has been changed forever.

Background

The COVID-19 pandemic has resulted in innumerable unprecedented challenges in the medical education system. Among other factors, personal protective equipment (PPE) restrictions, contact limitations, and social distancing measures have all significantly altered the structure of undergraduate medical education and have required rapid adaptation to an ever-changing environment.  As the pandemic surpasses one year in duration and the undergraduate medical education system concludes its first full pandemic year, we reflect on how medical schools have responded thus far to this crisis, where the current data stands in relation to safety of school reopening, and how the structure of undergraduate medical education has been changed forever.

 

 

For the majority of institutions, in-person courses and rotations were halted abruptly in mid-March as schools were forced to transition to a completely virtual learning environment for the remainder of the 2019-2020 academic year1. Anatomy, skills labs, and in-person problem based learning sessions ceased2. Instead of traditional clinical work, students on rotations completed their clinical training using virtual cases3. A subset of second-year preclinical students (including the author, Klein) became trapped in a cycle of exam cancellations and clerkship delays. Away acting internships, international electives, conference attendance, and interviews were prohibited immediately due to travel restrictions3,4. Lab closures effectively quelled many significant summer research projects4,5. In effect, undergraduate medical education came to a screeching halt, and school administrators had to act swiftly to ensure that student training proceeded as safely as possible. The 2019-2020 academic year ended with most students (pre-clinical and clinical) learning from home, wondering whether or not they would be returning to campus in the fall.

Materials and Methods

As the authors all attend an allopathic medical school and recognize that allopathic and osteopathic medical schools have different curricula and emphases, the choice was made to focus on allopathic medical programs. In order to select reopening plans to evaluate, the American Association of Medical Colleges (AAMC) website was filtered for allopathic medical schools located in the United States, including territories and commonwealths, that had incoming and returning medical students arriving for the Fall 2020 semester. 155 allopathic medical schools listed by their full names were placed alphabetically into a “random order generator” on www.random.org/lists and the first 25 allopathic medical schools were analyzed for reopening plans for the Fall 2020 semester. For each school examined, “[Medical school full name] COVID-19 reopening plan” was entered into Google and then links within the school’s website were followed until a plan was found. If no plan pertaining specifically to the medical school was publicly available on a school’s website, or if the plan’s applicability to medical students was not referenced in the reopening guidelines for the larger university, the next school on the randomly generated list was substituted for analysis. 

Results

Heading into the 2020-2021 academic year with the knowledge that the COVID-19 pandemic would affect the fall semester at the very least, many medical schools developed plans to reopen in some capacity. We randomly selected 100 of the 155 U.S. MD programs for evaluation of their COVID-19 reopening policies, of which 25 were found to have publicly available medical school-specific plans. Among these schools, all adopted a version of hybrid medical education, and mask use, social distancing of more than six feet at all times, and enhanced disinfection of common areas were universally implemented early in the fall semester (Table 1). Most schools required some form of daily screening before arriving on campus, which often consisted of students manually entering symptoms into a mobile app that would issue guidance on whether they should be physically present, stay home, or seek COVID-19 testing. Other schools either screened entering faculty and students at the door or required students to self-monitor without formal documentation of their symptoms.

 

In regard to the preclinical curriculum, didactic lectures and most small group discussions moved completely online for the fall semester. Remote teaching technologies were used to deliver content through either live or pre-recorded lectures and small group sessions aiming to reinforce this material generally followed suit, as well. Still, 23 of 25 medical schools continued to require that students attend activities like anatomy lab and clinical skills simulations in-person, relying on the aforementioned risk mitigation tactics.

 

While all 25 schools examined brought back clinical students for their rotations in the fall, medical schools generally did not draft (publically available) policies universally applicable to their student bodies. Every school prohibited clinical students from taking care of patients with a confirmed or suspected diagnosis of COVID-19, with several institutions going so far as to create graphics and/or algorithms to determine whether or not a student should be allowed to see any given patient (figure 1). Regardless, every school discussed the need for PPE and emphasized that the students’ ability to participate in clinical rotations was contingent on sufficient PPE supply, however defined by the institution. These definitions varied between schools, ranging from the provision of masks and face shields to clinical students to the assurance that clinical students would have access to the same in-hospital protections as the full-time medical team. Other schools deferred this decision to their affiliated hospitals and thus lacked a coherent PPE policy that applied to all of their clinical students.

