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Letters to the Editor

In Reply to Ramotshwana et al

Flotte, Terence R. MD; Larkin, Anne C. MD; Fischer, Melissa A. MD; Chimienti, Sonia N. MD; DeMarco, Deborah M. MD; Fan, Pang-Yen MD; Collins, Michael F. MD

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doi: 10.1097/ACM.0000000000003997
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We acknowledge the unfortunate consequences that U.K. medical students experienced due to COVID-19 pandemic–related early graduations. We believe that the structural differences in the U.S. medical education system may account for the contrasting U.K. experience.

At the University of Massachusetts Medical School, fourth-year medical students rarely complete required clinical experiences in the 2 months before graduation. Most use this time for nonclinical requirements, electives that augment clinical exposure, or personal needs before beginning residency training. Our students front-load their fourth-year required clinical experiences from the prior May through October, completing a few final rotations January through March. Consequently, nearly all of our fourth-year medical students had completed traditional requirements at the time of their early graduation and seemed prepared to join frontline workers as limited-licensed physicians called surge contractors.

To address concerns of early graduates having low confidence in entering the workforce, such as those expressed by Ramotshwana and colleagues, we solicited structured feedback after the 90-day term ended. The majority of both surge contractors and supervising physicians indicated surge contractors had the appropriate level of supervision, emotional support, and preparation to deal with the challenges of COVID-19 patients. Overall, both supervising physicians and early-graduate surge contractors found their experience positive, and the surge contractors practiced skills, particularly end-of-life discussions, that they will carry into future patient encounters.

This experience highlighted the dedication, compassion, and commitment of the medical students in the class of 2020. The early graduates demonstrated readiness and a willingness to serve, with appropriate assignment and supervision, at a time when their contributions were both impactful and appreciated. Although we hope that this decision does not need to be made in the future, we are confident that our curriculum and training structure will prepare our student doctors well should the need for an early graduation arise again.

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