Given the ongoing COVID-19 pandemic, we recognize that there have been significant changes to medical student education including transition to remote learning and cancelation of clerkships and electives. For those students planning to apply for residency training this fall, these changes may feel especially disruptive. Students may be worrying about impact on the application process and the competitiveness of their candidacy. There may concerns for access to away rotations, the impact of cancelled clerkship or delays in scheduling USMLE exams. Students may also be disappointed in the inability to engage in highly anticipated clinical rotations or to cultivate relationships with supervisors and mentors.

While some of these experiences are difficult to replicate virtually, there are a number of ways students in their clerkship year or final year of medical school can continue to demonstrate interest in psychiatry and remained engaged in important psychiatric work during these challenging times.

Clinical Electives

While most medical schools have canceled clerkships and in-person clinical electives, many psychiatric services (including outpatient and consultation-liaison psychiatry) remain actively engaged in clinical work, as well as educational case conferences using audio and video technology. These services could provide an opportunity to gain additional exposure to clinical psychiatry as well as to learn skills related to telepsychiatry. If your school has not already created remote clinical electives, reach out to the faculty who run these services to see if they would be willing to host you for a virtual experience.

Service Experience

Medical students throughout the country have been actively involved in supporting the hospital mission through volunteer efforts during the COVID-19 crisis. Some of these activities are patient-facing (e.g. calling to check in on isolated patients living alone, helping overworked inpatient teams to keep family members updated, or scheduling telehealth visits for patients with their outpatient providers), while others involve fundraising, providing babysitting services for healthcare workers, sourcing supplies and providing tech support.

Some medical students with student-run free clinics are continuing to see patients using telehealth modalities; in some cases, students are even able to provide mental health treatment for patients in these clinics. Inquire as to needs and opportunities at your own institution and get involved if you can.

You may want to search for volunteer opportunities that involve working with mental health clinicians and/or their patients. If such opportunities do not exist, reach out to psychiatry faculty members or staff whom you met previously, even during your pre-clinical courses, to see if they know of service opportunities within the department or institution.

Scholarly Experiences

Now is a great time to become involved in new scholarly experiences related to psychiatry. A scholarly project might include working on a review paper (eg. pandemics and psychiatry, ethical challenges in healthcare resource allocation, COVID-19 and the brain, impact of COVID-19 on front line health care workers, or a case report with a clinical or research faculty member).

If you are less interested in writing or research, you might instead choose to participate in an ongoing quality improvement (QI) initiative within the psychiatry department by contacting the identified faculty or staff member in charge of QI work. You could also work with the clerkship director or a pre-clinical course director to develop new curricular experiences, including virtual learning opportunities. You may even be able to receive elective credit for these experiences.

Self-Directed Learning

This is a time of rapidly changing information with near-constant flow of new information via listservs, websites and the medical literature. Organizations such as APA, as well as many of the psychiatry specialty organizations, have portions of their websites dedicated to COVID-19. Scientific journals are publishing articles quickly on their online sites. Pick a reputable website or psychiatric journal and educate yourself on a regular basis. Many of those same sites are offering free webinars and learning modules. Share new knowledge with peers and mentors.

Knowledge gained will ensure that you remain informed and current when you return to on-site clerkships or electives and may even spark new ideas and conversations that will help you as write your personal statement and embark on the residency interview process.

Involvement with National Organizations

Many regional and national psychiatric and psychiatric subspecialty organizations, such as APA, have free or heavily discounted membership options for medical students. Now is a good to join one of these organizations and take advantage of resources they offer, such as online learning, mentorship programs, residency application guides, and travel scholarship for future meetings.

You might also consider joining the Psychiatry Student Interest Group (PsychSIGN), the national group of medical students interested in psychiatry, which offers networking opportunities and many other useful resources.

ERAS Application

While revisions to the timeline for the ERAS application have not yet been finalized, students are encouraged to use this time to work on components of the application, such as identifying programs of interest, updating your CV, and drafting the personal statement. Many residency programs have robust websites and other alternative sources such as AAMC's Residency Explorer or Texas STAR.

As students begin to work on personal statements, they might consider including observations from their personal and professional experiences during the COVID-19 crisis:

• How has the COVID-19 crisis impacted your personal narrative?
• How did the cancelation of clerskhips impact your desire to serve or your identity as a future physician?
• Were you involved in supporting the mission of your medical school or hospital and what role did you play?
• Did you acquire new skills during the crisis?
• What did you learn about yourself during this challenging time and how will you use this new knowledge as you move forward in your career development?
• What do you anticipate will be the mental health impact of the pandemic on frontline healthcare workers and patients?
• How might you utilize your skillset as a future psychiatrist to address this impact?

Conclusion

This is by no means an exhaustive list, nor do we have any expectations that all students should be doing this. We are incredibly sensitive to the fact that some students may have family responsibilities or personal situations that preclude involvement in any of these activities. Other students may still have time consuming school obligations.

Maintaining your own wellness and safety, as well as that of your family and friends, is the first priority during this frightening and difficult time. Each situation and set of challenges are unique and only the individual person can know what is a reasonable load to take on in this moment.

Follow the rules of your school, city and state; be well and stay safe. And most importantly, be assured that program directors will most certainly view your application holistically. Resilience, leadership, and a passion for psychiatry are highly valued attributes and there are a myriad of ways to demonstrate these.

We also encourage you to review A Roadmap to Psychiatric Residency as you embark on the residency application process. Please be advised, however, that changes to the residency application timeline and process are still being discussed on a national level; therefore some of the guidance may less applicable for the 2020-2021 Match Cycle (for July 2021 start). Please connect with your faculty advisors for the most up to date information.

Authors:

Carrie Ernst, M.D.
Anna Kerlek, M.D.
Lia Thomas, M.D.