 

Strategic testing of asymptomatic medical students for COVID-19 was not widely implemented.

 

Of the 25 schools examined, only nine had explicit plans to test asymptomatic students for reasons other than probable exposure, with five schools requiring that students be tested upon their arrival back on campus for the fall semester and four requiring that students participate in routine testing over the course of the academic year. The remaining 16 schools either noted that COVID-19 tests were available should a student wish to be tested, explicitly stated that they would not be requiring testing of their students except following a probable exposure, or did not mention asymptomatic testing of students at all.

Discussion

The relative homogeneity of the core policies implemented at these institutions is unsurprising. Masks, social distancing, personal hygiene, and screening for symptoms are vital to the global strategy for combating COVID-19, and have been emphasized by the Centers for Disease Control and Prevention (CDC) and/or the National Academies of Sciences, Engineering, and Medicine in their guidance regarding the reopening of primary schools, secondary schools, and universities.6,7 Additionally, the Association of American Medical Colleges (AAMC) has stressed the importance of these measures in a statement to the general public in August.8 Other publicly available AAMC guidance documents directed towards medical school deans underscore the importance of contact tracing and testing; encouraging direct patient contact — broadly defined — to be avoided wherever possible, and for students to be provided sufficient PPE where it cannot; and putting in place “reasonable safeguards… to minimize medical students’ risk of contracting COVID-19”.9,10

 

Differences between the policies of the individual institutions examined can largely be attributed to the AAMC’s belief that this “guidance… is intended to add to, but not supersede, an academic medical center’s independent judgment of the immediate needs of its patients and preparation of its students,” as well as differing local regulations, transmission patterns, and available resources.9,11 The CDC takes a similar approach, seeking to “assist institutes of higher education… in making decisions rather than establishing regulatory requirements”.12 Even against this backdrop, however, the divergent approaches of the examined institutions towards testing asymptomatic students with no probable exposure to SARS-CoV-2 appears especially stark, with policies ranging from no testing at all to multiple tests per week. While the available evidence on the utility of routine testing of asymptomatic students in higher education settings is quite limited, the little that does exist confirms its benefits, even if whether those benefits justify the associated costs is debated.13,14 Some have advocated for this approach to be adopted extensively by universities15,16 as well as in a myriad of other settings including healthcare facilities,17-20 K-12 schools,21 and the population at large.22-25 But here, too, the evidence is less than definitive and generally only certain types of healthcare facilities26-32 and well-resourced professional sports leagues33-38 have adopted routine testing, with the latter mostly avoiding any large-scale, uncontrollable outbreaks. Still, 45,000+ cases at colleges across the United States have occurred since the end of July, including high profile outbreaks that forced schools like the University of North Carolina at Chapel Hill and Notre Dame to pause their reopening plans and move classes entirely online.39-41 Therefore, it should be noted that, despite the inherent differences between undergraduate universities and medical schools, the reopening plans of the latter may have been insufficient as currently constructed and additional measures such as routine testing could have been necessary to prevent cases. There is no publicly available database of cases by school, so the actual efficacy of routine testing among medical schools could not be effectively evaluated in this study (the nearest available proxy was county data, which is a poor representation of these measures).

 

The structural divergence from the pre-pandemic academic status quo is notable and has posed significant challenges for some, largely due to an abrupt transition to self-directed learning and the necessity for consistent access to reliable internet.  However, in many ways the organization of the lectures and emphasis on self-directed learning are remarkably similar to the structure created by students at numerous medical schools who did not regularly attend non-mandatory classes before the pandemic — an option long afforded to students using recordings of lectures as a proxy for attendance. Indeed, many students were already studying on their own schedules and utilizing various outside resources (e.g., First Aid, SketchyMedical, Pathoma, Boards and Beyond) prior to this semester and its transition to a more self-guided approach.  The main issue early on — that was resolved quickly but should be addressed in future rapid curriculum changes — was difficulty in translating clinical skills to online learning modules. 

 

Now, as highly efficacious vaccines become readily available and schools begin to plan for the next academic year, a sense of normalcy has begun to emerge.  Universities across the country are reopening for the 2021-2022 year with vaccine requirements, and state and local governments in regions with high vaccination rates have begun to loosen restrictions.  Perhaps the next academic year will represent a return to pre-pandemic academic structure; however with the successful advent of remote learning technology, it is to be expected that some elements of pandemic learning will remain in place, serving not only as an effective learning tool but also as a reminder of one of the most memorable years in recent history.

Conclusion

The COVID-19 pandemic has resulted in a radical upheaval of undergraduate medical education at both the preclinical and clinical levels. In the span of one year, preclinical education transitioned from traditional, classroom-based learning to a predominantly hybrid model. The elimination of in-person large lectures and focus on small group discussion has generated a much more interactive learning environment, despite, in some cases, students being dispersed across the country. Additionally, clinical students are learning in a completely different environment from their predecessors and will be more prepared than previous generations to handle similar crises in their own careers.

 

Although the COVID-19 pandemic has had an unconscionable impact on our society, it is important to recognize the good that has come out of it, as well. Critical structural and systemic issues in healthcare systems have been identified, novel vaccine technologies and therapeutics have been developed at a rapid pace, and public health has entered the media spotlight and is now a dinner table conversation topic.

 

As students in the field of medicine, our nature is to help however we can; we are drawn towards medicine because it allows us to use our scientific knowledge to alleviate suffering. Medical students across the U.S. have contributed to COVID-19 response efforts in numerous ways, including creating community health information websites, staffing COVID-19 hotlines, providing childcare and grocery services to essential workers, volunteering at testing sites, assisting in public health studies, contact tracing (including author Silverstein), and joining vaccine research efforts (including authors Klein and Muller).  COVID-19 has affected every organ system and specialty in medicine, and we hope that our experience as students in these times will enable us to handle similar situations in the future, regardless of where our careers take us.

References

  1. Torda A. How COVID‐19 has pushed us into a medical education revolution. Internal medicine journal. 2020;50(9):1150-1153. https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.14882. doi: 10.1111/imj.14882.
  2. Sahi PK, Mishra D, Singh T. Medical education amid the COVID-19 pandemic. Indian pediatrics. 2020;57(7):652-657. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=7387262&tool=pmcentrez&rendertype=abstract. doi: 10.1007/s13312-020-1894-7.
  3. Theoret C, Ming X. Our education, our concerns: The impact on medical student education of COVID‐19. Medical education. 2020;54(7):591-592. https://onlinelibrary.wiley.com/doi/abs/10.1111/medu.14181. doi: 10.1111/medu.14181.
  4. Ferrel MN, Ryan JJ. The impact of COVID-19 on medical education. Curēus (Palo Alto, CA). 2020;12(3):e7492. https://www.ncbi.nlm.nih.gov/pubmed/32368424. doi: 10.7759/cureus.7492.
  5. The impact of the COVID-19 pandemic on medical student education in wisconsin. Wisconsin medical journal (Madison, Wis.). 2020;119(2):80-82. https://search.proquest.com/docview/2423798738.
  6. Centers for Disease Control and Prevention. Considerations for institutions of higher education. Centers for Disease Control and Prevention. 2020.
  7. National Academies of Sciences, Engineering, and Medicine. Reopening K-12 schools during the COVID-19 pandemic: Prioritizing health, equity, and communities. Reopening K-12 Schools During the COVID-19 Pandemic. 2020:28-41.
  8. Association of American Medical Colleges. The way forward on COVID-19: Consensus guidance on face coverings<br>. Association of American Medical Colleges. 8/12/20.
  9. Association of American Medical Colleges. Guidance on medical students’ participation in direct in-person patient contact activities. Association of American Medical Colleges. 8/14/20.
  10. Liaison Committee on Medical Education. LCME guiding principles for re-entry of medical students into the clinical learning environment. Liaison Committee on Medical Education. 7/16/20.
  11. Bradley EH, An M, Fox E. Reopening colleges during the coronavirus disease 2019 (COVID-19) Pandemic—One size does not fit all. JAMA Network Open. 2020;3(7):e2017838. http://dx.doi.org/10.1001/jamanetworkopen.2020.17838. doi: 10.1001/jamanetworkopen.2020.17838.
  12. Centers for Disease Control and Prevention. Interim considerations for institutions of higher education administrators for SARS-CoV-2 testing. Centers for Disease Control and Prevention. 6/30/20.
  13. Gressman PT, Peck JR. Simulating COVID-19 in a university environment. Mathematical biosciences. 2020;328:108436. http://dx.doi.org/10.1016/j.mbs.2020.108436. doi: 10.1016/j.mbs.2020.108436.
  14. Paltiel AD, Zheng A, Walensky RP. Assessment of SARS-CoV-2 screening strategies to permit the safe reopening of college campuses in the united states. JAMA Network Open. 2020;3(7):e2016818. http://dx.doi.org/10.1001/jamanetworkopen.2020.16818. doi: 10.1001/jamanetworkopen.2020.16818.
  15. The Independent Scientific Advisory Group for Emergencies. Independent SAGE-behaviour group consultation statement on

universities in the context of SARS-CoV-2. The Independent Scientific Advisory Group for Emergencies. 8/20/20.

  1. Wrighton MS, Lawrence SJ. Reopening colleges and universities during the COVID-19 pandemic. Annals of internal medicine. 2020. https://search.proquest.com/docview/2420146916. doi: 10.7326/M20-4752.
  2. Day M. Covid-19: Identifying and isolating asymptomatic people helped eliminate virus in italian village. BMJ. 2020;368:m1165. http://dx.doi.org/10.1136/bmj.m1165. doi: 10.1136/bmj.m1165.
  3. Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: The case for health-care worker screening to prevent hospital transmission. The Lancet. 2020;395(10234):1418-1420. http://dx.doi.org/10.1016/S0140-6736(20)30917-X. doi: 10.1016/S0140-6736(20)30917-X.
  4. Grassly N, Pons Salort M, Parker E, et al. Report 16: Role of testing in COVID-19 control. . 2020. http://hdl.handle.net/10044/1/78439.
  5. Gandhi M, Yokoe DS, Havlir DV. Asymptomatic transmission, the achilles’ heel of current strategies to control covid-19. The New England Journal of Medicine. 2020;382(22):2158-2160. http://dx.doi.org/10.1056/NEJMe2009758. doi: 10.1056/NEJMe2009758.
  6. Bonell C, Melendez-Torres GJ, Viner RM, et al. An evidence-based theory of change for reducing SARS-CoV-2 transmission in reopened schools. Health & place. 7/21/20;64:102398. http://dx.doi.org/10.1016/j.healthplace.2020.102398. doi: 10.1016/j.healthplace.2020.102398.
  7. Raffle AE, Pollock AM, Harding-Edgar L. Covid-19 mass testing programmes. BMJ. 2020;370:m3262. http://dx.doi.org/10.1136/bmj.m3262. doi: 10.1136/bmj.m3262.
  8. Studdert DM, Hall MA. Disease control, civil liberties, and mass testing — calibrating restrictions during the covid-19 pandemic. The New England journal of medicine. 2020;383(2):102-104. http://dx.doi.org/10.1056/NEJMp2007637. doi: 10.1056/NEJMp2007637.
  9. Peto J, Alwan NA, Godfrey KM, et al. Universal weekly testing as the UK COVID-19 lockdown exit strategy. The Lancet (British edition). 2020;395(10234):1420-1421. http://dx.doi.org/10.1016/S0140-6736(20)30936-3. doi: 10.1016/S0140-6736(20)30936-3.
  10. Müller M, Derlet PM, Mudry C, Aeppli G. Testing of asymptomatic individuals for fast feedback-control of COVID-19 pandemics. Physical biology. 2020. https://search.proquest.com/docview/2425002626. doi: 10.1088/1478-3975/aba6d0.
  11. Gruskay J, Dvorzhinskiy A, Konnaris M, et al. Universal testing for COVID-19 in essential orthopaedic surgery reveals a high percentage of asymptomatic infections. Journal of bone and joint surgery. American volume. 2020;102(16):1379-1388. https://search.proquest.com/docview/2411592895. doi: 10.2106/JBJS.20.01053.
  12. Louie JK, Scott HM, DuBois A, et al. Lessons from mass-testing for COVID-19 in long term care facilities for the elderly in san francisco. Clinical infectious diseases. 2020. https://search.proquest.com/docview/2425591628. doi: 10.1093/cid/ciaa1020.
  13. Blitz MJ, Rochelson B, Rausch AC, et al. Universal testing for coronavirus disease 2019 in pregnant women admitted for delivery: Prevalence of peripartum infection and rate of asymptomatic carriers at four new york hospitals within an integrated healthcare system. American journal of obstetrics & gynecology MFM. 2020;2(3):100169. http://dx.doi.org/10.1016/j.ajogmf.2020.100169. doi: 10.1016/j.ajogmf.2020.100169.
  14. Rudolph JL, Halladay CW, Barber M, et al. Temperature in nursing home residents systematically tested for SARS-CoV-2. Journal of the American Medical Directors Association. 2020;21(7):895-899.e1. http://dx.doi.org/10.1016/j.jamda.2020.06.009. doi: 10.1016/j.jamda.2020.06.009.
  15. Fassett MJ, Lurvey LD, Yasumura L, et al. Universal SARS-cov-2 screening in women admitted for delivery in a large managed care organization. American journal of perinatology. 2020;37(11):1110-1114. http://dx.doi.org/10.1055/s-0040-1714060. doi: 10.1055/s-0040-1714060.
  16. Naqvi M, Burwick R, Ozimek J, Greene N, Kilpatrick S, Wong M. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) universal testing experience on a los angeles labor and delivery unit. Obstetrics and gynecology (New York. 1953). 2020;136(2):235-236. https://www.ncbi.nlm.nih.gov/pubmed/32433450. doi: 10.1097/AOG.0000000000003987.
  17. Miller E, Grobman W, Sakowicz A, Rosati J, Peaceman A. Clinical implications of universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in pregnancy. Obstetrics and gynecology (New York. 1953). 2020;136(2):232-234. https://www.ncbi.nlm.nih.gov/pubmed/32433449. doi: 10.1097/AOG.0000000000003983.
  18. Axisa M. How MLB plans to handle positive COVID-19 tests; and other notable measures in league’s 101-page safety manual. CBS Sports Web site. https://www.cbssports.com/mlb/news/how-mlb-plans-to-handle-positive-covid-19-tests-and-other-notable-measures-in-leagues-101-page/. Updated 6/24/20.
  19. Bontemps T. In documents, NBA details coronavirus testing protocols, including 2-week resting period for positive tests. ESPN Web site. https://www.espn.com/nba/story/_/id/29321006/in-documents-nba-details-coronavirus-testing-process-orlando-campus-life. Updated 6/16/20.
  20. Mike Brehm. Inside NHL return: How league plans to decide stanley cup champion amid pandemic. USA today (Arlington, Va.). Jul 12, 2020. Available from: https://search.proquest.com/docview/2422672868.
  21. Jori Epstein. NFL, NFL players association agree on COVID-19 testing protocols. USA today (Arlington, Va.). Jul 20, 2020. Available from: https://search.proquest.com/docview/2425365411.
  22. Tariq Panja. English premier league plans to resume june 17. New York Times. May 28, 2020. Available from: https://search.proquest.com/docview/2407335793.
  23. Hamilton T, Uersfeld S. German bundesliga resumes after coronavirus outbreak: What matchday, player testing and safety will look like. ESPN Web site. https://www.espn.com/soccer/german-bundesliga/story/4092930/german-bundesliga-resumes-after-coronavirus-outbreak-what-matchdayplayer-testing-and-safety-will-look-like. Updated 5/8/20.
  1. The New York Times. Tracking covid at U.S. colleges and universities. New York Times Web site. https://www.nytimes.com/interactive/2020/us/covid-college-cases-tracker.html?action=click&module=Top%20Stories&pgtype=Homepage. Updated 2020. Accessed 9/7/, 2020.
  1. Richard Fausset. Outbreaks drive U.N.C. chapel hill online after a week of classes. New York Times (Online). August 17, 2020. Available from: https://www.nytimes.com/2020/08/17/us/unc-chapel-hill-covid.html.
  2. Frances Robles. Notre Dame and Michigan state shifting online as campus outbreaks grow. New York Times. Aug 18, 2020. Available from: https://www.nytimes.com/2020/08/18/us/notre-dame-coronavirus.html.
  3. Guidance on Medical Students’ Participation in Direct In-person Patient Contact Activities. Aug. 14, 2020.

Table 1: Medical Schools

Total Number of U.S. MD Schools

155

Number of Schools Examined

100

Number of Schools with School-Specific Plans

25

Mandatory mask usage

25 (100%)

Social distancing regulations

25 (100%)

Enhanced disinfection techniques (responsibility of individual and by paid staff)

25 (100%)

Daily screening of symptoms

19 (76%)

COVID-19 testing of asymptomatic students

4 (16%)

COVID-19 testing on return to campus

5 (20%)

Pre-clinical option of entirely virtual vs. in-person for small group activities

2 (8%)

Supplement: Materials and Methods

As the authors all attend an allopathic medical school and recognize that allopathic and osteopathic medical schools have different curricula and emphases, the choice was made to focus on allopathic medical programs. In order to select reopening plans to evaluate, the AAMC website was filtered for allopathic medical schools located in the United States, including territories and commonwealths, that had incoming and returning medical students arriving for the Fall 2020 semester. The 155 allopathic medical schools in the United States were listed by their full names and placed alphabetically into a “random order generator” on www.random.org/lists. School websites were analyzed for reopening plans for the Fall 2020 semester until 25 plans were identified, which occurred after 100 school websites were analyzed, indicating a yield of 25%. Due to an error collecting names from the AAMC website, the Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine was accidentally omitted from the list entered into the random order generator. On examination of that school’s website, however, no reopening plan could be found. For each school examined, “[Medical school full name] COVID-19 reopening plan” was entered into Google and then links within the school’s website were followed until a plan was found. If no plan pertaining specifically to the medical school was publicly available on a school’s website, or if the plan’s applicability to medical students was not referenced in the reopening guidelines for the larger university, the next school on the randomly generated list was substituted for analysis. The randomly generated list of allopathic medical schools is below:

 

  1. University of California, Riverside School of Medicine
  2. Medical University of South Carolina College of Medicine
  3. Virginia Commonwealth University School of Medicine
  4. University of Nebraska College of Medicine
  5. Kaiser Permanente Bernard J. Tyson School of Medicine
  6. University of North Dakota School of Medicine and Health Sciences
  7. Stanford University School of Medicine
  8. University of Kansas School of Medicine
  9. Western Michigan University Homer Stryker M.D. School of Medicine
  10. Washington State University Elson S. Floyd College of Medicine
  11. Howard University College of Medicine
  12. University of Massachusetts Medical School
  13. Icahn School of Medicine at Mount Sinai
  14. Morehouse School of Medicine
  15. Duke University School of Medicine
  16. State University of New York Downstate Medical Center College of Medicine
  17. Boston University School of Medicine
  18. The Warren Alpert Medical School of Brown University
  19. University of Illinois College of Medicine
  20. Rutgers New Jersey Medical School
  21. University of Arizona College of Medicine – Phoenix
  22. Harvard Medical School
  23. University of Florida College of Medicine
  24. Eastern Virginia Medical School
  25. University of Texas Southwestern Medical School
  26. University of California, Los Angeles David Geffen School of Medicine
  27. Indiana University School of Medicine
  28. Tulane University School of Medicine
  29. University of Houston College of Medicine
  30. California University of Science and Medicine-School of Medicine
  31. Saint Louis University School of Medicine
  32. Cooper Medical School of Rowan University
  33. Brody School of Medicine at East Carolina University
  34. Southern Illinois University School of Medicine
  35. University of Miami Leonard M. Miller School of Medicine
  36. Medical College of Wisconsin
  37. University of Washington School of Medicine
  38. Renaissance School of Medicine at Stony Brook University
  39. New York University Long Island School of Medicine
  40. Texas Tech University Health Sciences Center School of Medicine
  41. University of Missouri-Columbia School of Medicine
  42. Wayne State University School of Medicine
  43. University of Texas Medical Branch School of Medicine
  44. Louisiana State University School of Medicine in New Orleans
  45. West Virginia University School of Medicine
  46. Marshall University Joan C. Edwards School of Medicine
  47. The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine
  48. New York Medical College
  49. Charles E. Schmidt College of Medicine at Florida Atlantic University
  50. Medical College of Georgia at Augusta University
  51. University of North Carolina at Chapel Hill School of Medicine
  52. University of Colorado School of Medicine
  53. Creighton University School of Medicine
  54. Rush Medical College of Rush University Medical Center
  55. The University of Toledo College of Medicine and Life Sciences
  56. Columbia University Vagelos College of Physicians and Surgeons
  57. University of Texas at Austin Dell Medical School
  58. Keck School of Medicine of the University of Southern California
  59. Northwestern University The Feinberg School of Medicine
  60. Johns Hopkins University School of Medicine
  61. USF Health Morsani College of Medicine
  62. University of Arkansas for Medical Sciences College of Medicine
  63. Baylor College of Medicine
  64. University of Tennessee Health Science Center College of Medicine
  65. University of Missouri-Kansas City School of Medicine
  66. Washington University in St. Louis School of Medicine
  67. University of Central Florida College of Medicine
  68. Loma Linda University School of Medicine
  69. Oakland University William Beaumont School of Medicine
  70. Vanderbilt University School of Medicine
  71. Tufts University School of Medicine
  72. University of South Dakota, Sanford School of Medicine
  73. Albert Einstein College of Medicine
  74. University of Louisville School of Medicine
  75. Frank H. Netter MD School of Medicine at Quinnipiac University
  76. University of Maryland School of Medicine
  77. George Washington University School of Medicine and Health Sciences
  78. University of Nevada, Reno School of Medicine
  79. University of South Carolina School of Medicine Greenville
  80. Ohio State University College of Medicine
  81. Florida International University Herbert Wertheim College of Medicine
  82. University of Virginia School of Medicine
  83. California Northstate University College of Medicine
  84. University of Kentucky College of Medicine
  85. Geisinger Commonwealth School of Medicine
  86. University of Utah School of Medicine
  87. Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine
  88. Perelman School of Medicine at the University of Pennsylvania
  89. Geisel School of Medicine at Dartmouth
  90. Weill Cornell Medicine
  91. University of South Alabama College of Medicine
  92. TCU and UNTHSC School of Medicine
  93. Wake Forest School of Medicine of Wake Forest Baptist Medical Center
  94. East Tennessee State University James H. Quillen College of Medicine
  95. University of California, San Francisco, School of Medicine
  96. Chicago Medical School at Rosalind Franklin University of Medicine & Science
  97. Carle Illinois College of Medicine
  98. Oregon Health & Science University School of Medicine
  99. University of Nevada, Las Vegas School of Medicine
  100. University of California, Irvine, School of Medicine
  101. San Juan Bautista School of Medicine
  102. McGovern Medical School at the University of Texas Health Science Center at Houston
  103. Mayo Clinic Alix School of Medicine
  104. Robert Larner, M.D., College of Medicine at the University of Vermont
  105. Ponce Health Sciences University School of Medicine
  106. Michigan State University College of Human Medicine
  107. Lewis Katz School of Medicine at Temple University
  108. CUNY School of Medicine
  109. New York University Grossman School of Medicine
  110. Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
  111. Drexel University College of Medicine
  112. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
  113. State University of New York Upstate Medical University
  114. University of Texas Rio Grande Valley School of Medicine
  115. University of Iowa Roy J. and Lucille A. Carver College of Medicine
  116. Yale School of Medicine
  117. Emory University School of Medicine
  118. University of Alabama School of Medicine
  119. University of New Mexico School of Medicine
  120. University of Minnesota Medical School
  121. University of Michigan Medical School
  122. Pennsylvania State University College of Medicine
  123. University of Chicago Division of the Biological Sciences The Pritzker School of Medicine
  124. Mercer University School of Medicine
  125. Louisiana State University School of Medicine in Shreveport
  126. Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine
  127. Virginia Tech Carilion School of Medicine
  128. University of Wisconsin School of Medicine and Public Health
  129. Albany Medical College
  130. University of Oklahoma College of Medicine
  131. Florida State University College of Medicine
  132. Case Western Reserve University School of Medicine
  133. Meharry Medical College
  134. Georgetown University School of Medicine
  135. University of South Carolina School of Medicine
  136. Sidney Kimmel Medical College at Thomas Jefferson University
  137. University of Pittsburgh School of Medicine
  138. Texas A&M Health Science Center College of Medicine
  139. Rutgers, Robert Wood Johnson Medical School
  140. University of California, Davis, School of Medicine
  141. University of Puerto Rico School of Medicine
  142. University of Hawaii, John A. Burns School of Medicine
  143. University of Rochester School of Medicine and Dentistry
  144. Hackensack Meridian School of Medicine
  145. University of Connecticut School of Medicine
  146. Loyola University Chicago Stritch School of Medicine
  147. Universidad Central del Caribe School of Medicine
  148. Central Michigan University College of Medicine
  149. University of Cincinnati College of Medicine
  150. University of California, San Diego School of Medicine
  151. Northeast Ohio Medical University
  152. University of Mississippi School of Medicine
  153. University of Arizona College of Medicine
  154. Wright State University Boonshoft School of Medicine
  155. Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine


(Accidentally omitted from random number generator due to similarity to #40)

About the Authors

Andrea L. Klein

Andrea L. Klein is a fourth year MD student at The George Washington University School of Medicine and Health Sciences in Washington, DC. She graduated from the University of California San Diego with honors in Biochemistry and Cell Biology, specializing in neuroscience and molecular genetics. She has published and presented extensively in neurosurgical oncology and is pursuing a career in academic neurosurgery.

Daniel J. Muller, MPhil

Daniel J. Muller is a third-year medical student at the George Washington University School of Medicine and Health Sciences. Daniel graduated with a BA in History from Brown University in 2017 and with a Master of Philosophy degree in History and Philosophy of Science and Medicine from the University of Cambridge in 2018. He hopes to pursue a career in Infectious Disease and global health policy development, specifically focusing on improving accessibility to and quality of healthcare for underserved patient populations.

Zach Silverstein, MHS

Daniel J. Muller is a third-year medical student at the George Washington University School of Medicine and Health Sciences. Daniel graduated with a BA in History from Brown University in 2017 and with a Master of Philosophy degree in History and Philosophy of Science and Medicine from the University of Cambridge in 2018. He hopes to pursue a career in Infectious Disease and global health policy development, specifically focusing on improving accessibility to and quality of healthcare for underserved patient populations.